I'M GLAD TO BE BACK!

It’s been a while since I was on this page. The last 6 months started with emergency eye surgery, followed by several months of taking care of my Father-in-Law with his dementia, many summer visitors and finally my Stepson’s wedding in the mountains of Colorado.

Those months were frightening, concerning, uplifting, exhausting, fun and often filled with laughter and tears.

I’m relieved to say I didn’t loose the vision in my left eye, my Father-in-Law is now in a safe environment and I wouldn’t trade the time with family and friends for anything.

Having said all that I’m glad to be back where I love to be, researching, wading through medical records, helping organize mounds of chaos and finding those needles in a haystack. I love being able to help those that need it and let’s face it, somewhere along the way we all need it.

I’m looking forward to those new challenges ahead.

THE REPORT DILEMMA: WHAT REPORT IS RIGHT FOR YOU?

There are many styles, types and formats of reports. It depends whether you are representing the plaintiff or defense, personal injury or medical malpractice, product liability or toxic tort.  Maybe a little explanation will help you decide.

VERBAL SCREENING OPINION:

·         Assessing whether a case has merit or is defensible.

·         Usually the first service provided by a CLNC©

·         Helps keep non-meritorious cases out of the system.

·         Promotes faster settlement.

·         Cost effective.

Report takes about 90 minutes per page and is given as a 1 page verbal or email opinion.

BRIEF REPORT:

·         1-15 pages long.

·         Often used by defense.

·         Used by Consulting and testifying experts.

·         Narrative and outline format are used most commonly.

On average it takes 90 minutes per page to produce. Report would include: Opening paragraph, services requested and what records were reviewed, bottom line opinion whether meritorious or not and case theme. The body of the report would include a discussion of the facts and opinions with reference to key standards and research. Followed by recommendations for other services or additional records and documents necessary to develop the case.

MODERATE REPORT:

·         16-50 pages.

·         Usually for plaintiff or complicated defense case

·         Used by consulting experts.

·         Format can be narrative, outline, chronological timeline (with or without comment), tables or graph.                                       These reports take on average 90 minutes per page.  The components of these reports could include:

1.       Opening paragraph explaining services requested and a list of documents and records reviewed.

2.       Issues

3.       Bottom line opinion and case theme.

4.       Summary of the case facts and relevant information.

5.       Deviations from and adherences to the standards of care with reference to key standards and research.

6.       Possible defenses.

7.       Injuries sustained and Causation analysis.

8.      Problems with case for plaintiff and defense.

9.       Recommended types of testifying experts.

10.   Recommendations for additional discovery.

11.    Recommendations for additional services, further case development and necessary future action.

12.    Conclusion.

COMPREHENSIVE REPORT:

·         50 pages or more.

·         Primarily used by consulting experts.

·         The format can be narrative, outline, chronological time line and table and graphs. Usually consists of a combination of all of the above.

·         Usually used for complex cases involving death or significant injuries with large volumes of medical records.

               The components of these reports are similar to the moderate report.

DO IME’s REALLY HELP YOUR CASES?

An Independent Medical Examination (IME) is supposed to be an objective assessment of a Client/Victims medical condition, including if treatment is needed, whether permanent impairment is involved and to what degree and ability they are able to work in the future. However, whether the IME is truly objective may depend, in part, how the Doctor is selected. It seems so often these days that these Doctors are “hired guns”.

As a CLNC©, one of the services we offer is to attend IME’s. We are able to make sure the Client/Victim is treated appropriately and with respect. We can assure that the questions asked are applicable to each individual case and that the answers needed are obtained from an objective opinion. I am aware of more than 1 case where the Clients questions were not answered, the questions were inappropriate to her conditions and the answers given by the Client were not the answers written in the report. How was that an accurate objective opinion? Meanwhile the clients claim outcome may be based on that report.

QUESTIONS TO BE ANSWERED IN AN IME:

*  Has the condition been correctly diagnosed?

*  Does the Client/Victim have the condition they claim?

* Did the incident or exposure actually cause the symptoms?

*  Is additional treatment or testing required?

