1 COMMUNICATING COMPLEX MEDICAL ISSUES: A VISUAL APPROACH Paper presented at the Trial Lawyers Association of British Columbia Persuasion and the Complex Case Strategies to Simplify Challenging Medical/Legal Cases 07 December 2012 By Stephen R. Mader (BSc, BScAAM, MScBMC, CMI, FAMI) President, Certified Medical Illustrator Artery Studios Inc
2 COMMUNICATING COMPLEX MEDICAL ISSUES: A VISUAL APPROACH By Stephen R. Mader (BSc, BScAAM, MScBMC, CMI, FAMI) UNIQUE COMMUNICATION CHALLENGES FOR LITIGATORS Law schools focus on the art of language use rulings, legal precedents, salient legal details all using the written word to ensure accurate interpretation of the law. But few law schools (if any) integrate courses on human anatomy, biomechanics, physiology, radiology, obstetrics or other medical subjects. Most personal injury lawyers are self-taught when it comes to understanding medicine. X-rays are ubiquitous in healthcare, and many personal injury cases include x-rays in the hospital records. Yet interpreting these accurately requires specialized knowledge and experience, and an ability to visualize anatomical structures three-dimensionally. These diagnostic images capture anatomy in two-dimensions only, with often overlapping structures and critical subtleties not evident to the untrained eye. Yet medical experts often use x-rays alone when testifying which may be virtually incomprehensible to a lay audience when communicating injury details to the jury (Irwin 1987). Figure 1: Complex trauma issues such as the details of fractures of the pelvis must be communicated at mediation or other settlement meetings or at trial so that all participants fully appreciate the injury implications. Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 2 of 24
3 Radiology, medical reports, operative notes, treatment procedures, pathology, obstetrics these are complex subjects. And the complex case often has reams of detailed information associated with it. Not only must a personal injury litigator understand the anatomical, surgical, pathological, physiological, pharmacological, functional and other medical and technical issues for a myriad of different files, his or her legal team must all be able to understand the important medical concepts being discussed often by the injured client during case intake and in subsequent meetings who may know the specific medical issues related to his or her own body quite well. Getting the entire team onto the same page can be onerous when developing the case. Then, when arguing the case at mediation, the medical issues must be confidently communicated and the germane issues emphasized, to ensure the mediator has a clear understanding of the severity of the medical factors. At trial, the orchestration of medical experts testimony must link together to tell a compelling story that holds together from the trauma, surgical and complications perspectives. These issues must also be made memorable to the mediator, adjustor, or judge and jury argued in a convincing manner during the mediation or in closing so that a fair award is rendered (see Figure 1). Similar to a doctor communicating medicine to a patient, usually non-medically-trained participants are deciding the merits of the case. Mediators may have little or no knowledge about the medical matter before them, the education level of the jury may vary significantly, and words that are heard (or read) may cause a unique mental picture to be formed in the mind of the decider of fact, that relates in no way to the actual medical facts. All of these factors (see Figure 2) create challenges to arguing and clearly presenting the complex case. Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 3 of 24
4 Figure 2: Overview of factors of medical complexity associated with personal injury files. Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 4 of 24
5 MAKING CASE INFORMATION MEMORABLE: VISUAL LEARNING Although most of us participated in Show and Tell early in school, we may have forgotten how natural it was to communicate visually while explaining something orally. Research has shown that visuals assist the viewer in perceiving and retaining the information presented (Cooper 1999, Weiss-McGrath 1989). Legal participants have difficulty absorbing complex information that is delivered only orally (Ferguson 2004). In the Weiss-McGrath report, the authors examined how people best retain information (Weiss-McGrath 1989). In that study, information was presented to individuals in three ways: orally only; visually only; and both visually and orally. The study found a 100% increase in jurors retention of information when presented visually, versus orally, and a significant 600% increase in retention of information when presented in a combination of visual and oral presentations, over oral presentations alone (see Figure 3). The authors concluded that when information is presented through combined visual and oral modalities, there is significantly increased information retention, for a longer period of time. Figure 3: Findings of Weiss-McGrath report, showing the dramatic increase in long-term retention of information when presented to jurors both visually and orally. By extension of this research, trial efficiency is increased when visuals are used that... enhance retention of information by the jury, summarize large amounts of information in an understandable fashion, simplify complex information, and assist the witness in explaining his or her testimony (Legate 2006). As every good teacher knows, visual aids, by allowing jurors to see abstract concepts and relationships, significantly enhance both understanding and retention. Trial lawyers must remember that most jurors receive their primary information from television and are Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 5 of 24
6 conditioned to learn more from visual images than from words alone. (Babcock and Bloom 2001) THE PROFESSION OF MEDICAL ILLUSTRATION Medical illustrators create illustrations, animations, models and other media (collectively known as visuals ) that help communicate complex biomedical and scientific issues, by presenting them in a simplified, easily comprehended format (Mader 1995, Legate 2006). They have a unique combination of specialized education and experience in medicine and visual communication. Most have Master s degrees from one of only five medical illustration programs of study in North America all offered within departments at medical schools. Courses of study include: human anatomy, embryology, neuroanatomy, pathology and histology (see Figure 4). Many medical illustrators are certified by the Association of Medical Illustrators which requires formal academic training, as well as ongoing professional development to acquire and maintain certification. Figure 4: Some of the courses studied by medical illustrators in faculties of medicine in the few specialized programs offered in North America, leading to a Master s in medical illustration. Medical-legal illustrators specialize in communicating issues associated with accident and medical malpractice claims for legal proceedings. They translate radiological images (x-rays, CT Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 6 of 24
