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.
www.illustratedverdict.com

 

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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
Premature Infant with
Necrotizing Enterocolitis

A premature infant was born at 25 weeks’ gestation. He developed necrotizing enterocolitis (NEC) that required extensive surgery and removal of a significant portion of his intestine.

Directly after birth he began feedings with total parenteral nutrition (TPN). At 6 weeks of life, the infant developed extensive NEC, with no intestinal perforation, and he was treated with antibiotics. At 2 months, he required a 29 cm bowel resection with an ileostomy. At about 3 months, he was able to take oral feedings. He would later develop an intestinal obstruction from a walled-off bowel perforation at 3 1/2 months, and a secondary wound infection post-operatively. Malabsorption due to short gut syndrome developed secondary to the extensive bowel resection. Subsequently, he became TPN dependent, resulting in cholestasis and direct hyperbilirubinemia jaundice. A G-tube (feeding tube) was placed in his stomach at this time.

Once his medical condition stabilized, he was transferred to a different facility for rehabilitation, advancement of his G-tube feedings (with formula), and weaning from his TPN. Unfortunately, he developed sepsis (blood infection) and expired a little over a month after admission to the second facility.

 

PLAINTIFF'S CLAIM:

The defendants (in the second facility) failed to treat the infant’s injured bowel as evidenced by recurrent bloody loose stools, abnormal x-ray findings, clostridium difficile infection, clinical evidence documented on exam, and abnormal vital signs. The enteral feeds furthered his intestinal injury and more likely than not, caused his ultimate decompensation and death.

 

DEFENSE'S ARGUMENT:

The main objective of his hospitalization at the rehab facility was to wean him from the TPN which was causing him to suffer liver failure, with high bilirubin counts, and worsening jaundice. In order to decrease his TPN, he would have had to have been tolerating his G-tube feedings - but each time they increased his G-tube feedings he developed diarrhea - indicating he was not tolerating his G-tube feedings. They increased the TPN in order to keep him nourished, but were not able to progress his formula beyond 1/2 strength for any length of time. During his stay at the second facility there was no evidence of free air on the x-rays indicating any perforations or injuries in his bowel. The ultimate source of the sepsis infection was unknown as there was no perforation found in his bowel on autopsy. With no perforation of the bowel to explain the infant's septic condition, the organisms found in his blood could not have been caused by a perforation of his bowel.



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.

 

We began with illustrations that demonstrate the normal anatomy of the abdomen of an infant.

 

A second diagram was created to illustrate necrotizing enterocolitis.

 

Another diagram was used to show the resection of the right ascending colon including the cecum and distal ileum.

 

A forth diagram was used to illustrate the second procedure of taking down the colostomy and resection of a jejunal obstruction.

 

A schematic was created to demonstrate the length of a normal newborn intestine.

 

Another schematic was developed to compare with the normal version to show the length of the infant’s intestine at the time of death.

 

Finally, a graph was created to illustrate data on the infant’s feeding and bowel movements. The purpose of the feeding data graph was to show that the feedings were not tolerated as each time they tried to increase his G-tube feeds he had worsening diarrhea thus he could not be weaned from the TPN.

 

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

  • The infant underwent significant changes in the anatomy of his gastrointestinal system and the defendants were working towards healing him as well as they could given his condition.
  • There was no perforation found at the time of autopsy that would support the plaintiff’s theory that the increased formula feeds were a factor in his overall condition and the infection that eventually took his life.

 

RESULT:
The jury found in favor of the defense. 

“By the way, we won that last case - and I believe it was in no small way connected to our visuals, especially the stretched out intestinal schematic!

- Attorney Lee B. Gosciminski, Gervais & Davenport, Medford, MA