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
Pulmonary Embolism Following
Laparoscopic Gastric Bypass

http://www.illustratedverdict.com/projectreview/IV/IV_v1_2012web/1650m3_2580m1_small.jpg

The patient was a 5'4", 338 lb morbidly obese woman with a BMI of 57. She went in for an open gastric bypass and primary repair of a large incisional hernia and tolerated the procedures well. At the postoperative visit she had +1 edema of her ankles. She experienced a pulmonary embolism (PE) postoperatively which caused her death.


PLAINTIFF'S CLAIM:

The plaintiff’s claim was the patient’s morbid obesity placed her at increased risk for development of a postoperative DVT (deep vein thrombosis) and PE. Accordingly, a filter should have been placed preoperatively and she should have been continued on postoperative anticoagulant medication upon discharge. In addition, the plaintiff claimed that the postoperative finding of +1 edema required a compression Doppler study.  



DEFENSE'S ARGUMENT:

The defense’s position was that the preoperative and postoperative care was within the standard of care. It was the defense's position that the patient did not require either placement of a filter or the continued use of anticoagulants and that the risks associated with either approach outweighed any potential benefit. The defense also argued that the patient had no clinical signs or symptoms of a DVT at the postoperative visit and that the +1 edema was not a sign of DVT.


___________________________________________________________________

VISUAL STRATEGY:

Collaborating with the defense experts and attorney, IV created a visual strategy that helped the experts explain the defense's position that the defendant properly followed the standard of care in the postoperative care of the patient.

The first diagram illustrated the type of gastric bypass surgery the plaintiff underwent: Roux-en-Y Bypass.

The next diagram was of the venous system of the leg; it helped to orient the jury on where DVTs typically occur.

The third diagram demonstrated how a Doppler study of the leg is performed and how fat can obstruct the view of the vessels in the leg.

The next couple of diagrams illustrated the anatomy of the vasculature from the legs up to lungs and the blood flow through the heart into the lungs.

The fifth diagram demonstrated a pulmonary embolism.

Another board on pulmonary embolisms explained how an embolism can be thrown from the legs and enter the lungs.

The next illustration showed the concept of a pulmonary shower emboli, which is what the defense experts believed happened in this case.

The final diagram illustrated the placement of a Greenfield filter within the inferior vena cava.

 

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

  • That performing a Doppler ultrasound on an obese individual’s leg can be extremely difficult.
  • There are risks involved when prescribing anticoagulant medications.
  • There are risks in placing a filter in the inferior vena cava (large vessel in the body).
  • Explaining the vascular system and how pulmonary embolisms occur.


RESULT:

The jury found in favor of the defense. 

"The illustrations were helpful in my examination of my client, my experts and the pathologist in that they illustrated the vascular system and explained how the Deep Vein Thrombosis developed into a fatal Pulmonary Embolism."

- Attorney, Thomas W. Boyce, Jr., Esq., Halloran & Sage, LLP,
New London, CT