7 and MRI scans, etc.) into simplified visual concepts, which can be comprehended by a lay audience. Detailed surgical procedures are depicted concisely: what lies under the skin or behind other structures (i.e., showing what a camera can not); relationships between anatomical structures (e.g., injury of a nerve adjacent to a fractured bone); and underlying anatomical causes for long-term disability (e.g., joint deterioration from osteoarthritis which, in turn, resulted from cartilage damage). Figure 5: Example of a medical illustration exhibit, which simplifies complex medical information into a readily understood visual presentation. These types of visuals summarize the trauma, anatomical, surgical and injury complication issues in a PI case (see Figure 5). Information presented in this way is especially persuasive - it involves the viewer and is remembered (Oatley 1998). Research conducted by interviewing practicing personal injury litigators (Mader et al 2005) found that lawyers expressed a need for these types of visuals to: to maximize understanding; be credible and admissible; and be personalized to the case. Medical-legal visuals must be simple, focused, and serve to clarify the issues (Turbak et al 1994). Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 7 of 24
8 TYPES OF CUSTOMIZED MEDICAL VISUALS RADIOLOGY EXHIBITS (ENHANCED RADIOLOGY POSITIVES) Because x-rays, CT scans and other forms of radiology are often extremely complex, even highly trained radiologists must carefully analyze them to fully appreciate all details. Adding overlays to clarify such things as fracture details or hardware, labels from the radiologist s report, as well as colour, shading and titles, can greatly assist in communicating radiological findings to nonmedically trained people (see Figure 6). While this form of demonstrative evidence allows for the presentation of some case issues, a knowledgeable medical expert may still be required to walk the viewer through the findings if the films are quite nuanced. These images may be presented as an electronic display (see Transitional Image Sliders below) or as a poster panel. Figure 6: Example of an enhanced radiology image with the addition of colour, outlines, shading, fracture details and labels. VIRTUAL 3D RADIOLOGICAL IMAGES Current imaging software allows for the creation of digital models from CT and MRI data. By controlling the software parameters, specific anatomical structures may be demonstrated (e.g., bones), and others excluded (e.g., soft tissues or internal organs), in order to depict trauma issues such as fractures (see Figure 7). Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 8 of 24
9 Figure 7: A virtual 3D radiological image constructed from CT data. Fractures of the facial bones are demonstrated note fractures below the orbits and through the nasal bones. CASE-SPECIFIC MEDICAL ILLUSTRATIONS Medical illustrations are simplified to show only those anatomical, surgical or pathological issues that are relevant and important for understanding the critical issues of the file. The amount of information communicated in each illustration is limited so as to not overwhelm the viewer. Surgical depictions (see Figure 8) demonstrate only the main stages of the procedure. Figure 8: Depictions of lengthy surgeries are simplified to focus only on the key stages of the operation, in an easily followed format. ANIMATIONS Animations depict issues that are best demonstrated by showing moving elements in virtual 2D or 3D space. They are motion-based depictions of a medical expert s opinion or theory (Rogers 2004). Issues of time and motion may be presented in animation format, such as the proposed Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 9 of 24
10 mechanism of injury, trauma complications or mobility issues (see Figure 9). Computer animations clearly and persuasively communicate technical concepts to a non-technical audience (Oatley 1999). Figure 9: Still frames from an animation that depicts traumatic forces to the spine with resultant intervertebral disc injury. STEP-BY-STEP SLIDE PRESENTATIONS Step-by-step presentations communicate the critical stages of an event as though in time-lapse format (see Figure 10). They are typically viewed in PowerPoint TM or Flash TM. The lawyer or expert can display each image for as long as required to explain it. This visual format is ideal for showing surgical issues, where details of complex procedures may need to be emphasized. Figure 10: Frames from a step-by-step presentation. The slides in this example depict details of craniotomy surgery with opening of the dura and exposure of the subdural blood. STORYBOARDS Storyboards are composed of sequential drawings (see Figure 11) that represent a frame-byframe account of what a full animation would depict (Mader 2006). This visual is analogous to a Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 10 of 24
11 comic strip, except that the drawings are detailed, realistic and without dialogue balloons (Bailey 1994). Figure 11: Example of a frame from a storyboard. TREATMENT CHARTS Charts showing such issues as medications, medical treatments and employment patterns can organize and display significant quantities of important and complex information spanning periods of time (see Figure 12). This format of presentation can demonstrate patterns that support case arguments. Figure 12: Example of a treatment chart, which provides a visual representation of a large volume of data (all physician names have been changed). Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 11 of 24
