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
Failure to Diagnosis and Treat
Rare Endometrial Cancer

The patient, a woman in her 60s, was seen by the defendant, who performed a pelvic ultrasound. The ultrasound revealed a thickening of the uterine wall, and the defendant informed the patient of the need for follow-up studies. The patient did not make a follow-up appointment with the defendant.

Several months later, the patient was seen by an urologist, who performed a cystoscopy that showed no lesions within the bladder. However, additional studies revealed a pelvic mass, and the patient was referred to a gynecologic oncologist for evaluation.

The gynecologic oncologist noted gross hematuria (blood in urine) as well as the presence of a palpable pelvic mass at the umbilicus. A CT scan confirmed the presence of an enlarged uterus. A month later, the patient underwent a hysterectomy with staging, at which point she was diagnosed with stage IV papillary serous endometrial cancer. Despite extensive treatment, she unfortunately passed away.

 

PLAINTIFF'S CLAIM:

Had the patient been diagnosed during her initial evaluation by the defendant, the cancer would have been discovered at a less advanced stage, resulting in a better outcome.

 

DEFENSE'S ARGUMENT:

The defense believed the defendant followed the standard of care by asking the patient to follow up for further tests, even though she failed to do so. She also had an aggressive type of endometrial cancer that generally has a poor prognosis. In a typical endometrial cancer, a mass has an inward growth that initially thickens the endometrial lining of the uterus, showing up on some ultrasounds. Papillary serous cancers of the endometrium have an abnormal pattern of growth: The mass often grows outward from the inner cavity of the uterus, invading the uterine muscle and outer serosal wall. The presence of the mass will not be apparent to ultrasound until it breaks through the serosa and invades the surrounding pelvic anatomy, which is usually in the advanced stages of the cancer.




VISUAL STRATEGY:

Collaborating with the defense attorney and experts, IV created a visual strategy to help explain the pattern of growth in this type of aggressive uterine cancer, supporting the view that the defendant’s actions were within the standard of care.

 

The initial illustrations demonstrated the normal anatomy of the female abdomen and pelvis. The first showed the female reproductive system, and the second showed the relationship of the reproductive system to the urinary system.

 

The next exhibit showed the normal anatomy of the pelvis, along with a cross section of a normal uterus.

 

Another illustration demonstrated the inward growth (into the endometrial cavity) typical of endometrial cancer. This was then compared to an illustration of endometrial papillary serous cancer with outward growth (through the outer uterine wall).

 

The sixth diagram showed how a cystoscopy is performed.

 

The seventh showed how a transabdominal ultrasound is performed.

 

Finally, an exhibit of the female body and organs showed basic overall anatomy.

 

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

  • The relationship of the female reproductive system and the urinary system and basic anatomic relationships as a whole.
  • How and why a cystoscopy is performed.
  • How and why transabdomial ultrasounds are performed.
  • The type of endometrial cancer the plaintiff had, endometrial papillary serous cancer, is a rare and aggressive cancer that can be harder to diagnose compared to more common forms of endometrial cancer.

 

RESULT:
The jury found in favor of the defense. 

“We tried the case last week, defense verdict after a little over an hour of deliberation! We used the IV graphics extensively and they were extremely helpful.”

- Attorney Michael Bell, Lightfoot, Franklin & White, Birmingham, AL