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
Lung Cancer vs. Infection

In December 2010, a 65 year old former heavy smoker underwent a fine needle aspiration biopsy for a right lung, lower lobe nodule. On 12/3/10, the defendant pathologist reviewed the pathology slides from the biopsy. She noted the presence of positive malignant cells, adenocarcinoma with bronchioalveolar features and a few microgranulomata. Her findings were confirmed via a review by another pathologist. Subsequently on 12/16/10, the plaintiff underwent a Video Assisted Thoracic Surgery (VATS), right lower lobectomy, and mediastinal lymph node dissection. Examination of surgical specimens did not indicate lung cancer, rather, granulomatous inflammation associated with pneumonia, which would not have been treated with surgery but with medication. On 12/21/10, this case was discussed at an intradepartmental consensus meeting; pursuant to that meeting, the defendant was advised to revise her findings to “atypical” instead of malignant, so the patient did not carry an incorrect diagnosis with him if he went to another institution. On 12/22/10, she completed an addendum pathology of the 12/3/10 pathology report and the addendum noted atypical cells with granulomatous inflammation.

 

PLAINTIFF'S CLAIM:

Plaintiff is claiming improper diagnosis of lung cancer resulting in an unnecessary surgical procedure to remove his right lower lobe of his lung. Further, the plaintiff alleged continued incisional pain, pulmonary issues, and diminished energy level. Plaintiff was also claiming emotional distress for erroneously believing he had lung cancer.

 

DEFENSE'S ARGUMENT:

The defense experts believed that this patient would have needed a VATS regardless. According to another defense expert the patient's post-op pulmonary function tests were normal, showing no long lasting effect to his quality of life.



VISUAL STRATEGY:

Collaborating with the defense attorneys and experts, Illustrated Verdict created a visual strategy to help explain the steps taken in the care of the plaintiff, supporting the view that the defendant’s actions were within the standard of care.

 

The initial diagram illustrated normal anatomy of the lungs.

 

The second diagram illustrated the location of the mass in the lower lobe of the right lung.

 

The next diagram showed how a fine needle aspiration is preformed and how the cells look on the pathology slide.

 

Another illustration showed how the Video Assisted Thoracic Surgery (VATS) was performed in removing the lower lobe of his right lung. This was also important in showing how the middle lobe of the right lung expands to take over the space from the removal of the lower lobe.

 

The fifth diagram we created was to help explain the similarities in respiration in normal lungs vs the removal of the lower lobe of a lung.

 

The CT films from 2/19/10 and 11/15/10 were also useful in showing location of the mass in the lower lobe of the right lung.

 

Also from the November 2010 CT films we were able to create a 3D digital model showing location of the mass.

 

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

  • The defendants worked within the standard of care and diagnosed the plaintiff as she saw correctly based off of the pathology slides from the fine needle aspiration and had a second opinion as well that it was cancer.
  • It is easy to look back at something and realize that is was incorrect, but at the time with the plaintiff’s history of smoking, the CT evidence, as well as the appearance of cells in the pathology this mass appeared to be cancer.
  • The patient has no long lasting effects from the VATS procedure and has normal pulmonary function.

 

RESULT:
The jury found in favor of the defense. 

“Thank you so much for your assistance with the trial. The illustrations were very helpful, you did a great job. By the way, we won!”

- Defense Attorney, New York, NY