12 COMPARATOR SLIDE PRESENTATIONS This presentation mode allows for the direct comparison of contrasting procedures or anatomical views. For example, operative errors may be contrasted against what should have been done by the surgeon (see Figure 13). Figure 13: Frame from a comparator slide presentation. Contrasting images allow for comparison between possible options. Illustration on left shows what surgical procedure should have been performed; image on right shows what was actually done. INTERACTIVE MEDICAL ILLUSTRATIONS The functionality of presentation software (Flash TM ) can be integrated into illustrations that are interactive including for the ipad. In an interactive illustration typically one main image provides orientation for the viewer. When specific anatomical regions are selected, a larger, detailed view grows to fill the screen (see Figure 14). This type of presentation is ideal for cases that require depictions of injuries to numerous anatomical regions. Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 12 of 24
13 Figure 14: Frame from an interactive medical illustration. The illustration on the left provides orientation, while enlarged images, presented consecutively, demonstrate details of each injured region. INTERACTIVE TIMELINES Digital timelines may depict detailed information correlated with time, including notations from the hospital records or test results, and may also include radiology, medical illustrations and animations (see Figure 15). In many cases judges appreciate a timeline (Ferguson 2004). Figure 15: Frame from an interactive timeline. When a date is selected, details of the medical issue associated with that time consecutively enlarge to fill the screen. Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 13 of 24
14 TRANSITIONAL IMAGE SLIDERS These presentations allow for transitioning (or morphing ) between one image and another 1 (see Figure 16). This allows for depiction of such things as comparisons between before and after views, and radiological images with accompanying explanatory illustrations (Mader 2006). Figure 16: Stages of a transitional image slider, which morphs between an x-ray of the cervical spine and a corresponding illustration of it. Exact explanation of the film, while not losing a depiction of the original, may be obtained with this visual type. INTERACTIVE FETAL MONITORING STRIP In birth injury cases, the fetal heart monitoring strip or tracing, documents specific medical findings of both fetus and mother during labour, including the baseline heart rate, accelerations and decelerations to the heart rate, and uterine contractions. Interactive Fetal Monitoring Strips are created by digitally assembling the long strip into a seamless display, thereby showing several hours of monitoring in an easy-to-use format (see Figure 17). Electronic interactivity is added to assist in presenting key information in the tracing, such as the ability to scan back and forth, pause on a critical point, highlight and annotate areas and search by time stamp. Explanatory illustrations may be added to demonstrate issues such as placental abruption or other birth trauma complications. 1 Initial research in the academic use of Flash TM -based medical-legal visuals was performed at the University of Toronto (Division of Biomedical Communications), by Assistant Professors Leila Lax and Jodie Jenkinson. Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 14 of 24
15 Figure 17: Screen from an Interactive Fetal Monitoring Strip showing highlighting and other interactivity options. RAPID PROTOTYPE MEDICAL MODELS Innovations in 3D printing allow for a radiology model to be printed as an actual physical lifesized (or scaled) model that can be held in the hand (see Figure 18). CT and MRI data are reformatted (similar to Virtual 3D Radiological Images see above), with details carefully adjusted to demonstrate the injury issues. Colour is added to the model to communicate fracture patterns or other pathology. Trauma, surgery, long-term degeneration and other injury issues may all be demonstrated with this type of visual. Figure 18: Photographs of a Rapid Prototype Medical Model constructed from CT data, cast as a life-size physical model, and details hand-painted to depict pathology (fractures). Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 15 of 24
16 INTEGRATING VISUAL STORYTELLING A. PRODUCTION OF CUSTOMIZED MEDICAL VISUALS All medical documents from the legal file are reviewed, including radiology reports, operative notes, physician letters, rehabilitation notes and medical-legal expert reports. Issues that are relevant to the production of visuals are noted. From this information, a comprehensive proposal is sent to the lawyer, outlining all suggested visuals that would demonstrate the salient issues of the file, and incorporating any specific directions provided by the firm. Figure 19: Summary of how medical-legal visuals are produced. Once the proposed ideas are approved, production of visuals proceeds. X-rays are traced to capture all proportions and medical content, pencil sketches are drawn, colour images are rendered, animations and interactive medical are created (where relevant), and all graphic Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 16 of 24
17 elements (i.e., illustrations, labels, titles, prints of radiology, etc.) are designed into readily understood panels, movie scenes or interactive digital files (see Figure 19). Consulting medical experts may provide input throughout the production of these images and definitely after their completion. They write a short report identifying the visuals they have reviewed and attesting to the accuracy and relevance of the visuals. B. HOW THE MEDICAL ILLUSTRATOR ENSURES ACCURACY OF VISUALS The careful analysis of all relevant medical reports and diagnostic images from the case, allows for the accurate creation of visuals that address all essential issues and dovetails with the legal argument and opinions of the medical experts. Size, position and proportions of anatomical structures and associated injury pathology, surgical hardware and other details are rendered directly from the films. Written descriptions in the medical reports are used to supplement these images, such as descriptions of injured nerves and vessels. Finally, respected medical literature is used to augment additional depictions. Extraneous or potentially inflammatory depictions, are excluded from the visuals. Although all relevant surgical, trauma and anatomical issues may be demonstrated, an experienced medical illustrator will include enough detail to provide a clear depiction while not incorporating inadmissible portrayals (Mader 2003). Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 17 of 24
18 Figure 20: Summary of steps followed to ensure accuracy of customized visuals. Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 18 of 24
