When an angle grinder malfunctioned, its blade violently ripped open a man’s forearm and sliced major arteries that carried blood to his hand. He was rushed to the hospital in plenty of time to restore blood flow and avoid amputation. However, medical providers neglected to follow proper procedure.
The hand surgeon failed to correctly repair damaged vessels for two days - until the patient was transferred to a new facility. Before being transferred, the surgeon encountered blood clots and vessel spasm blocking blood flow during repair of the severed arteries, but did not use heparin or an anti-spasmotic drug to address the problem. Moreover, the surgeon disregarded hospital policy by not using a shunt to provide blood flow to the hand while repairs were being attempted.
Defense attorneys argued that the hospital was not responsible for any damages, and that the amputation was the result of the initial injury. They refused to offer a dime, and argued that the situation was too complicated to lay definitive blame on medical providers.
Plaintiff Attorneys Dan Lipman and Lorraine Parker needed to show a jury why the surgeon was liable for their client’s amputation because he neglected to follow standard hospital procedure put in place specifically to prevent this scenario. We delivered legal graphics and illustrations to achieve the following visual objectives:
- Anchor the jury’s understanding of the left arm’s basic skeletal and vascular anatomy.
- Illustrate how medical negligence resulted in blood clots, increased pressure in muscles, and restricted blood supply - inevitably leading to the destruction of tissue, and the eventual amputation of his hand.
- Demonstrate the correct procedure that was performed two days later at a different hospital, after it was too late to save his hand.
- Highlight the hospital policies the first surgeon ignored.
- Show how following these policies in the correct order would have resulted in establishing blood flow early, correctly, and with enough time to save the patient’s hand from amputation.
The defense tried to complicate the case and make liability seem unclear. However, visuals simplified these complex issues, and showed very clearly where, how, and why medical negligence occurred. The defense offered nothing before walking into trial, and would walk away owing about $5M after interest and costs were calculated into the final verdict amount.
High Impact is a key part of my litigation team and any large case that we do, it's important to have High Impact involved. Whether it be for mediation or trial, the use of effective visuals makes a difference in ensuring a positive result. What sets High Impact apart in this regard is that they are "STRATEGISTS” and not just order takers.Dan Lipman, Esq., Parker Lipman, LLP, Denver, CO
Bone vs Vascular Anatomies
The first mistake made by the hand surgeon was failing to prioritize restoring blood flow instead of fixating the patient’s bone fractures. This first illustration anchored the jurors’ understanding of these two anatomies with a visual that established the damaged areas.
We also highlighted the hospital’s policy, as dictated by the “Green’s Operative Hand Surgery” surgical manual. The book specifically dictates that the surgeon should have immediately ensured the revascularization of blood supply to the hand tissue before addressing non-urgent bone fractures.
A vascular shunt should be placed as an initial step. This should be done before operative debridement or skeletal fixation to reperfuse tissues and remove time pressure so that meticulous debridement and appropriate skeletal fixation and tendon repair can be performed before definitive revascularization.Green's Operative Hand Surgery - Dr. David P. Green
Delayed and Incorrect Procedure
This next illustration shows how the surgeon not only waited until after fixating the bone to restore blood flow - they also tried to repair damaged blood vessels using other damaged vessels from the injured area.
The correct surgical procedure, as dictated by hospital policy, would have been to harvest a vein from an uninjured area, such as the lower leg.
If a vein graft is required, it is also important to harvest vein from outside the zone of injury.Green's Operative Hand Surgery - Dr. David P. Green
Salvaging Failed Repairs
After performing the incorrect procedure above, blood clots formed repeatedly in the patient’s arteries, as the surgeon scrambled to salvage the mess he had made. This illustration shows the recurring arterial thrombosis, and how the surgeon attempted to to treat the failed vascular repairs.
Had the surgeon performed this stent correctly and on time, these complications would not have occurred. The fact that these procedures took place is evidence that medical providers were not prepared to deliver the proper Standard of Care.
The operating theater is not the setting for practice. Though possible, it is very difficult for a microvascular surgeon functioning independently to maintain a high success rate in replantations... A replantation team should be available around the clock, every day.Green's Operative Hand Surgery - Dr. David P. Green
Compartment Syndrome with Ischemia
These exhibits show the swelling of the patient’s arm and blackening of his fingertips as excessive pressure built up inside the enclosed muscle, impeding the flow of blood to and from his hand.
Standard of Care dictates a fasciotomy is immediately necessary if the slightest indication of compression or constriction is present. It took these medical providers two days to transfer the patient to a more equipped facility.
If the reattached part appears to be in jeopardy (detected by skin temperature, color, pulp turgor, capillary refill, or any combination of these signs), immediate rectifying action must be taken.Green's Operative Hand Surgery - Dr. David P. Green
Too Little, Too Late
After being transferred to a bigger facility, medical providers recognized symptoms of ischemia in the patient’s hand and immediately performed a fasciotomy. This time, they repaired the artery using an undamaged vein from outside the injured area in the patient’s ankle.
However, two days of impeded blood flow to the hand was too long for the tissue to survive. Eventually the plaintiff’s hand suffered necrosis, and required an amputation. This all could have been prevented had the proper procedures been followed correctly the first time.
High Impact’s team of visual strategists, artists and developers can build and customize your digital presentation for any case involving personal injury, medical malpractice, birth trauma - or any subject involving complex information.