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
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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
MVA Leads to Fetal Demise

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A pregnant woman at 32 weeks gestation presented in the ER severely injured after a motor vehicle accident (MVA). Upon the patient’s arrival in the ER, the nurses quickly found a fetal heartbeat and performed an ultrasound, through which they identified fetal movement before moving on to care for the mother. Upon examination, a CT showed the patient had an extensive pneumothorax (i.e., collapsed lung). Physicians put a chest tube in, validated placement, and sent the mother up to Obstetrics for further evaluation. When the patient arrived on the Labor and Delivery unit, no fetal heartbeat was found and it was apparent that a placental abruption had occurred. The patient immediately went into surgery and was found to have a 70% placental abruption, a couvelaire uterus, a retroperitoneal bleed, and a posterior rent in the uterus at the level of the fetal head.

 

PLAINTIFF'S CLAIM:

The baby would have survived if the abruption had been diagnosed upon the patient’s arrival in the ER and if she had been sent up to Labor and Delivery for an immediate cesarean delivery.

 

DEFENSE'S ARGUMENT:

Standard of care dictates that the first responsibility of the clinicians is to treat and stabilize the mother. Even if they had known about the placental abruption, the clinicians would have needed to treat the mother first, since the patient’s condition was severe and life-threatening. Furthermore, without a chest tube, the patient would not have been able to survive a cesarean delivery procedure.

In addition, the baby had already suffered extensive damage from the MVA, which likely resulted in significant brain damage. The physicians responded quickly and appropriately, attending to the damage to the uterus from the trauma. The mother did not suffer any permanent injury, and had no future complications from these injuries.



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 physicians appropriately managed the situation by responding quickly to mother’s rapidly declining condition, stabilizing the mother and then attending to the 32-week fetus.

 

We began with a presentation of the mother’s condition, showing the initial CTs taken in the ER and creating film enhancements outlining the massive pneumothorax.

With the illustration imposed directly on the film, we showed to what degree the lung was collapsed, justifying the need for immediate treatment of the mother.

 

Next, we addressed the baby’s situation. We started by showing normal fetal circulation and went into further detail about the uterus, placenta, and umbilical cord.

 

We then focused more specifically on the details of this case, illustrating the size and position of this 32-week fetus.

 

Following this introduction, we went on to show the injuries that were sustained from the MVA. Based on the operative reports and documentation, we demonstrated the extent of injury .
The findings included:

  • A 70% placental abruption, as drawn in a progress note by an attending physician
  • A retroperitoneal bleed
  • A posterior rent in the uterus at the level of the fetal head
  • Blood found in the colonic gutters 

The illustrations helped identify where bleeding occurred and how the rent in the posterior uterus likely developed due to the impact of the fetal head during the accident.

 

We went on to illustrate a couvelaire uterus, a condition stemming from trauma-induced placental abruption, whereby blood from the placenta invades the uterine muscle and eventually extends into the peritoneal cavity.

 

This series of visuals helped the defense successfully convey the following key points to the jury:

  • The severity of the injury sustained by the mother
  • The severity of the injury involving the 32-week fetus
  • The timely and appropriate response of the physicians, given the entire situation

The injury to the fetus was fatal and unfortunately irreparable for the physicians involved in the mother’s care. The physicians responded quickly to stabilize the mother, after which they expediently attended to the fetal situation. The physicians’ care prevented the mother from suffering any permanent injury, and she subsequently had no complications in future pregnancies.

 

RESULT:
After a short period of deliberation, the jury found in favor of the defense.

“Your ability to refine the illustrations in a timely fashion was crucial. We were able to both project them and use the boards on an easel, close to the jury when preferable, as decided by the witness. My client looked at the finished product and said: ‘That’s it! That’s what I saw at surgery.’”

—Attorney, Stephen Ryan, Marshall, Dennehey, Warner, Coleman & Goggin, King of Prussia, PA