19 C. INTEGRATION WITH MEDICAL EXPERT OPINION The testifying physician uses the customized visuals to explain the relevant points of the case convincingly, in detail and with authority. Because the illustrations, animations and other media often rely upon the opinions expressed in the expert s report, and are created ultimately for his or her use at trial, that expert must review the visuals and provide feedback to the medical illustrator well in advance of trial. Any requested changes are incorporated into the final visuals. The expert then writes a brief letter attesting to the accuracy and relevance of the images (Mader 2003). Involvement of the expert in the creation of the customized demonstrative evidence is critical for its successful use: The use of the doctor [in] making of either a diagram or video is to illustrate his testimony, not substitute it for his testimony. In the end, it is his opinion [that] is the evidence upon which the trier of fact will base the decision, while the illustrative aid will have only assisted in understanding that opinion. (Legate 2006) While on the stand, visuals may be critical to assisting the medical expert: Consider a doctor testifying about his patient s injury. Much testimony may be required to describe the location, extent and functional impact of a calcaneus fracture. A medical diagram will illustrate the doctor s testimony readily. The doctor can clarify that it is merely an illustration, intended to assist the trier of fact in appreciating the testimony. If movement is impaired, a series of illustrations, or a video, can illustrate the doctor s testimony further. It will have the advantage of ensuring that the jury understands what the doctor intends them to understand, rather than being misled and potentially conjuring up some other part of the body or mechanism of injury. (Legate 2006) D. USING VISUALS AT MEDIATION Although most cases settle before trial, plaintiff lawyers must treat a case as though it will end up in court (McLeish 2004). Many plaintiff lawyers wish to have visuals prepared in time for use at mediation. Use of customized images at this stage of file development demonstrates a thoroughly prepared case one that is ready to proceed to trial if necessary and provides a psychological edge during mediation (Mader 1995, Oliver 1994). Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 19 of 24
20 The types of demonstrative evidence used in the mediation setting must be carefully considered plaintiff lawyers should focus their demonstrative aids on the main facts and use them to educate the opposing side about complex issues of the case (Wheatley 2004). At mediation, plaintiff counsel must explain the medical concepts without the assistance of the medical experts therefore, the use of case-specific visuals can be particularly helpful with this communication challenge. PowerPoint TM presentations may be used, with visuals incorporated into them (Mader 2003). When using visuals at mediation, plaintiff lawyers develop a very good idea of how a jury will react to the images, should the case end up proceeding to trial (Oatley and McLeish 2004), and can, in turn, communicate this to other mediation participants. At the same time, defense counsel will assess the credibility of the case, the client, and the plaintiff lawyer, in order to conclude what impression will likely be made on a judge or jury (Wheatley 2004). The use of effective visuals at mediation can have a profound impact on the attempted settlement of cases. E. USING VISUALS AT TRIAL Visuals may be referred to in trial opening provided it has been determined that defense will not be objecting to the use of them: Use demonstrative evidence early and often from the opening address to the first witness and every witness thereafter. Repetition is pivotal to persuasion. Demonstrative evidence is pivotal to persuasion. The repetitive use of demonstrative evidence will have a synergistic effect and will significantly increase your chances of success. (Vigmond 2007) The visuals must be formally admitted as evidence through the testimony of the medical expert on the case. During testimony, he or she will support their use and assure the court that the visuals are accurate, relevant, and useful to explain the issues of the case. Most visuals produced by medical illustrators are considered illustrative evidence, rather than substantive evidence. Much has been written on admissibility issues of demonstrative evidence (see Legate 2006, Oatley 1999, Oatley and McLeish 2004). Evidence is categorized as either substantive evidence, which has probative value, or illustrative evidence, which supports other substantive evidence (Legate 2006). If the evidence is merely illustrative of otherwise proven substantive evidence, the test for admissibility should be more relaxed. For such evidence, providing the evidence is not unfair Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 20 of 24
21 or misleading, and providing it is relevant and helpful to the trier of fact, it should be admissible if it accurately illustrates otherwise admissible substantive evidence. (Oatley 1999) The intention of customized demonstrative evidence is to assist in appreciating, recalling and understanding the issues and evidence in action the intention is not to mislead (Legate 2006). OUTCOMES OF USING VISUALS IN LITIGATION PROCEEDINGS Lawyers report that integrating customized visuals adds impact to their arguments and that their use contributes to faster resolution of files with fairer awards for their clients. The use of demonstrative evidence is critical in a presentation of evidence in respect to damages both pecuniary and non-pecuniary (Vigmond 2007). Most experienced medical experts are well accustomed to using illustrations indeed, many expect to use them, to help communicate to a jury: Their technical and often boring but important testimony is lost on the juror who cannot follow or is uninterested in following the evidence of the expert. While the trial judge is allowed in our system of justice to take copious notes, the jury is expected to sit and only listen. Without some sort of aid to assist in the comprehension of technical evidence, the juror is at risk of making wrong decisions. It is for that reason many experts have been allowed by modern judiciary to use visual aids to demonstrate and illustrate their testimony. (Legate 2006) Visuals can further assist in the testimony of medical experts by helping control the presentation of their evidence, by guiding and assisting them, and by focusing the jury s attention on their critical evidence being presented (Cooper 1999). Further, the images may stimulate feelings and affect the listener emotionally, thereby enhancing a persuasive argument or the testimony of an expert (Babcock and Bloom 2001). Judges report they may have difficulty understanding oral testimony, and appreciate the use of visual presentations; expert witnesses may need to explain complex issues, which are better communicated with visual images (Ferguson 2004). Finally, reliable demonstrative evidence can shorten the litigation process. It can focus expert testimony, help dispel non-issues, and shorten the length of time required for experts to be on the stand (Legate 2006). Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 21 of 24