* Will the Client/Victim be able to return to work? If so will there be any restrictions

*  Is there any permanent disability and if so to what extent?

Make sure you’re IME really is an independent medical opinion. Pick the right Doctor and call a CLNC© to assist you every time.

TAMPERING ALERT SIGNALS:

·         Records are MISSING.

·         An Incident or event is NOT documented in the record.

·         Record conflicts with Victims testimony.

·         Different inks were used.

·         Entries that should be by 1 provider show different handwriting.

·         Copies of the record from different sources reveal differences.

·         Late entries or entries out of sequence.

·         Additions are squeezed in or obviously added later

·         Additional pages added after the record completed.

·         Evidence of substitution.

·         Records show erasures, obliterations or scratch-outs.

·         Destruction of original records

·         Major discrepancies in documentation patterns.

·         Notes were dictated weeks or months after the fact.

·         Suspicious entries.

There are a lot of ways that the medical record could have been tampered with and every medical record reviewed should be checked for evidence of tampering.

If tampering is suspected it may require a forensic document examiner or an Electronic Medical Record (EMR) expert.

SNOWMAGEDDON

Well this was a challenging week. 18 inches of snow in The Pacific Northwest is like 6 feet in Denver. We’ve had no power for the last 4 days, it usually goes out when you’re just about to cook dinner, fingers crossed not tonight.

I am so grateful to all those power workers who have been out there in the snow, the wind, the rain, the ice and the freezing dark temperatures to restore one of our vital resources.

I don’t mind the lights being out, it’s so quiet, no appliances humming in the background, the flicker of the candle flames and the heat of a roaring fire. The hard part is having no water as our well pump goes out. We could fire up the generator but they’re so loud and the fumes so strong. We go for the camping style ourselves. Boiling water form the 5 gallon jug to wash your face, the dog goes out to eat snow when she’s thirsty and writing reports for my upcoming deadlines by lantern. You put on a few more layers, snuggle up with loved ones and play some board games you haven’t found the time for in a while.

It’s good to put away the electronics from time to time, appreciate the strength of mother nature and be grateful for one another.

Thank you snowmageddon.

HOW A CERTIFIED LEGAL NURSE CONSULTANTS REPORTS CAN GIVE YOU THE WINNING EDGE TO YOUR CASES:

Whether we are analyzing injuries, damages and their causation or deviations from standards of care a CLNC’s reports can make the medical information available to you clear, concise and from the perspective of a multi-faceted objective.

Your expert MD’s will only look at those records from Physician’s but what about the Nurses, Physical Therapists, Hospital Systems and other Ancillary Staff who may be involved and have an impact on the outcome.

Do you understand those complicated diagnosis? We do and can explain the significance to you as they relate to your case.

What may seem like a slam dunk case may not be when you delve deeper into the relevant medical information about the incident. Was that low blood pressure significant? Did the mechanism of the seat belt  cause the chest injury? Were those lab tests painting a different picture from the admission note in the medical records?

Was there evidence of tampering? Were there staffing issues the day in the Emergency Room? Were pre-existing conditions exacerbated? Were hospital policies and procedures followed?

There is far more to a medical record than just a car accident with resulting injuries or a surgery with bad outcomes.

It could be a verbal screening opinion, brief-moderate report or chronological time line with comments and analysis but what ever fits your need case by case a CLNC’s report can make a huge impact on your business for every medical related case.

CLNC® SERVICES AVAILABLE, SOME MAY BE SURPRISING TO YOU:

 SCREEN/INVESTIGATE CASES FOR MERRITT

Screening is the initial service provided by the CLNC® to assess whether cases have merit or are defensible. Screening is an objective opinion, usually delivered verbally or by email and is expected to take 3-8 hours to complete depending on the complexity of the case.

ASSESS ALLEGED DAMAGES/INJURIES

Identify actual damages/injuries in the case, the significance, potential for recovery, expected outcomes, complications and present level of recovery. 

ASSESS CAUSATION FACTORS CONTRIBUTING TO DAMAGES/INJURIES

Identify factors that may have caused or contributed to the alleged damages/injuries.  Determine variances that indicate that the alleged damages/injuries were not caused by the incident under investigation.

