IV Case in Point
Illustrated Verdict shares case examples from our archives to show how a visual strategy can support the defense effort. We hope that it is of value in your practice as you develop your defense strategies on behalf of health care providers. Please feel free to forward it to colleagues or clients.

About Us
IV is a leading provider of demonstrative evidence for the defense of medical malpractice claims. Our team of medical illustrators consults with defense teams to educate the lay jury audience about the complexities of medical care. We do this by developing a visual strategy with expert witnesses including high-quality case-specific medical illustrations, x-ray enhancements, and multimedia presentations. IV receives judgment for the defense in over 94% of the cases we participate in, as compared to the national average of 73%. Additionally, insurers who supply us with their trial list enjoy a win rate of up to 97%.
To learn more, e-mail us or call 617-530-1001.
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Case In Point Library
Click to view other editions:

Case In Point Library Page

Pregnancy and Delivery:
Fetal Assessment 2009v1
Shoulder Dystocia 2009v3
MVA Leads to Fetal Demise 2010v4
Fetal Descent Stalled 2010v5
Shoulder Dystocia / Erb's 2011v4
Fetal Tracings / Hypoxic Injury? 2013v1

Heart:
Coronary Artery Disease 2009v5
CAD / Recurrent MI 2010v1
Aortic Valve Replacement 2011v1

Lungs:
Stroke After Lung Surgery 2009v2
PE / Infection 2010v3
PE Following Roux En Y 2012v1
Intubation / Macklin Effect 2012v4
Lung Cancer vs. Infection 2015v3

Female Pelvis:
Hysterectomy / Fistula 2011v9
Hysterectomy / Ureter Injury 2010v2
Hysterectomy / Kinked Ureter 2010v8
Diag Lap / Bowel Injury 2012v3
Cervical Cancer 2013v3
Endometrial Cancer 2014v1

Male Pelvis:
Bladder Cancer 2013v2

Digestive System:
Gastric Bypass 2009v6
Recurrent Hiatal Hernia 2009v8
Right Colectomy / Leak 2010v7
Gastric Bypass / Volvulus 2011v2
Nissen Fundoplication 2011v3
Large Hiatal Hernia 2013v5
Necrotizing Enterocolitis 2013v7
Arrest during ERCP 2015v4
Diverticulitis Complications 2015v5

Abdomen:
Spleen Injury and Bleed 2009v4
Bleed Following Lithotripsy 2012v2
Lap Cholecystectomy 2012v5
Bowel Injury Lap Ovarian Cyst Removal 2013v6
LapChole - Hepatic Duct Injury2015v1

Orthopedic:
Partial Hip Replacement 2010v6

Vasculature:
tPA Infusion 2009v7
Vertebral A. Coil Embolization 2015v7

Head and Neck:
Bell's Palsy 2013v4
Tongue Cancer 2014v2
Chiari I - Vision Loss 2015v2

Judgment for the Defense
Coronary Artery Disease Leads to
Recurrent MI and Premature Death

http://www.illustratedverdict.com/projectreview/IV/IV_1109web/2577m1_small.jpg

PLAINTIFF'S CLAIM:
The wrongful death of a 56-year-old man was due to an alleged significant delay in the diagnosis and treatment of recurrent coronary artery disease, thereby allowing his condition to progress to the point that he suffered another myocardial infarction (MI, heart attack) and died.

DEFENSE'S ARGUMENT:
The plaintiff had a history of coronary artery disease that was followed appropriately and treated with both non-surgical and surgical options.

The plaintiff sustained his first myocardial infarction (MI) in 1984, when he was in his late 30s.  After his diagnosis and treatment for coronary artery disease, he subsequently lived symptom-free for 4 years.

In 1988, the plaintiff was diagnosed with another MI.  An angiogram identified multiple blockages of major coronary arteries, and bypass surgery was recommended. In June 1988, he underwent a successful quadruple bypass surgery.

In 2002, the patient presented with symptoms of recurrent coronary artery disease.  A cardiac catheterization was performed that showed occlusion of the grafts from his surgery 14 years ago.

The plaintiff’s recurrent disease and subsequent treatments were not due to the previous care of his physicians and surgeons. Rather, the recurrent MIs resulted from the plaintiff’s unwillingness to change his lifestyle, ultimately resulting in his premature death.

VISUAL STRATEGY:
IV worked with the attorneys and experts to develop a visual strategy that would help explain to the jury in detail how the plaintiff’s procedures were done appropriately and without error. Also, IV illustrated the extent of disease that was seen on the plaintiff’s 2002 catheterization.

We began by showing normal anatomy of the heart and location of the coronary arteries to orient the jury.

We also illustrated a normal schematic of the coronary vessels.

The cardiology expert who we worked with on the case had created sketches of the patient’s coronary system for use in court. 

From those sketches we created informative illustrations that were used to help the jury understand the plaintiff’s complex system of heart disease and coronary bypasses.

  • The first illustration based on the expert’s sketches detailed the plaintiff’s condition on 4/28/88.
  • The second illustration was of the plaintiff’s 6/6/88 quadruple bypass, which showed how the grafts were placed and their intended purpose to bypass the blockages.
  • The third illustration based on the expert’s sketches was the 3/22/02 cath findings, which showed total occlusion in two of the four bypass grafts.

This combination of illustrations helped the defense successfully explain that:

  1. Since the plaintiff’s first MI in 1984, his coronary artery disease and recurrent MIs were properly treated with both non surgical and surgical therapy.
  2. The stenosis found in the grafts on 3/22/02 was no fault of the plaintiff’s physicians and surgeons. Rather, it was the natural consequences of the plaintiff’s unwillingness to change his lifestyle, which allowed his condition to progress.  Ultimately, this resulted in another myocardial infarction that led to his premature death. 

 

RESULT:
The jury found in favor of the defense.

Attorney Edward Hinchey called to thank us after the verdict:
“Jurors were on the edge of their seats because of the illustration boards. My expert was great in his testimony and this was greatly attributed to the quality of the exhibits.”
-- Attorney Edward Hinchey, Sloane and Walsh LLP, Boston, MA