22 Figure 21: Summary of the effects of a visual approach to communicating cases. CONCLUSION: ENHANCING PERSUASION Customized, case-specific medical illustrations, animations, models and interactive media are critical to the effective communication of medical issues and can play a significant role in complex case litigation (see Figure 21). They demonstrate a thoroughly developed file and add impact to the evidence presented. They are essential to fostering understanding of important medical issues and have become the accepted norm in many jurisdictions. We have come so far, that more than one lawyer has expressed the view that the failure to use demonstrative evidence in any complicated case approaches negligence. (Legate 2006) A visual approach to communicating complex cases, makes arguments memorable, demonstrates confidence in knowing the medicine, assists in development of the entire legal team, and facilitates medical expert testimony. Customized visuals are of great benefit in the art of persuasion. Stephen Mader 2012 With thanks to Elina Mer and the other staff members at Artery Studios Inc. Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 22 of 24
23 STEPHEN R. MADER BSC, BSCAAM, MSCBMC, CMI, FAMI Stephen Mader is a Certified Medical Illustrator (CMI) and is the President of Artery Studios Inc, a visualization company that specializes in creating medical illustrations, animations, interactive media and models for plaintiff lawyers litigating personal injury and medical malpractice claims. As well as undergraduate degrees in biology (BSc) and medical illustration (Art as Applied to Medicine BScAAM), he holds a Master of Science in Biomedical Communications (MScBMC) from the Institute of Medical Science, Faculty of Medicine at the University of Toronto. His graduate research examined personal injury lawyers perceptions of effective visual communication tools. Mr. Mader has contributed illustrations to numerous publications, including Grant s Atlas of Anatomy, The Oatley-McLeish Guide to Demonstrative Advocacy, and has extensively presented and written papers on medical-legal visualization. REFERENCES Babcock, C.L., and Bloom, J.S Getting your message across: Visual aids and demonstrative exhibits in the courtroom. Litigation 27(3): Bailey, W.S Storyboards: Inexpensive and effective. In: Turbak, N.J., Bailey, W.S., Heninger, S.D., Rosen, W.W., & Christy, G. If a picture s worth a thousand words Trial September: Cooper, M.Q Practitioner s guide: The use of demonstrative exhibits at trial. Tulsa Law Journal 34(3): Ferguson, D. (The Hon Mr. Justice) The use of technology in the trial courts. The Litigator Fall: Irwin, D Medical illustration as demonstrative evidence. The Advocates Society Journal 6(4): Legate, B.L The Admissibility of Demonstrative Evidence in Jury Trials: Applying the Principled Approach to the Law of Evidence. Advocates Quarterly 31  Mader, S.R The preparation of customized medical illustration exhibits for use in the courtroom [chapter update]. In: Goldstein, E. ed Visual evidence: A practitioner's manual. Toronto: Carswell Thomson Professional Publishing. Mader, S.R Using medical illustrations and animations in personal injury litigation. The Litigator. Fall: Mader, S.R., Wilson-Pauwels, L.A., Nancekivell, S.L., Lax, L.R., Agur, A.M.R., Mazierski, D.M Medical-legal illustrations, animations and interactive media: personal injury lawyers perceptions of effective attributes. Journal of Biocommunicaiton 31(3): Mader, S.R Dramatic Visuals: Medical Illustrations, Animations and Interactive Media for Personal Injury Litigation. Paper presented at the Hamilton Law Association: 6 th Annual Advocacy Conference (April 2006). McLeish, J.A Preparing for Trial. In: The Oatley-McLeish Guide to Personal Injury Practice in Motor Vehicle Cases. Aurora, Canada: Canada Law Book Inc. Oatley, R.G Making the Invisible Visible in the Courtroom Demonstrative Aids in Traumatic Brain Injury Cases. Paper presented at OTLA Spring Conference (21 May 1998). Retrieved 15 May 2007 from: Oatley, R.G Computerization of Demonstrative Evidence: Changing the Face of Advocacy. Paper presented at Continuing Legal Education Society of British Columbia Communicating Medicine: A Visual Approach Stephen Mader/Artery Studios Inc Page 23 of 24
The Use of Next Generation Visual Evidence and Its Importance to Expert Witness Testimony and Presentation. National Trial Lawyers Summit January 18-21, 2015 Daniel L. Buckfire Buckfire & Buckfire, P.C.
: Personal Injury Lawyers Perceptions of Effective Attributes Stephen Mader, Linda Wilson-Pauwels, Sharon Nancekivell, Leila Lax, Anne Agur, David Mazierski A literature review identified a lack of research
CREATIVE DEMONSTRATIVE EVIDENCE: ADDING THE MIDAS TOUCH A. Introduction We all know that the use of demonstrative evidence can be crucial to the jury s ability to understand complex issues at trial. There
1 Key Medical Evidence Used to Win Personal Injury Cases Brought to you by the attorneys at Shapiro, Cooper, Lewis & Appleton, P.C. Overview An injury inflicted at work, at school, while shopping, or elsewhere
New York Law Journal Tuesday, November 28, 2000 HEADLINE: BYLINE: Trial Advocacy, Direct Examination Of A Medical Expert Ben B. Rubinowitz and Evan Torgan BODY: The direct examination of your medical expert
Sequence of Evidence and Witnesses in a Traumatic Brain Injury Case Sequence of Evidence and Witnesses in a Traumatic Brain Injury Case Who's on First? Princeton, New Jersey Trial Diplomacy Journal, Vol.
STEPS IN A TRIAL Note to Students: For a civil case, substitute the word plaintiff for the word prosecution. A number of events occur during a trial, and most must happen according to a particular sequence.
