Injury Illustrated

How Medical Images Win Legal Cases

R. Annie Gough

• Publisher: CRC Press
• Year: 2020
• ISBN:
  9781000215601
• Edition: 1
• Topic: Jura
• Subtopic: Medizinrecht

The best storytellers and presenters know that a picture is worth a thousand words. Pictures simplify stories. They make stories memorable. They clarify complex concepts and they educate the audience in the easiest way. That is why attorneys work with artists—medical illustrators, to be exact.

Injury Illustrated is the first book of its kind. It is the essential guide on medical illustrations used in the legal context. This book examines the creation of visual graphics known as demonstrative exhibits. These exhibits provide an understanding of traumatic injuries, surgeries, and radiology studies for the jury, judges, adjustors, mediators, and the attorneys. These chapters describe how to tell a clear story about gross anatomy, medical malpractice, and/or death investigation in court by using medical images. While medical illustration and injury law are very different professions, illustrators are the ideal partners for lawyers when solving problems and preparing for litigation.

Divided into five sections, this book details who medical illustrators are, how they are educated in medicine, the skills and services they can provide to trial lawyers, and the countless benefits resulting from record review and case preparation.

Find techniques to best use medical images during all stages of litigation

Learn how graphic exhibits engage a jury and empower justice

Understand why attorneys win more cases by collaborating with medical illustrators

All readers will learn about this unique career and the attorney-illustrator relationship. More specifically, attorneys, artists, animators, law students, medical students, forensic scientists, and medical experts will understand how demonstrative exhibits assist legal proceedings in forensic matters and civil lawsuits.

Warning; these images will be graphic and the cases at times will be catastrophic.

Chapter 1

Dominos

Warning: Graphic Images

From the bench, a picture is worth well more than a thousand words. These visuals save myself and the jury from ALL the words a lawyer would use to describe what can be captured in one illustration.

The Honorable Shelyna V. Brown, Superior Court Judge, California

Trey was hungover. Proud of making it onto the job site at all, he felt brave enough for a little pick-me-up, just something to kick his headache. After a sip, he reached into the little pocket in the front of his jeans, took out two pills and swallowed them. He locked his car and sauntered past the orange cones. Trey was the original and only crane operator for this project. He settled into the seat, and the large crane whirred to life. Today, they were finally going to raise the concrete walls for the new outlet mall.

In a construction process known as “tilt-up,” the giant exterior walls are poured on site before they are raised to the vertical position. The process is months faster than traditional steel frame construction and is typical for big-box structures like Home Depot, Walmart, and Target. A crane lifts and sets each wall into place like dominos. The ground crew stabilizes the points where each wall meets another.

The crew on the ground was also starting their work-day. Most were geared up and getting instructions; some of the managers chatted casually. Jack was a master welder and licensed tattoo artist, and he was checking out the general contractor’s new ink. They shared a laugh. Jack was well respected by his coworkers and considered the go-to guy on the job. Placing his hard hat over his bright blue bandana, Jack settled into his position. Trey waited for the okay flag.

After a couple of hours, Trey had another concrete wall floating high in the sky. His hands shook over the controls, he could not focus. Sweat beaded on his upper lip and his head pounded. Suddenly, he knocked the bottom corner of the massive suspended wall into the top of a standing wall. That wall started to tip, knocking into another wall, which also started to descend. The men on the ground started running in every direction.

In the madness, Jack ran. The shadow of a falling wall darkened his path. He ran so hard. He was scrambling over wood pallets when the concrete hit him. Jack was pushed into the wooden slats as the weight of the concrete broke his bones. The load cracked his hard hat and squished soft tissue out of his skin and between the boards.

The concrete panel weighed 70,000 pounds. A special forklift was brought in to lift the wall off Jack. The medical examiner prepared an autopsy report. All anatomical systems of the body were described in detail. Some bones were fractured, some organs were injured, and some organs were intact. The medical examiner believed Jack’s death was not instant. There were fractions of time when Jack had felt pain and had been aware of his imminent doom. The attorney representing Jack’s family scheduled a deposition of the medical examiner. This was the attorney’s chance to establish how long Jack had lived, feeling and knowing his trauma until his last breath. The 14-page autopsy report was substantial. The information was a lot for the attorney to digest, perhaps too much for the mediator and judge, and definitely too much for the potential jury; no way an insurance adjuster would read each page.

The examination read something like this: “The brain weighs 1,236 mgs presenting moderate congestion of the leptomeninges. Overlying dura demonstrate numerous lacerations. Cerebral hemispheres reveal normal gyral pattern with severe global edema. The brainstem and cerebelli are normal in appearance with no evidence of cerebellar tonsillar notching. The Circle of Willis is patent.” And so on.

As a medical illustrator contracted by the attorney, it is my job to resolve problems like this: a voluminous complex medical record and a simple audience. It is my job to summarize the report with an illustration, as accurately and clearly as possible. I read the autopsy report and review the scene photographs. In this case, my task was to create one simple exhibit to aid in the upcoming deposition, and quickly. Once complete, I was invited to a conference call with both the attorney and the medical examiner. The medical examiner, who did not believe I could summarize his report into one page, had just received my illustration via email. After a few short introductions, he exclaimed, “You hit the nail on the head.” I laughed to myself and pumped my fist in the air like Tiger Woods sinking a putt on Sunday. These are my victories. With my illustration the medical examiner had a complete summary of his autopsy report to recall specifics during his testimony in the courtroom. The page was presented during the deposition and added as an exhibit to the case.

