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%.
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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
Complications Post Op
Partial Hip Replacement

http://www.illustratedverdict.com/projectreview/IV/IV_v2_2010web/2624m7changed_small.jpg

An 84-year-old patient underwent a joint replacement surgery (right Austin Moore arthroplasty) during which a dysfunctional femoral head is replaced with an Austin Moore prosthetic. The surgery was performed on September 17, 2001, and the patient encountered postoperative complications that ultimately resulted in a total hip replacement.


PLAINTIFF'S CLAIM:

The plaintiff claimed that the implant size, specifically, the prosthetic stem, was incorrect.  If the correct size had been used, the patient asserted, no complications would have arisen and the total hip replacement would not have been necessary.



DEFENSE'S ARGUMENT:

The defense maintained that the prosthetic was the right size, that the surgery went well, and that films done immediately following the operation confirmed the correct position, placement, and size of the prosthetic. Over time, the prosthetic did loosen, which is a known complication of the original procedure.  Once this was recognized, the appropriate response — a total hip replacement — was undertaken.  In addition, the defense pointed out that the plaintiff’s counsel incorrectly indicated that the joint was replaced with a bipolar prosthetic. In fact, a one-piece Austin Moore prosthetic, with no interchangeable pieces, was used. This was documented in the operative reports and supported by the films taken following the procedure.


___________________________________________________________________

VISUAL STRATEGY:

Using the documentation available, IV prepared a presentation that included diagrams of normal hip-joint anatomy and illustrations of the orthopedic structures involved. We then illustrated the specific posterolateral approach and the surgery done with the specific prosthetic used in this case.

Using the postoperative x-ray, we created a film enhancement — directly on the original studies — showing all pertinent structures. This allowed the jury to see that the prosthetic used was the correct size and that the hip was aligned properly.

A second board was prepared comparing the two prosthetics discussed, highlighting their differences.

Finally, we presented the remaining films.  This served to establish exactly when the prosthetic started to loosen — again, a recognized complication of the procedure — thus demonstrating that the loosening was not due to any negligence by the defendants.

This combination of illustrations helped the defense successfully explain the following:

  • The surgery was done correctly with the proper prosthetic device.
  • The placement was monitored appropriately through a series of postoperative films taken over a reasonable period of time.
  • Movement or loosening of the prosthetic is a recognized risk of the procedure and was in no way a result of negligence on the part of the physicians involved.


RESULT:

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

—Senior Claims Manager, Ronda Brockway, Medical Protective Company forwarded the following email:

Tim,
Some feedback from Jim Doherty, Esq.

Dear Ronda:

To follow up our telephone conversation yesterday when I advised you we got a defense verdict, I wanted to let you know that Advanced Practice Strategies did a great job for me in securing excellent illustrations that I used effectively during this trial.  The particular illustrator was Sheri Healy.  She was extremely cooperative.  She created these illustrations pursuant to my request and my client’s input.  She did them in a very professional manner, and she met all of our time limitations.

My client called me again this morning to thank me but also to thank Medical Protective for “sticking with him” and not trying to force him to settle the case when he knew he didn’t do anything wrong.

Very truly yours,

Jim

—Attorney, Jim Doherty, Scanlon, Howley & Doherty, Scranton, PA