Whether you are anticipating your first courtroom experience as an expert or are highly familiar with the rigors of the witness stand, being an effective and successful expert is a critical skill for anti-fraud
ATTORNEY HELP CENTER: MEDICAL MALPRACTICE The healthcare industry has exploded over the last thirty years. Combined with an increasing elderly population, thanks to the Baby Boomer generation, the general
Page 1 of 7 Ben Brodhead on proving causation and damages in spinal fusion cases. Friend on Facebook Follow on Twitter Forward to a Friend Proving Causation and Damages in Spinal Fusion Cases By: Ben C.
Medical Illustrator At a Glance Medical illustrators use their knowledge of art and science to create illustrations for the health and medical fields. Search by Cluster Fashion & Design Medical & Health
DIRECT EXAM OF EXPERT ON COMPLICATED SUBJECT MATTER THE ART OF EXPLANATION I. INTRODUCTION Many cases involve complicated subject matter. A trial lawyer s presentation requires making the complicated understandable
TRIAL IS DEFINED AS, A FAILURE TO SETTLE The Mediator s Perspective By Professor John Burwell Garvey Franklin Pierce Law Center For the typical case involving insurance defense, mediation should be the
OPENING STATEMENT FROM THE DEFENSE PERSPECTIVE BY JAMES C. MORROW MORROW, WILLNAUER & KLOSTERMAN, L.L.C. 53--1 Where Voir Dire is an opportunity to give the jurors an outline of your themes, opening statement
THE LAW OFFICES OF DIANA SANTA MARIA, P.A. University Place 5220 South University Drive SUITE 205C FT. LAUDERDALE, FL. 33328 (954) 434-1077 1-800-668-2156 Website: www.santamarialaw.net e-mail address:firstname.lastname@example.org
Medical Malpractice Litigation What to Expect as a Defendant Being named as a defendant in a malpractice suit may be your first exposure to civil litigation. You will probably wish it would just go away.
Choosing An Attorney For Your Accident Case By Michael A. Schafer, Attorney at Law 440 South Seventh Street, Ste. 200 Louisville, Kentucky 40203 (502) 584-9511 www.mikeschaferlaw.com CHOOSING AN ATTORNEY
ATTORNEY SUPPORT Creating Timelines for Litigation Presentations: By Timothy A. Piganelli Attorney teams frequently require assistance creating chronologies of events based on either facts or documents.
THE IMPORTANCE OF COMPREHENSIVE NOTES AND RECORDS by: Ryan A. Murray, Oatley Vigmond Personal Injury Lawyers LLP Introduction Comprehensive clinical notes and records are an important part of patient care.
How to Prepare for your Deposition in a Personal Injury Case A whitepaper by Travis Mayor, Attorney If you have filed a civil lawsuit in your personal injury case against the at fault driver, person, corporation,
THE DEFENSE LAWYER S TOOL KIT FOR WORKING WITH MEDICAL EXPERTS ABA Tort Trial & Insurance Practice Section Medicine and Law Committee Annual Meeting August 1, 2009 Jessie L. Harris Williams Kastner 601
USE OF DEMONSTRATIVE EVIDENCE IN THE TRIAL OF A MILD TRAUMATIC BRAIN INJURY CASE Your client, who sustained a closed head injury in an automobile crash one year ago, appears perfectly fine as his trial
Mandatory Arbitration The Alternative To Trial By Christopher M. Davis, Attorney at Law 206-727-4000 Phone: 206-727-4000 Fax: 206-727-4001 email@example.com Copyright 2007 by Christopher Michael
April, 2011 VOL. 5, ISSUE 2 How To Use The New Expert Witness Rule To Negotiate A Good Deal By Cary N. Schneider Cary N. Schneider is a partner at Beard Winter LLP who specializes in accident benefit and
STEPS IN A MOCK TRIAL 1. The Opening of the Court Either the Clerk of the Court of the judge will call the Court to order. When the judge enters, all the participants should remain standing until the judge
Preparing Birth Injury Case Prior To Expert Review of Causation Careful collection, organization and review of medical information essential to documentation of injury By RICHARD A. SILVER When analyzing
OPENING STATEMENTS Introduction The opening statement is a most important part of trying a lawsuit. Many lawyers do not treat the opening statement with the importance it deserves. Many opening statements
The Defense Lawyer s Tool Kit For Working With Medical Experts Jessie L. Harris You may have to play catch-up, but you can play it to win. Jessie L. Harris is a trial lawyer and Member in the Seattle office
PRACTICAL ADVICE ON THE MOST EFFECTIVE WAY TO SETTLE YOUR CASE WITH THE GOVERNMENT This article is collaboration between the panel moderator Brian J. Alexander and panel participants, Richard Saltsman,
The Petrylaw Lawsuits Settlements and Injury Settlement Report TRAUMATIC BRAIN INJURIES How Minnesota Juries Decide the Value of Pain and Suffering in Brain Injury Cases The Petrylaw Lawsuits Settlements
BIOMEDICAL COMMUNICATIONS biomedical engineering BIOMEDICAL COMMUNICATIONS BIOMEDICAL COMMUNICATIONS CHAIR, GRADUATE PROGRAM Lewis E. Calver, M.S. DIRECTOR, BIOMEDICAL ILLUSTRATION Lewis E. Calver, M.S.