In preparation for mediation, the illustration was printed on a giant board. The board was covered with a piece of butcher paper and showed a sticker that read: “Warning: Graphic Image.” The paper-covered board stood on an easel in the corner. It loomed there throughout the day, dominating the bland conference room decor. Liability facts were argued by both sides. Engineers and construction experts disputed negligence. After some additional arguing, Trey’s drug test results were presented.

When it was time to discuss damages, the lawyer made a big to-do about excusing the attendees from the room if they did not want to see the image under the paper with the warning label. It was the likeness of either their client, coworker, husband, or son. The lawyer’s theatrical sensitivity combined with honest respect toward the family made quite the impression. Given the choice to not view the illustration, everyone chose to stay. He lifted the butcher paper and revealed the image of Jack, fatally crushed. The lawyer discussed the trauma and violent forces of the falling wall. He believed the medical illustration summary was a critical asset in the large confidential settlement offered and accepted that same day. I also believe the pure anticipation of the illustration was a key factor in the successful outcome.

Figure 1.1 Summary of fatal injuries.

This is my daily work. Yes, it is dark, and I love it. When I am not giving a lecture or visiting a law firm, I am in my pajamas, I sit all day in my pajamas drawing pictures for lawyers. Well, I have a standing desk. I stand all day in my pajamas, in front of a computer, drawing pictures for lawyers, reading medical records, and calling testifying experts. It’s a good gig.

When I asked Judge Brown to send a quote to open this chapter, we chatted on the phone for a bit. She said she had just come out of a murder trial. The victim had been bludgeoned to death with a brick to his face. The attorney showed the autopsy photograph of the victim’s face, completely red with blood, messy, and disturbing. She said she looked at the jury and thought, “Where is Annie, where is Annie?” Judge Brown said she wished someone had sketched the man’s face without all the blood. She wanted to see a skull under the skin. She said everyone in the courtroom needed something to clarify the various fractures, the individual lacerations, and qualify the number of strikes without all the gore. Even the medical examiner could not count the blows with the photograph alone.

We often rely on the quote, “A picture is worth a thousand words.” It really does make the point. But professionally, I believe people want more solid evidence than a catchphrase. Not only do few people know that medical illustration is a career, but few people know that medical illustrators and animators are educated in medical schools and specially trained in visual problem-solving. Even fewer people know that attorneys and their clients have the best opportunity to benefit from storytelling with medical illustrations.

Chapter 2

The Brief

The Reason and the Reasoning

Medical illustrators draw what can’t be seen, watch what’s never been done, and tell thousands about it without saying a word.

Frank H. Netter, MD

In this book I hope to teach attorneys, and anyone else with the stomach to learn, about the world of medical illustration. I will explain who medical illustrators are and how to win cases by collaborating with one. This book will walk through real cases, including illustrated exhibits, much storytelling by me, and plenty of gross anatomy. Fair warning: the medical images will be graphic. I will share war stories, and I will reminisce. I hope to keep the serious discussion light when appropriate. Some humor is crucial for enduring the emotional terror experienced in the practice of injury law. As always, every case is respected and remembered for education and learning purposes. This book is written from my personal experiences and is not intended to be disrespectful of any attorney or client. The daily pain and suffering of the clients and their loved ones is not forgotten. Please note all of the names have been changed, unless requested otherwise.

I will concentrate on various visual exhibits for plaintiff personal injury, medical malpractice, and wrongful death cases, and I will also reach into criminal defense projects and medical malpractice defense strategy. I will not discuss the differences in rules for demonstrative evidence, as they vary from state to state and province to province, even parish to parish.

The chapters are organized into the following:

Section A. Who am I? This is my story; the unique path that brought me to medical-legal illustration.

Section B. Who are we? Who are medical illustrators? We go to medical school, not art school.

Section C. Why would an attorney hire a medical illustrator? How medical illustrations solve countless legal case problems.

Section D. What additional benefits do you get when you collaborate with a medical illustrator? Medical illustration is more than a product; it is a valuable service.

And finally, Section E. I call this section “The Wall.” We spend a lot of time behind the wall of science, stacking bricks between our professional minds and our tear-jerking feelings. When attorneys and illustrators are required to be dispassionate, visuals open the hearts of the decision-making jurors. Emotion is the key to jury engagement. Evoking emotion in the closing argument will also conclude this book. Medical illustrations have a power to elicit empathy for the client as a real person with a face, and a life, and loved ones. Illustrations place a human skin over the hard-to-follow anatomical jargon. Illustrations also manage sensitive content, build credibility, and conjure up focus on days when the lawyer might have none left.

Everyone is familiar with the posters in the doctor’s office showing anatomy cut in half. Most medical illustrators and animators work in this industry of patient education. Many illustrators practic...