Demonstrative evidence: Malpractice defense from Advanced Practice Strategies

In addition to my consulting work and writing the Health Business Blog, I'm chairman of the board of Advanced Practice Strategies, a medical risk management firm that provides litigation support for malpractice defense and an eLearning curriculum focused on enhancing patient safety. I've posted a case study below.

Illustrated Verdict by APSEvery month APS's Demonstrative Evidence Group will share 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 healthcare providers. Please feel free to forward it to colleagues or clients.About UsAPS 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. To learn more, e-mail us or call 877.APS.4500.Case RequestIf you have an upcoming case in any of the following areas, please send us an e-mail about it and we’d be happy to show you some relevant examples of our work:Bariatric/Gastric BypassBirth Injury & DefectsBrain InjuriesCancersCosmetic SurgeryDelayed/MisDiagnosisDental IssuesDigestive Tract IssuesEmergency RoomFemale ReproductionHeart Attack & CardiacInfectionLasik Eye SurgeryMale ReproductionMedication IssuesSpinal Cord InjuriesSurgical IssuesGeneral Inquires

Judgment for the DefenseFetal Assessment and ResponsePLAINTIFF'S CLAIM:Delay in performing a Caesarean delivery, caused low APGAR scores and cerebral palsy.DEFENSE'S ARGUMENT:The clinical management of labor was reasonable. While decelerations were noted, they recovered with positioning of the mother and the strips returned to baseline with good variability -- a sign of no ischemic event. At Phase 3 of labor the labor and delivery team encountered limited progress and prepped the mother for vacuum extraction. But, vacuum also resulted in limited progress. The team realized that the mother's pelvic disproportion made vaginal delivery impossible. As soon as they realized this, a Caesarean was performed.VISUAL STRATEGY:Like many cases, the challenge here was to back the jury up to the beginning of the delivery and help them understand how temporal labor is. Despite the bad outcome, the healthcare provided along the way was appropriate, given the information the team had.A major portion of our visual strategy was to rely on the Fetal Monitoring Strips: Using the Plaintiff's Fetal Monitoring Strips in an HTML-based template, with recognized textbook examples, the jury was walked through the labor. Testifying experts explained visually where decelerations took place, where the recovery and return to baseline occurred, and what steps were performed to correct the problem. Experts were able to explain terms such as baseline, variability, late deceleration, variable deceleration in a way that the jury could understand. Decelerations are worrisome if they are consistently repetitive, and do not recover using the accepted maneuvers such as turning the mother and administering O2 and Fluid. The nurses documented on the strip when the vacuum was applied, for how long and when they decided to go to Caesarean delivery. Documentation directly on the fetal strips by the nurses, in real-time, demonstrated that the team responded promptly and appropriately to each situation. The jury was very responsive to the demonstrative evidence and responded with a defense verdict in less than 2.5hrs. RESULT: Judgment for the defense.