Thursday, December 10, 2009

Presenting Multiple Injury Cases

A good client called this week to discuss her latest case involving a car v. pedestrian collision. It was a great case with no real issues concerning liability, but the presentation of the medical facts was going to be a challenge since the case involved over a dozen traumatic injuries and over fifty surgical procedures. While consulting in this case, I realized that I had offered the same suggestions many times before in similar cases which inspired me to write up a general overview to assist all of you. When considering presentation options for cases involving multiple injuries, there are two specific areas you need to consider: effectiveness and budget. Due to the massive amount of information that may need to be portrayed, these two factors are often in conflict and need to be balanced.

When I say that you need to consider the effectiveness of your presentation, I am referring to the strategic organization of the information, the educational value of the visuals you select and the dramatic impact of those visuals. If these three factors come together well, you will have a better chance of creating an effective presentation that will help you to achieve your goals. In cases with an overwhelming amount of information, the biggest challenge is usually the strategic organization. You can't show everything at once, so which items should be grouped together and in what sequence should they be displayed?

In general the information can be arranged chronologically, anatomically or strategically. A chronological organization could show all the injuries at one time, all the initial surgeries next and all the secondary surgeries later. An anatomic presentation would organize the information by body region. For example, you might show the head injuries first, the spine injuries next and then show the ankle injuries last. These exhibits might combine post-accident, intra-operative and post-operative information together so that each body region could be covered fully before moving on. A strategic presentation revolves more around the testimony to be given. In a strategic presentation, you might choose to divide the information according to how you will get it admitted or by which information each expert will discuss. Therefore, you will concentrate your efforts on illustrating items of interest to the experts who will appear live at trial or will be deposed on video while leaving off issues which are not supported by the experts you have at your disposal.

Next we must consider the education value of our presentation. If we can't afford to create demonstrative evidence for all the issues, we should at least use the power of illustrations for those that are the most complex or difficult to understand. For example, you might instinctively hope to illustrate the dramatic open fracture of the lower leg including the surgical fixation with multiple plates and screws, but there's also a pulmonary embolism to consider. Although the leg fracture and fixation would be impressive as an illustration, it would probably be easy for a lay audience to understand the issues without demonstrative evidence. On the other hand the formation and consequences of the pulmonary embolism would be exceedingly difficult to describe verbally and would most likely be a better focus for a limited budget. The object is to concentrate your efforts in areas where you need the most assistance in making yourself understood.

Last but not least, in order to insure your presentation is effective, you need to consider the dramatic impact of your demonstrative evidence. Drama can be important for many reasons from holding the attention of your audience and making your presentation memorable, to increasing sympathy for your client and increasing the amount of your award. For many, dramatic impact is the most important factor when gauging effectiveness, outweighing the other issues of educational value and strategic organization. Basically, in any multiple injury case, some issues, injuries and surgeries are just going to be more dramatic than others. No matter how important this aspect of effectiveness is to you personally, it is certainly something that needs to be considered when making the decision as to how to allocate resources.

And that leads us to the consideration of your budget. Thankfully, we have already covered almost all the aspects of this consideration while discussing the issues involved in the effectiveness of your presentation. All considerations must be weighed against the others when the information available is too voluminous to be covered comprehensively. Your budget will only set a guidepost for how severely you must sacrifice some considerations when weighting your presentation toward another. For example, if your budget only allows for one topic to be covered by your demonstrative evidence, you may need to select the exhibit that would be the most educational, or that would be the most dramatic or that would specifically support the testimony of the one expert who will be testifying live, but you may not be able to full achieve all three. With a larger budget, you will need to cut fewer corners but decisions will still need to be made.

My opinion is that the best decision is an informed and purposeful decision. You may have made these decisions many times although you may not have been consciously aware of the options you were considering. Hopefully, now that we have discussed the various considerations in detail, you can more purposefully weigh the various options you have and make decisions with which you can fell confident. Of course, I'm always available to discuss options with you, if you feel you need additional assistance.


  1. Ben,

    I want to thank you for a well written article on presenting multiple injuries. The Academy discusses this topic frequently with Members. What we do is correlate current research to the injuries. What we are developing is presentation of Scientific Consensus, rather than simply an "expert opinion". Having the expert tesify is a very important component of the case, however it has been shown that not all "experts" are in line with the Scientfic Consensus on a National Level.

    Your pictures are worth 10,000 words and the fact is, the peer reviewed medical research supports long term consequences of these types of injuries.

    The Academy is looking forward to helping develop a Scientific Consensus to comliment the Demonstrative Evidence. I will be looking through your Blog in the next several weeks to connect some of our research reviews with your very interesting and important topics.


    William J. Owens Jr DC DAAMLP
    President - American Academy of Medical Legal Professionals

  2. It is my pleasure today to get to read this informative blog page.Accidental injuries and harm creates traumatic situation in a person's life both emotionally and financially.
    Consequences of surgeries and budget which is an interesting segment detailed in this blog which i do not get to observe usually.It reveals your profound knowledge and concern regarding sociology and human biology.
    In addition to this the pictorial representation of anatomy of human body made it much easier to understand the effects and cause of injuries.
    Thanks and regards.