 DEFINE APPLICABLE STANDARDS OF CARE

CLNC®’s will research, obtain and apply the appropriate Standards of care in place at the time of the incident. Standards of care being the measuring tool for determining whether a healthcare provider was negligent in their actions causing a breach of duty.

ASSESS CAUSATION FACTORS CONTRIBUTING TO DAMAGES/INJURIES

Identify factors that may have caused or contributed to the alleged damages/injuries.  Determine variances that indicate that the alleged damages/injuries were not caused by the incident under investigation.

ORGANIZE, TAB AND PAGINATE MEDICAL RECORDS

Medical records can be very confusing, often out of sequence, and difficult to determine the order of care/events. CLNC®’s can organize the medical records for each individual Attorney, tab important events and deviations, creating a better timeline.

DETECT TAMPERING WITHIN MEDICAL RECORDS

The CLNC® is an expert on medical records, and is very aware of the significance of tampering in any case and the alert signals to look for when reviewing every medical record assigned to them.

SUMMARIZE, TRANSLATE & INTERPRET MEDICAL RECORDS-WRITTEN REPORTS

Once all relevant medical records are organized, analyzed, standards of care applied, legal elements investigated and an opinion formed, a report can be written. Reports can be brief, moderate or comprehensive and may be designed in several formats. Some styles of formats include narrative, chronological timeline, summary with comment, outline or chart layout. Each personalized for individual attorney needs and requests.

IDENTIFY POTENTIAL DEFENDANTS

Plaintiff attorney wants to sue all culpable parties before statute of limitations expires and defense has vested interest in knowing who all culpable players are. CLNC®’s can help identify those defendants in a timely manner. 

 LITERATURE SEARCHES, INTEGRATING THESE INTO ANALYSIS

Literature searches may include, specific articles, journals, books, audio-visual, internet or library searches. There are many reasons for medical literature searches including, obtaining factual information, educating attorney or client, locating experts or locating standards of care. These search results can then be included in the final report.

RESEARCH VALIDITY/RELIABILITY OF RESEARCH STUDIES

It is important to verify that any research study being relied upon by all parties is factual and authoritative. A CLNC® can analyze these studies to ensure their validity.

IDENTIFY/REVIEW ALL RELEVANT RECORDS AND TANGIBLE ITEMS· 

  A CLNC® can help identify relevant records, documents and tangible items necessary to the case. These may include medical records, hospital policies and procedures, photographs, rhythm strips, hospital bills etc.

EXPAND ATTORNEYS MEDICAL LIBRARY

A CLNC® can help identify and locate appropriate medical text books, journals or articles to help the attorney increase their knowledge about each specific case and generalized medical terminology and practice.

CONSULT WITH HEALTHCARE PROVIDERS

The CLNC® can help communicate and coordinate during the litigation process with other healthcare providers, including, chiropractors, respiratory and physical therapists, physicians, Nurse practitioners and other members of the medical tea

 IDENTIFY TESTIFYING EXPERTS REQUIRED

A CLNC® can review the medical records and help pin point the types of testifying experts that will be required/suggested for each case.

LOCATE EXPERTS

CLNC®’s can research and locate potential expert witnesses for Attorneys to interview and select for their case needs.

COMMUNICATE WITH POTENTIAL TESTIFYING EXPERTS

The CLNC® can communicate with potential expert witnesses, plaintiff and defense, translate medical terminology and help assess their suitability as a witness.

 ANALYZE AND COMPARE EXPERT WITNESS REPORTS

A CLNC® can examine witness reports from the opposing team and verify accuracy of material, witness suitability and strengthen own litigation teams material.

SERVE AS LIAISON BETWEEN ATTORNEY AND ALL OTHER PARTIES

The CLNC® can be “the go between” between all parties concerned, translating medical information for both Attorney and clients as needed

PREPARE INTERROGATORIES

CLNC®’s can help write up a list of potential interrogatories that have been identified during the medical record screening and /or report writing.

