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
Fetal Tracings / Hypoxic Injury?

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

A 28-year-old female had labor induced at 39 weeks and 3 days. During the course of labor, the patient’s physicians and nurses monitored the EFM (electronic fetal monitoring) tracings continuously. However, the patient failed to make adequate progress in labor, and the decision was made to perform cesarean delivery. The baby was born with APGAR scores of 5 and 7 at 1 and 5 minutes, respectively. As the child grew, she began to display developmental delays suggestive of a neurologic injury.

 

PLAINTIFF'S CLAIM:

The Plaintiff believed that a cesarean delivery should have been performed earlier, that the EFM tracings showed abnormal findings, and that action should have been taken sooner to effect delivery. They also claimed that because of the delay in delivery, an acute intrapartum hypoxic event occurred and this led to the child's adverse neuro-developmental outcome. At two years of age, she exhibited developmental delays and microcephaly.

DEFENSE'S ARGUMENT:

The defense believed that an HIE (hypoxic ischemic event) did not occur in this case; had an HIE occurred, as the plaintiff claimed, it would have occurred prior to birth (in utero), not at the time of the labor or delivery. The defense experts helped to explain that there are certain criteria that need to be met in order to determine that there was an acute hypoxic intrapartum birth injury. During labor or soon after delivery, the blood pH is calculated to determine if there is metabolic acidosis (which can indicate an intrapartum injury). In this case, the cord pH value was normal at the time of birth. Another indication of hypoxic intrapartum birth injury is the presence of cerebral palsy with quadriplegic spasticity (over-stiffening in joints of arms and legs) or dyskinesis; and the child did not exhibit findings consistent with this diagnosis. Other supporting findings that point to an intrapartum injury are neonatal APGAR scores typically between 0-3 at 5 minutes; and in this patient, the 5 minute score was 7.



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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 intrapartum fetal tracings were displayed in court using the IV EFM Viewer.


The first diagram was created to illustrate the normal anatomy of the placenta, umbilical cord, and oxygen flow to the fetus.


The second diagram was a cross section of the placenta.


The third diagram was an illustration of the maternal-fetal exchange of oxygen and carbon dioxide.


A video animation was created to help demonstrate the difference between normal blood flow and oxygen exchange in the placenta vs. decreased blood flow and oxygen exchange in the placenta.


Another diagram was used to demonstrate the fetal station, as the fetus descends the pelvic canal.


The fifth diagram illustrated a vacuum delivery.


The final diagram helped explain to the jury what cerebral palsy with spasticity looks like in a child.

 


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

  • What events occurred during the delivery, based on the fetal tracing presentation and illustrations.
  • How maternal blood flow supplies oxygen to the fetus through the placenta.
  • Which clinical findings support the Defense’s claim that an HIE did not occur during labor or delivery.

 


RESULT:
The jury found in favor of the defense. 

"We tried the case to a conclusion last week. IV provided support on several items including reducing the fetal monitor strips to an electronic format. I witnessed much of the testimony and thought that the presentation of the strips was very helpful. The jury returned a verdict in favor of the insured doctor and hospital.”

- Senior Vice President/Claims Ron Poindexter, Healthcare Services Group, Jefferson City, MO

 

“We survived the trial with success and greatly appreciate your help. The illustrations, and in particular fetal monitoring viewer, were a critical component in the trial. We sincerely appreciate the time and work you put into the project!”

- Attorney Nicole L. Sublett, Newman, Comley & Ruth P.C.,
Jefferson City, MO