Medical Visuals Help Experts' Testimony Come Alive in the Courtroom
By Kelly M. Pyrek

If a picture paints a thousand words, a medical visual can condense complex information contained in a patient's thick stack of medical records. In a courtroom where lives are at stake and where the information conveyed can make or break a case, the right illustrative tools are essential.

"It has everything to do with the way people learn," says medical illustrator Elizabeth Denny Sims, MA, executive vice president of MediVisuals, Inc., which provides consultation, research and production services for medical illustrations, graphics, medical 3-D models, animation and photography, with a specialization in medical litigation. "Some people take in their world aurally, but many take it in visually. When you have the combination of court testimony and illustrations, the information is retained much longer. Plus, the jurors can't take the expert into the deliberation room, but if the visuals are admitted into evidence, jurors can take them to refer to as they deliberate."

Sims continues, "Even if a medical visual isn't admitted into evidence, it is used as a valuable demonstrative aid that will help comprehension. Testimony that is accompanied by a visual is a good way to convey a clear message regarding a complex subject matter like medicine or anatomy. A lot of people don't even know what normal anatomy inside the body looks like much less any abnormal pathological conditions. So if you compare the normal anatomy to the actual injury, they will understand why it is at issue. Things like 'How displaced was this organ? How gangrenous is the skin compared to normal?' suddenly are easier to understand by jurors."

Sims and her husband Thomas D. Sims, CMI, president and CEO of the business and fellow illustrator, say the majority of their casework revolves around personal-injury trials and medical malpractice suits. However, they encounter occasional forensic cases such as shaken-baby syndrome and burn injuries. A notable case Elizabeth says was the illustrations they did of burn patterns found on a little girl who allegedly was killed while being held under scalding water in the bathtub.

In another forensic-related case MediVisuals was asked to illustrate injuries sustained in an alleged child abuse case.

"We did the visuals necessary to prove a child was being abused and to help get the child away from the people with whom he was living," Elizabeth recalls. "The client was very happy with that exhibit and they won the case. Another case was a husband-and-wife battle in California that resulted in a knife injury through the neck that missed the carotid. Another case involved a man who was stabbed in the chest. The knife handle broke off. The knife blade was surgically removed. The plaintiff ultimately died of adult respiratory distress syndrome caused by bacteria on the blade."

Before taking a case, MediVisuals gathers some preliminary information, including the purpose of the visuals, whether they will be part of a demand for settlement, settlement conference, mediation, arbitration, video deposition of an expert or for trial. "We ask for a brief verbal overview of the case and the name of the opposing counsel to check for conflict," Elizabeth says. "Then we submit a request for some medical records. Depending on the case, we might need EMA and ER records, diagnostic films with radiological reports, operative report, discharge summary and/or autopsy report. Expert testimony in the form of reports or depositions is invaluable. We review all reference material and develop ideas for the most effective exhibits. A written proposal is submitted to the forensic nurse and the attorney, describing each proposed exhibit (with cost estimate) for authorization. Once we get the OK, one of MediVisuals' 14 medical illustrators begins drafting the exhibits and will revise them until they are a perfect extension of the expert's opinion and the medical facts. If on the stand he or she can swear it is accurate, that is usually foundation enough for admitting them into evidence."

Tom Sims says cases with criminal allegations such as stabbings or shootings represent eight to 10 cases per year out of the average 500 cases they accept annually. However, cases having to do with injuries sustained from trauma such as electrocution or motor vehicle accidents are more common and are about a third of MediVisuals' caseload.

"I'd love to see forensic cases as an area of growth for us," Tom says, and Elizabeth concurs they have a great respect for the approach forensic nurses and legal nurse consultants take in their clinical and legal work.

"Nurses are organized, practical, hands-on professionals," Tom says. "In the hands of an articulate expert, an authoritative illustration can definitely help to persuade jurors."

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