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
Laparoscopic Cholecystectomy

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

A 26-year-old female, with multiple episodes of right upper quadrant pain for three months prior, underwent a laparoscopic cholecystectomy after her symptoms and ultrasound were indicative of symptomatic gallstones. The surgery was performed without complications but approximately seven days after being discharged, she was readmitted with worrisome symptoms. It was discovered that she had injury to the common hepatic duct and a resultant bile leak.

PLAINTIFF'S CLAIM:

The defendants allegedly failed to identify, isolate, and protect the common hepatic duct and negligently clipped and transected it, causing bile to leak into her peritoneal cavity. The injury required the plaintiff to undergo additional surgery, and quite possibly, shortened her life expectancy.

DEFENSE'S ARGUMENT:

The defense argued that the care provided by the defendant was well within the standard of care. During the preoperative meeting, the plaintiff was counseled on the risks of bleeding, infection, and possible injury to other anatomic structures, including the bile ducts. The defense argued that throughout the operation, the defendants appropriately identified the common bile duct and that the risk and/or occurrence of this type of injury are well-recognized complications of this specific procedure.

In addition, the defense experts believed that the plaintiff had aberrant anatomy, that the cystic duct was either extremely short or absent. As there was a delay between when the operation took place and when the bile leak symptoms presented, it is plausible that the leak did not occur directly during or immediately after the surgery. If the defendants had injured the duct during the initial surgery, the symptoms would have presented much sooner.



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VISUAL STRATEGY:

Collaborating with the defense attorney and experts, IV created a visual strategy that helped explain that the defendant actions were within the standard of care.

The first diagram demonstrated variations in the cystic duct. The experts were able to use this diagram to explain that the anatomy can vary from patient to patient.

The second diagram displayed the surgical approach and trocar placement in the abdomen.

Another diagram was created to illustrate, in more detail, the variations in the cystic duct that can be seen and what the defense believed led to the injury in this case, a short cystic duct.

The final diagrams were used to show two possible scenarios. The experts believed there was an extremely short cystic duct and when lateral traction was applied to the gallbladder, the duct was tented causing:

    Or

The defense expert also provided photos of an actual laparoscopic cholecystectomy to help the jury visualize what the doctor views during a procedure.


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

  • There are many variations in anatomy, in this case cystic duct anatomy with a short cystic duct.
  • Although rare, injury to ducts can occur during a laparoscopic cholecystectomy and are well recognized risks.

 


RESULT:
The jury found in favor of the defense. 

"FYI, defense verdict today for all defendants! The illustrations were extremely useful for both the experts and our client. Thanks for all the great help."

- Attorney George Wakeman, Esq., Adler, Cohen, Harvey, Wakeman and Guekguezian LLP, Boston, MA