Tort Law: Medical – Legal Illustrations

Summary

The only purpose of a medical-legal illustration is to help a layperson understand complicated medical issues. Conventional medical illustrations are apt to be as all-inclusive and complex as possible. They are intended to be teaching tools for physicians. Thus, these drawings contain a saturation level of information that is too difficult to be understood by a lay jury.

Use of Medical Illustrations

I have become a believer in using medical illustrations as part of presenting my case to a jury. Through experience and watching others, I have formed some opinions as to how illustrations can best be utilized. The most important rule is best stated by a familiar cliche: “Keep it simple, stupid.” The only purpose of a medical-legal illustration is to help a layperson understand complicated medical issues. If your illustration is too complex, it defeats the purpose for which it was created.

You must insist that an illustration be anatomically correct and as simple as possible. Illustrators left without guidance are apt to include too much information with too many labels. It is for this reason that medical atlases and text books usually do not meet your needs. Conventional medical illustrations are apt to be as all-inclusive and complex as possible. They are intended to be teaching tools for physicians. Thus, these drawings contain a saturation level of information that is too difficult to be understood by a lay jury.

Disadvantages of Textbook Medical Illustrations

A separate problem with using medical textbook illustrations is the attempt to utilize a plate showing normal anatomy and then asking your medical witness to draw in the pathology. Doing this effectively can be a problem because it depends on the physician’s ability to draw. She may make the drawing more, not less, confusing.

It is my opinion that in a case of significance you should have case-specific drawings created. Such drawings properly done can be of immense value in helping you to educate the jury. I believe they have been the difference between winning and losing in several cases in which I have participated.

Working With The Medical-Legal Illustrator

If you are going to have illustrations specifically created for trial, you must have a game plan. The illustrations need to be the product of a team consisting of the physician, the illustrator and the attorney. I believe the best way to proceed is to first meet with your key doctor and ask her to suggest what illustrations would best help her to explain to a jury the nature and extent of the injury, the treatment she rendered, and the end result.

Simultaneously, and separately, you should contact your medical illustrator and ask her for recommendations of what she believes would be an appropriate illustration plan. An experienced medical illustrator can be invaluable in making recommendations. In fact, an experienced medical-legal illustrator probably has the ability to visualize your demonstrative needs better than you or your doctor.

In order to make recommendations, the illustrator needs to understand the medical issues. You should send her all the key medical records. At a minimum this should include admitting history and physicals, reports of operation, all radiographic reports, discharge summaries and final reports from the treating physicians.

The illustrator needs enough information to understand the injury that flowed from the trauma, the sequence of medical treatment, and the final result. …/…

After you have recommendations from both the treating physician and the illustrator, you must create a tentative plan, keeping in mind what you want to emphasize. You need to decide whether you are emphasizing liability, medical causation, proximate cause, or the nature and extent of injury. After you have decided upon a tentative plan, you should present it to both your doctor and the illustrator for their input.

Only when you have a final plan does the illustrator start drawing. Because it is essential that your physician accept the accuracy of the illustrations, there must be constant coordination. There is nothing worse than showing a finished drawing to a physician who then says, “No that’s not exactly right – it’s too exaggerated. I can’t say this is a reasonably accurate depiction.”

One way of avoiding this problem is to authorize your illustrator to have direct contact with your physician. This is often difficult because doctors are busy and are not really interested in the legal process.

I believe the best way of insuring accuracy is to have your illustrator prepare pencil drawings which you can take to the doctor and review with her. If changes need to be made, they can easily be done. Eventually, your doctor will “sign off” on the drawings. At that point your illustrator can prepare the final panels.

When To Use Medical-legal Illustrations

The cost of case-specific illustrations is substantial. To the actual cost of the illustrator must be added the physician’s charges for consultation and your own time. Thus, drawings should be made only if the case merits it. Having given this warning, I also want you to understand that I believe that appropriately prepared drawings can result in increased verdicts which make the illustrations the best investment you ever made.

You should be aware that there are differences in the use that can be made of illustrations as opposed to exhibits. Illustrations are like chalks that can be used to assist in the understanding of a witness’ testimony but do not go to the jury room. Exhibits can be used to prove your case and go to the jury room. …/…

General illustrations are not exhibits; case-specific medical illustrations are exhibits. Despite the protests of your opponent, an illustration drawn specifically for a case is an appropriate exhibit if you lay the foundation for its admissibility. You must establish that the illustration is medically accurate and that it is relevant.

How To Use The Medical Illustrations

I have recently been having the x-ray from which the illustration is drawn mounted on the board. The doctor is asked to identify the x-ray and to establish that the illustration is an anatomically exact copy of the x-ray. It is a way of letting the jury see in positive form what the physician sees in the negative.

By establishing that the physician participated in the creation of the illustration and vouched for its accuracy, you are not only laying the foundation for admissibility; you are also creating an image of accuracy and credibility.

Where To Find An Illustrator

Until recently it was necessary to go out of state to find a professional medical illustrator. The trial bar is fortunate that Rachel Walker opened her firm, A Brush With Justice, in Auburn. Ms. Walker’s background as a registered nurse makes her uniquely qualified to assist in the planning and creation of the medical-legal drawings.

Despite the cost and the effort involved, you must, in cases of significance, consider medical-legal illustrations. It is your duty as an attorney to educate a lay jury. Often this can best be done with the assistance of medical-legal illustrations.

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