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
Arrest During ERCP

A patient went in for a cholecystectomy (gallbladder removal), and a possibly cancerous stricture was noted in his common bile duct. An endoscopic retrograde cholangiopancreatography (ERCP) was scheduled the following day to take brushings of the area of stricture for analysis by pathology.

 

PLAINTIFF'S CLAIM:

During the ERCP, which was performed under conscious (moderate) sedation, the defendant negligently failed to recognize medication-induced respiratory depression and negligently failed to terminate the procedure, leading to cardiopulmonary arrest, anoxic brain damage, and death.

 

DEFENSE'S ARGUMENT:

The patient appeared stable until he suddenly ceased having a blood pressure and respirations, at which time the scope was removed and a code was promptly called. The vital signs the plaintiff points to as evidencing "medication-induced respiratory depression mandating termination of the procedure" are known to transiently occur with relative frequency in procedures such as ERCPs. Until the end of the procedure, the change in vital signs appeared to be transient and not a sign of an impending arrest that would require termination of the procedure.



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 upper GI.

 

The second diagram illustrated a basic ERCP.

 

Also, Illustrated Verdict created an animation of the ERCP procedure of this patient, showing an event log chronicling the important events.

 

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

  • The patient was stable throughout the procedure.
  • The defendants properly monitored the patient during the procedure and reacted in an appropriate manner.
  • Once the patient coded after the procedure, the defendants reacted appropriately by removing the scope and treating the patient, even though the outcome unfortunately was death.

 

RESULT:
The jury found in favor of the defense. 

“We received a defense verdict. The illustrations and animation were most useful. We appreciate your work!”

- Attorney Joseph Reese Jr., Starnes Davis Florie LLP, Birmingham, AL