Legal Rx: Medical knowledge lawyers need to know and how to communicate it

By Minh T. Nguyen & DK Global, Inc.

The practice of personal injury law is where tort law intersects with medicine and physics. In addition to mastering torts -- the rules of evidence and civil procedures -- a good personal injury lawyer should have a strong working knowledge of medicine -- particularly orthopedics, brain injuries, nerve injuries, and pain medicine. Ultimately, our job is to persuade insurance adjusters or jurors about the fair and reasonable value of harm and injuries to human beings. The authors will write a series of articles discussing various aspects of personal injury law, common injuries, and the mechanism of those injuries (i.e., the physics and science behind biomechanics and injuries through specific case studies).

An old colleague of mine referred me a case involving an overweight security guard who was injured at a beverage distributor's truck yard. To protect her identity, I will refer to her as Susan. Susan worked from a small pod, tracking the trucks that came and left each day. One day, a driver forgot to engage one of the truck's airbrakes after parking it in the yard. Over the course of the next 10 hours, the truck began to roll across the yard and slammed into the security pod, throwing Suan against a large metal safe.

Susan was suffering. Worker's compensation doctors dismissed her shoulder and low back pain as not serious and, in part, attributed them to pre-existing conditions that were unrelated to the subject incident. Susan was morbidly obese. The doctors diagnosed her with muscle sprains and strains. They ordered a few months of physical therapy, some trigger point injections, and released her back to work. However, Susan was in too much pain and did not return to work.  When she contacted the referral lawyer, the lack of documented medical treatment meant the defense would not entertain an offer to settle for $500,000, which Susan offered at mediation.

When I took over the case, I visited Susan at her home. It was there that I noticed a half-empty Costco-sized bottle of vodka sitting on her kitchen table in the middle of the afternoon. With a bit of prying, Susan divulged that she was self-medicating with alcohol. Understanding that she had been self-medicating for years explained the gaps in her treatment. With a little cajoling and explanation, we got her to seek proper medical care. She told me that she had shoulder pain with reduced range of motion. (As her lawyer, I made sure she saw a shoulder specialist.) She reported neck pain with pin-like sensation down her arm. (As her lawyer, I made sure she obtained a neck MRI to see if there was any cervical/neck disc damage and to speak to a spine specialist. Discs in our necks can be damaged and inflame the nerves in our neck, which branch down to our hands.) She reported back pain that traveled down her buttocks and into her legs. (As her lawyer, I made sure she obtained a low back MRI and saw a spine specialist.) What she reported as symptoms were potentially significant shoulder impingements and cervical and lumbar disc injuries that were putting pressure on her nerves. After seeking proper medical attention and treatment -- which included gastric bypass surgery to help her lose weight so she could undergo a lumbar discectomy -- her case settled for $6,000,000.

More importantly, her health and quality of life improved.

Basic knowledge of medicine, anatomy and physiology, injuries, and pain management has been invaluable for me and my practice. It starts with listening to the client and understanding the etiology of the symptoms that are being reported. Understanding how the human body responds to trauma allows me to value personal injury cases. As a result, I can advocate for the right amount of justice for my clients.

Every PI lawyer should review a nerve dermatome chart when the client reports numbness or tingling in the hands to correlate with a cervical nerve or numbness or tingling in the lower extremities to correlate with a lumbar nerve. The same is true for any low back pain that radiates down either leg.

Frankly, all trial attorneys who practice personal injury should possess this knowledge. We owe it to our clients to understand their pain and symptoms. We must be able to assist with getting them care and explaining their pain and symptoms to insurance adjusters and/or jurors.

At our core, trial lawyers are storytellers. Once we identify the injury, establish causation, and adequately value damages, it's our responsibility to communicate those findings effectively and persuasively. Below are some tools that I use to augment evidence and expert opinions to get my arguments across effectively. They're all investments, and the returns justify them. Some are intuitive -- obvious even. However, recognizing the full depth of resources in our arsenal often goes a long way to attaining the justice our clients deserve.