What Happens Next? The Legal Process Roadmap for Personal Injury Cases By Ross A. Jurewitz Injury Accident Attorney, Jurewitz Law Group Jurewitz Law Group 600 B Street Suite 1550 San Diego, CA 92101 Tel:
CITATION Sanford SR: Informed consent: The verdict is in. ASA Newsletter 70/(7):15-16, 2006. FULL TEXT While the anesthesia community continues to debate the importance and manner in which informed consent
My Attorney What A Personal Injury Lawyer Can Do For You By Christopher M. Davis, Attorney at Law Davis Law Group, P.S. 2101 Fourth Avenue Suite 630 Seattle, WA 98121 206-727-4000 Davis Law Group, P.S.
Life as a Medical Malpractice Attorney A medical malpractice case lands on your desk. What is your first thought? What is your plan? If you re stumped or not sure where to begin, studying the anatomy of
Curriculum Vitae OF PAUL M. MANN, B.A., LL.B. Practice restricted to Medical Malpractice and Catastrophic Personal Injury Cambridge Office: 25 George Street South, Cambridge, Ontario. N1S 2N3 Telephone:
The Trial of a Soft Tissue Knee Injury Case By Ben Rubinowitz and Evan Torgan Although often overlooked as commonplace or insignificant, an injury to the knee joint often results in a severe, permanent
CAAHEP Accreditation The Accreditation Review Committee for the Medical Illustrator (ARC-MI) Sponsored by The Association of Medical Illustrators Recognized by The Commission on Accreditation of Allied
IN THE PENSION APPEALS BOARD IN RE THE CANADA PENSION PLAN BETWEEN: JUDY MANCHUR Appellant - and - MINISTER OF HUMAN RESOURCES DEVELOPMENT Respondent Appeal CP08485 heard in Regina, Saskatchewan October
From Opening to Summation, Making First Impressions Count By Ben Rubinowitz and Evan Torgan There is an old adage that every trial lawyer should accept as gospel: "You don't get a second chance to make
CASE STUDY LITIGATION SOLUTIONS Legal nurse consulting practice brings medical and legal facts to light using CaseMap software Overview Firm: Locations: Based in Agoura Hills, Calif., this consulting practice
The Adverse Direct Examination of a Defendant Doctor in a Medical Malpractice Case By Ben Rubinowitz and Evan Torgan There is no better way to prove medical malpractice than through the mouths of the defendant
Impeaching the Spine Injury Medical Expert By Ernest P. Chiodo, M.D., J.D., M.P.H., M.S., M.B.A., C.I.H. Physician-Attorney-Biomedical Engineer It is a common error that an attorney retains the wrong type
APPENDIX 2A Sample Initial Letter Dear [name]: Re: Motor Vehicle Accident Please read this letter carefully and retain it in your file, as it contains important information about your claim and the basis
How To Determine The Value Of A Personal Injury Case What Is Your Car Accident Case Really Worth? By Christopher M. Davis, Attorney at Law 206-727-4000 Phone: 206-727-4000 Fax: 206-727-4001 firstname.lastname@example.org
Reptile Theory: A Tail of Two Reptiles Julia B. Semenak If phrases like safety rules and community safety sound familiar, you have likely encountered a plaintiff s lawyer using the strategies set forth
DISTRICT COURT, JEFFERSON COUNTY, COLORADO 100 Jefferson County Parkway Golden, Colorado 80401-6002 MARION WHILDEN AND MARY WHLDEN Plaintiff, v. KIMBERLY CLINE, ELMER DUDDEN and COLORADO CAB COMPANY, L.L.C.
anatomage table Interactive anatomy study table Anatomage offers a unique, life-size interactive anatomy visualization table for the medical community. Anatomage Table offers an unprecedented realistic
MINOR CONSIDERATIONS, major CONCERns In representing children in personal injury cases, it all starts with their involvement and interests By CHRISTOPHER GULY One of the most challenging tasks for personal
I. ROBINSON V.BATES, 112 Ohio St.3d 17, 2006 Ohio 6362 (December 20, 2006). A. Landlord-tenant case In Hamilton County, Ohio, Plaintiff tenant sued her landlord for personal injuries caused when she broke
VOIR DIRE FROM THE DEFENSE PERSPECTIVE BY JAMES C. MORROW MORROW, WILLNAUER & KLOSTERMAN, L.L.C. 44--1 You have been sitting in your chair at counsel table for a good part of the day, perhaps making an
10 Things You Must Know Before You Find a H Seattle Injury Attorney www.seattleinjuryattorneyfaq.com 1 Should I get an attorney if I am in a car accident? If you have been hurt or have serious injuries,
TM SM The company you turn to for your Medical-Legal Support solutions. SM Nurse Consultants Comprehensive Medical Record Review Certified Nurse Life Care Planners Medicare Set-Aside Consultants Knowledge.
