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
Delay in Diagnosis of Cervical Cancer

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

A 40-year-old woman presented in July 2005 to her OB/GYN with complaints of bloating, left-side back pain, left-side pressure, and bleeding. At that time, the woman did have a cervical pap smear, which was read as normal, but a polyp was noted on her cervix. In 2004, she had an abnormal pap smear.

Seventeen months later in December 2007, the woman had a hysteroscopy, D & C, cervical biopsy, and biopsy of the left vaginal vault. She also had a CT scan that showed a 6 cm tumor in her cervix, extending into the left parametria (fibrous tissue that separates the supravaginal portion of the cervix from the bladder). The tumor was obstructing the left ureter and the woman eventually passed away from complications related to the cervical cancer.

 

PLAINTIFF'S CLAIM:

The plaintiffs believed that there was a delay in the diagnosis of the cervical cancer. They believed that the defendant should have biopsied the polyp, so that the cancer could have been diagnosed earlier and the defendant would have been able to treat it. If the cancer had been found at an earlier stage, the woman’s death could have been prevented.

 

DEFENSE'S ARGUMENT:

At the time of the polyp detection in 2005, a pap smear was done that was read as normal. Upon detection of the tumor during the hysteroscopy in 2007, the mass that was seen was nowhere near the polyp, they were two separate entities. If they had biopsied the polyp, it would have likely come back benign. In 2005, there was no way of knowing that the cancerous mass was there. When detected, seventeen months later in 2007, it was stage IIIB or IV. The defense experts believed that if the cancerous mass had been detected when the polyp was found in 2005, it would have been closer to a stage IIB-IIIB, but the outcome for the patient would not have changed.




VISUAL STRATEGY:

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

Normal anatomy diagrams were used to orient the jury to the anatomy that would be discussed during expert testimony:


A diagram of a pap smear was used to explain how the procedure is performed during a typical cervical exam.


A direct view of the cervix illustrated the location of the patient’s polyp.


A diagram of a hysteroscopy was used to show how the procedure is performed.


Another diagram of the hysteroscopy specific to this case was used to show the relationship of the polyp to the cancer.


A diagram of a detail of the cervix with the polyp and cancer was also used to show the relationship of the polyp to the cancer.


Finally, two diagrams were created to explain the stages of cervical cancer:


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

  • Cervical cancer is not always located in plain view during an exam.
  • The polyp seen in the 2005 exam was not related to the cancer.
  • Even if they had found the cancer during the 2005 exam the outcome for the patient, unfortunately, would have most likely been the same.


RESULT:
The arbitrator found in favor of the defense. 

“The case went to arbitration and the visuals were used during the presentation. They were very helpful in explaining to the arbitrator the anatomy and the location of the tumor. We received the result about 6 weeks ago, and the defendants (our client) prevailed. Thanks for all of your help, your patience and your persistence in getting this job done. I really appreciate it.”

- Attorney Karen Nobel, DanaherLagnese, P.C., Hartford CT