The use of medical images as evidence in a court case has become a pre-requisite for cases constructed by personal injury, workers' compensation, and criminal attorneys. This digital evidence is subject to the same discovery standards as hard copy documents and photographs. As such, the attorney has to be prepared to share these digital images with opposing counsel as they prepare for trial. But medical images are just compilations of electronic bits, subject to strict privacy law and are only as good as the medical image viewer on which they are analyzed. This presents a special challenge as it relates to transport and sharing of these medical images.Actually, the whole process of capturing evidence from the physician that performed the scan, its analysis by expert witnesses, the special concerns that HIPAA and other privacy statutes raise, chain of custody in criminal litigation, and the presentation of these images at trial are all quite complicated for the litigation attorney. So how does the diligent attorney prepare to use medical images for use at trial and share these with the requisite parties?
Obtaining Medical Images from Physicians
Patients don’t always have medical images readily available for their legal counsel. In fact, a medical image scan, especially a more complex scan like a CT or MRI, is expensive. Not every patient can afford these procedures in advance of bringing or defending a lawsuit.
Often personal injury or workers’ compensation attorneys themselves will pay the bill to have the appropriate scans performed. They do this as a part of a host of accumulated up front expenses that they hope to be repaid from the proceeds of a successful outcome, sometimes in the form of a formal medical lien, enabling a plaintiff client to avoid the out of pocket expenses associated with such a procedure.
When the scan is generated, it is up to the attorney to get access to the study for use at trial. Gaining access to a medical image is a mostly flawed process. Similar to the archaic way we all used to share digital files in the last century, prior to networks and the internet becoming ubiquitous, we copy these digital files to a disc and then manually carry this disc to the next computer. CDs or DVDs are the still popular medium for sharing studies. But images transferred to discs have their own problems.
Once the image is copied to a CD or DVD for transport a lot can happen. Leaving the transport task to the patient, who may be distracted by their injury with a whole lot on their minds, ends up with lost or forgotten discs. Overnighting discs wastes precious preparation time and can be expensive. And discs that end up in the wrong hands can be an expensive HIPAA or other privacy law violation.
Assuming the disc successfully arrives at the attorney’s office, the difficult task begins of trying to view the study and ensure that the image displays what the attorney expects. Many modern computers no longer have CD drives, causing the attorney to scurry around to find one that does. Then, too many times, the discs that arrive are damaged, missing information or contain the wrong patient’s records. Even if they do arrive intact and are able to be loaded onto a computer, figuring out how to view the image with either the rudimentary viewer embedded on the disk, or correctly loading it onto the viewer at the lawyer’s office also can be a challenging task. Not every image displays the same way on every viewer and the instructions for use will be different for different viewers, again wasting precious time, money and creating frustration for the non-technical, non-medical professional.
Sharing with a Medical Expert
In many cases, a successfully acquired medical image will need to be shared with one or more potential expert witnesses for their review and analysis. We can replay the whole imperfect process that we did for obtaining the images from the physician here once again. Cost, delay and frustration often occur.
Once it is determined that a medical image will be used as evidence in a court case, it is incumbent on the plaintiff’s counsel to share this evidence with opposing counsel. Ensuring that this gets handled with the necessary confidentiality as well as making sure that attorney receives, can view, and can see the same information as the provider-counsel, is also important.
Sharing Medical Images at Trial
Attorneys have found that medical images, when displayed effectively, can make all the difference with a non-medical-expert judge and jury. The ability to display a three-dimensional reproduction of an injury or forensic evidence or even a video view of a pathway through the patient’s anatomy can transform esoteric evidence into a clear and compelling view. But getting the medical image in the right place at the right time on the equipment available in the courtroom brings with it other challenges.
There Has to Be a Better Way
Sharing, making available for easy viewing, and displaying medical images as evidence in a court case can be much easier, faster, cheaper, more confidential and less prone to error. The newest way to handle medical images for use at trial is with a cloud based PACS (specialized data base for storing medical images) coupled with a web-based medical image viewer.
So how does this help?
Getting images from physicians can be quick, simple, and secure. With the right cloud based PACS the attorney can receive studies from physicians confidentially and electronically. Images, no matter their size, can be uploaded via a web-based browser, by simply dragging and dropping the image files into an electronic receptacle provided by the attorney. There is no need to establish this connect advance, making it possible to work with the patient’s existing physician.
The attorney or staff can quickly determine if the image is correct and can display what is required on any computer in the office, home, or anywhere, even including a tablet or smart phone.
Consulting with Experts is Easy
These images can be confidentially shared with a potential expert witness without additional worry, time or expense. Counsel can send a confidential email to the experts enabling them to view the image on any equipment they have on exactly the same viewer as the attorney, ensuring that they are coordinated in what they see.
Sharing with Opposing Counsel is Effortless
Similarly, once it is determined that an image may be used as evidence in a court case, counsel can provide similar sharing with opposing counsel. This sharing ensures confidentiality while also enabling even the novice counsel to share exactly the same view, satisfying discovery responsibilities.
Displaying in the Courtroom
Once it comes time for displaying medical images as evidence in a court case, all that is required is an internet connection. Trial counsel can summon the image, again confidentially and confidently, ensuring that it is truly the exact same image that was viewed by all parties during the trial preparation process. With the cloud, this is all done on one single image, satisfying even the strictest chain of custody requirements.
By graduating into the use of 21st century technology, the entire process of obtaining, sharing and displaying medical images can be done simply, efficiently, effectively, and securely when attorney’s avail themselves of a cloud-based PACS.