Illustrated Verdict by APS Every month APS’s Demonstrative Evidence Group 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 healthcare providers. Please feel free to forward it to colleagues or clients.
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Judgment for the Defense Stroke After Lung Surgery PLAINTIFF’S CLAIM: After surgery to remove a pulmonary sequestration (a cystic piece of abnormal lung tissue), post-operative bleeding occurred in a patient. The plaintiff alleged that the surgeons should have responded more aggressively by removing additional lung tissue. They further alleged that the post-operative care and drug administration caused the patient’s stroke and subsequent death.
DEFENSE’S ARGUMENT: Post-operative bleeding is a well-known complication of Video Assisted Thoracic Surgery (VATS). Every attempt was made to stabilize the patient post-operatively and, while there was an adverse outcome, it was not the result of negligence.
VISUAL STRATEGY: This was a complicated surgery with complex post-operative issues including atelectasis (the collapse or incomplete expansion of part of a lung) and fibrinolysis (the breakdown of blood clots), that had to be explained to the jury.
Prior to trial, APS assisted in the preparation of visuals for a Focus Group and worked in direct consultation with the defendant to create all of the medical Illustrations for trial.
Our involvement throughout the defense effort enabled us to help the defendant tell his story—first, locating the sequestration in the lung tissue; then performing surgery to remove it; identifying the post-operative complications; and finally, undertaking appropriate treatments to correct them. The visuals pulled together the complicated nature of the case and allowed the defendant to explain to a lay audience the medicine and care involved. This included:
Two to three hours later, under normal respiration, a clot began to form in the area of atelectasis. At the same time, regional fibrinolysis began breaking down the clot and caused bleeding out of the chest tube.
Treatments were applied to stop excessive bleeding from the chest tube. PEEP was utilized to fully inflate the lung and to tamponade bleeding with pressure. The drug, Amicar, was administered to neutralize fibrinolysis and stop further break down of the clot.
The treatments were successful in stopping any further post-op bleeding. Despite the unfortunate outcome of stroke, the health care provided both during the surgery and also post-operatively was appropriate and within the standard of care.