BITING THE BULLET: MEDICAL BILLS IN A POST HOWELL-CORENBAUM WORLD NOTE: This article was authored by Lawrence A. Strid and was published in the Spring 2014 edition of the Orange County Trial Lawyer s publication
May, 2011 FRCP and Physician Testimony: Treating Physicians, Experts, and Hybrid Witnesses The US Court of Appeals, Ninth Circuit, rules on these matters in the case of Goodman v. Staples the Office Superstore,
Expert Demonstrative Evidence by Richard M. Bogoroch and Melanie A. Larock Bogoroch & Associates Introduction Expert evidence is critical to the outcome of a personal injury case. As the reliance of expert
EVALUATING THE LOW IMPACT AUTO CASE Dana G. Taunton BEASLEY, ALLEN, CROW, METHVIN, PORTIS & MILES, P.C. Montgomery, Alabama 36104 I. INTRODUCTION Low impact auto cases may be simple or complex. A simple
2001 ONWSIAT 1893 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 193/00  This appeal was heard in Toronto on September 22, 2000, by Tribunal Vice-Chair N. McCombie. THE APPEAL PROCEEDINGS
Reconstruction of Construction Accidents New Tools for Litigation, Vol.3 Newsletter on using 3-D Computer Simulations and Analytical techniques to accurately reconstruct and illustrate an event. Challenge
IN THE CIRCUIT COURT OF THE CITY OF ST. LOUIS STATE OF MISSOURI, ) ) Plaintiff, ) ) Cause No. vs. ) ) Division No., ) ) Defendant. ) PLAINTIFF S INTERROGATORIES DIRECTED TO DEFENDANT Comes not plaintiff,
EXPERT EVIDENCE PAPER 2.1 Working with an Expert These materials were prepared by Leslie J. Mackoff of Mackoff & Company, Vancouver, BC for the Continuing Legal Education Society of British Columbia, October
CIVIL LITIGATION PRACTICE FOR PARALEGALS III. PREPARATION OF PLEADINGS Many attorneys, paralegals and legal assistants refer to pleadings as all court papers in the case. Technically speaking, the pleadings
A4002: Committee on Tort Liability and Risk Management Chairman: Brelend C. Gowan, California Department of Transportation Transportation Tort Law A Look Forward JAY L. SMITH, Missouri Highway Transportation
JUROR S MANUAL (Prepared by the State Bar of Michigan) Your Role as a Juror You ve heard the term jury of one s peers. In our country the job of determining the facts and reaching a just decision rests,
Medical Records: If the custodian of records delivers them by subpoena, pursuant to N.C. Gen. Stat. 1A- 1, Rule 45(c)(2), for the sole purpose of delivering the medial records, the custodian need not appear
Foundations in Law Unit 4: Lawsuits and Liability: The Civil Justice System Unit Overview How does the civil justice system hold people and corporations accountable for their actions? How does civil law
How to Determine the value of a personal injury case What is Your Car Accident Case Really Worth? By James Ferrell Ferrell Law Firm 901-754-1340 ph 901-881-6354 fax Ferrell Law Firm Phone: 901-754-1340
The Ohio State University Knowledge Bank kb.osu.edu Ohio State Law Journal (Moritz College of Law) Ohio State Law Journal: Volume 15, Issue 4 (1954) 1954 Law and Medicine: A Report on Interprofessional
Interpreting Legal Discourse and Working in Legal Settings: An AVLIC Position Paper Synopsis Prepared for ASL Translation Debra Russell - 2013 WHY DOES AVLIC HAVE A POSITION PAPER ON LEGAL INTERPRETING?
MEDICAL MALPRACTICE FACT BOOK - 1 - Firm Profile For over a decade, The Law Offices of Bruce M. Robinson have been dedicated to protecting the rights of victims who have been injured by the negligent and
Table of Contents Introduction 3 Why Not Settle With the Insurance Companies 4 What to do First 7 Hiring a Personal Injury Lawyer 11 How Much is My Claim Worth? 14 What if I have a Pre-Existing Condition?
Choosing a Lawyer How to Choose a Great Lawyer for Your Injury Accident Case By Ross A. Jurewitz Injury Accident Attorney, Jurewitz Law Group.JUREWITZ LAW GROUP Jurewitz Law Group 600 B Street Suite 1550
CAN JURY CONSULTANTS MAKE THE DIFFERENCE? A Plaintiff s Perspective By: Kathryn Burkett Dickson Dickson Levy LLP 180 Grand Ave., Suite 1300 Oakland, CA 94612 510-318-7706 email@example.com I. Introduction.
What Is My Injury Claim Worth? How insurance companies evaluate your injury accident case Based on California law. Written by a California licensed injury accident lawyer for Californians. Provided for
QUALIFYING THE EXPERT WITNESS Joseph A. Smith An expert is a witness with some specialized knowledge, skill, or education that will be helpful to the trier of fact in deciding the case correctly. See Daubert
IMPROVING SETTLEMENT SAVVY Kathy Perkins Kathy Perkins LLC, Workplace Law & Mediation www.kathy-perkins.com In these difficult economic times, parties may be looking to reduce litigation costs and risk
PRESENTATION OF INJURY CLAIMS John D. Malanga MALANGA LAW FIRM 3116 West 5th Street Suite 212 Fort Worth, Texas 76107-2140 Telephone: 817-332-1776 Fax: 817-332-1722 Email: firstname.lastname@example.org PRESENTATION
ALI-ABA SEMINAR Condemnation 101: How to Prepare and Present an Eminent Domain Case January 8-10, 2009 DIRECT EXAMINATION OF A VALUATION WITNESS Joseph P. Suntum Miller, Miller & Canby, Chtd. Rockville,
TIPS FOR HANDLING BRAIN AND SPINE INJURY CASES FOR THE PLAINTIFF S LAWYER Introduction This seminar includes presentations by several excellent experts on the medical topics of brain and spine injuries
2009 Medical Malpractice Claims Report Department of Commerce & Insurance November 1, 2009 Table of Contents 2009 Tennessee Medical Malpractice Report INTRODUCTION...2 I. REPORTING ENTITIES...3 II. REPORTING