1) Anatomical Models

Physical models of human anatomy are tried and tested for medical education. There's something particularly compelling about having something tangible to showcase to the other side, a mediator, or a jury.

2) Diagrams

Similarly, medical diagrams have historically been practical in educating people about human anatomy. However, they offer greater portability and versatility (e.g., digital or print) than anatomical models. That said, some medical diagrams can be overly technical, so select the right level of features for your audience.

3) Apps

Educational applications are available that are great demonstrative tools for explaining the spine. For example, one application that I use frequently is Spine Pro III, which is available for Apple products.

4) Props

On the theme of using physical, real objects, many attorneys use props at trial. Think toy cars to demonstrate forces and vectors in auto accidents. Jurors sometimes find everyday objects more relatable to communicate complex medical concepts. For example, use an egg to explain an egg-shell plaintiff and CACI instruction 3928, Unusually Susceptible Plaintiff.

5) Documentaries & Day-in-the-Life Videos

Beyond educating about medical concepts, we must present how our clients' injuries impacted their lives. Documentary-style videos -- also called day-in-the-life videos -- are an extremely effective solution. Well-done day-in-the-life videos show both how our clients altered their lives to cope with their injuries, as well as feature interviews with family members, friends, and experts. The end result can be extremely compelling.

6) Illustrations

In the custom visuals realm, medical illustrations are often the least costly option. By partnering with a visuals firm to create custom medical illustrations, I can tailor the medical concepts to my client's specific damages. High-quality medical illustrations can zero in on what I want to communicate, and this often supersedes pre-made diagrams in terms of the case outcomes that follow.

7) 3D Animations

However, when the right case calls it, a 3D animation can be the force multiplier that shifts the tone during mediation and trial. 3D animations run the gamut from reconstructions, surgical depictions, and damages flythroughs. When done properly, animations not only depict what happened to my clients, they communicate how viewers should feel about it. I often find that 3D presentations trump 2D because the sense of depth is more straightforward for audiences to follow. Accuracy and admissibility at trial are always essential factors to consider, so work with a firm that understands the Daubert Standard and has the proper skill level to catch errors and anomalies. The most important consideration is finding the appropriate presentation for your case and your audience.

Ultimately, our job as plaintiff attorneys is to get full and fair justice for our clients. Ideally, justice for victims should be based on the severity of the injuries, how the injuries affect human beings, and the harm the defendant caused. But, the reality is that a lawyer's financial resources often influence how much justice a plaintiff attains. For complex cases with substantial damages, attorneys need to be ready to invest the necessary time and capital to properly litigate on their client's behalf -- the experts, medical specialists, models, illustrations, videos, and animations. Otherwise, consider reaching out and potentially referring to an attorney who does.

Minh T. Nguyen is the founding partner of Nguyen Lawyers, APC. A lawyer for the people, he specializes in representing those with personal injuries, including car crashes, wrongful death, slip-and-falls, defective products, dog bites, and dangerous conditions of public property. Minh serves on the Executive Committee of the Consumer Attorneys Association of Los Angeles (CAALA) and was president of the organization in 2023 -- the first Asian-American to be elected to the role. He is a Past President of the Los Angeles Trial Lawyers' Charities and a founding member of the Orange County Trial Lawyers' Charities. He is on the faculty at the Gerry Spence Trial College. Minh has recovered over $400M for his clients. He is guided by the belief in attaining justice for every man, woman, and child regardless of race, gender, or sexual orientation.

DK Global, Inc. specializes in visual presentations for attorneys, particularly 3D animations and illustrations. Since 1998, DK Global has led the litigation visuals industry, introducing the most innovative and accurate medical reconstructions, accident simulations, and visual aid best practices. DK Global has provided animations for some of the most notable lawsuits in California and across the country, including the shooting on the Rust movie set, Nick Rowley's $42M verdict against Tesla for hitting a motorcyclist, the Thomas Fire lawsuits, the wrongful death shooting of a family at a crowded Costco by an LAPD officer, and the George Floyd wrongful death lawsuit against the City of Minneapolis.