REVIEW AND DRAFT RESPONSES TO LEGAL DOCUMENTS

The CLNC® can assist the Attorney in reviewing the opposing team’s responses to interrogatories, requests for production and requests for admission and help draft answers to discovery requested of them.

ASSIST IN EXHIBITION PREPARATION

The CLNC® can play a vital role in helping prepare demonstrative evidence for deposition or trial. 

 PREPARE DEPOSITION AND TRIAL QUESTIONS

The CLNC® can assist in drafting deposition/trial questions specific to the case

REVIEW, ANALYZE AND SUMMARIZE DEPOSITIONS

The CLNC® can review deposition transcripts of relevant witnesses and experts and prepare a summary 

 ATTEND DEPOSITIONS, TRIALS, ARBITRATION'S AND MEDICAL HEARINGS

The CLNC® can be an invaluable tool at depositions, mock trials, trials, medical examinations, and all forms of alternative dispute resolutions. CLNC®’s can help draft questions, review transcriptions, identify inconsistencies and errors in medical information given and help assess the credibility and effectiveness of an expert.  

HELP PREPARE WITNESSES/EXPERTS FOR DEPOSITION/TRIAL

The CLNC® can assist the attorney in preparing the witnesses/experts for trial, ensuring the material to be included is accurate and up to date for the time of the incident. That the medical information to be given is relevant to the case in hand and is presented in a clear, concise and appropriate manor. 

PREPARE WRITTEN REPORTS FOR STUDY TOOLS USED BY ATTORNEYS

At the time of depositions, trials or ADR’s it is useful to have a “cheat sheet” for attorneys to use in order to ask the appropriate and relevant questions for each individual case. 

COORDINATE/ATTEND INDEPENDENT MEDICAL EXAMINATIONS

A physical, mental or post mortem examination may be needed for many reasons, the CLNC® can assist in coordinating and attending any/all of these to ensure, correct procedure, accuracy, reliability and appropriate information reported by the examiner. 

DEVELOP LIFE CARE PLANS

A person’s future medical needs can be difficult to predict. A CLNC® has the medical expertise to be able to help determine those, often complicated needs and the potential cost associated with them. 

ASSIST IN FOCUS GROUPS AND MOCK TRIALS

A CLNC® can help set up mock trials/focus groups in all the same ways that they can with depositions and trials from start to finish. 

THE CLNC® CONSULTANTS IMPACT ON THE LEGAL SYSTEM

• Represent and speak for the nursing profession.

• Uphold standards of care for the healthcare community and its professionals by identifying meritorious cases and highlighting deviations from recognized and authoritative standards. The outcome is improved quality of care.

• Helping identify fraudulent and non-meritorious claims and help to defend against them or keep them out of the legal system.

• Help to ensure that the legal system uses up to date scientific, medical and nursing information properly and without distortion.

• Provide cost-effective adjuncts to the litigation process.

• Promote justice.

WHY YOU SHOULD CALL A CERTIFIED LEGAL NURSE CONSULTANT TODAY

1.     You have too many cases and not enough qualified help.

2.    Your paralegals need to concentrate on the legal aspects of the case and let the Certified Legal Nurse Consultants concentrate on the medical aspects.

3.    Your nurse paralegals are not experts in the medical aspects of every case and most of them are not clinically active. We have access to over 4,000 CLNC’s® who are experts in every specialty.

4.    We can screen cases very efficiently to keep non meritorious cases from taking up too much of your valuable time.

5.    Your MD experts are very expensive and don’t complete your cases within the necessary time frame.

6.    If you are already using an MD expert we can complement their work and focus on the nursing standards of care.

7.    We can save you time, money and frustration.

No other recipe for medical, legal success

AFTER POLITICS, RELIGION AND MONEY COMES DEATH:

Although Death Salon’s and Cafés are popping up all over the U.S. death is still a conversation rarely heard around the dinner table. According to The Washington Department of Social and Health Services (DSHS), only 37% of Americans have Advanced Directives for end of life care if they become seriously ill or unable to make health care decisions.

As a Hospice Nurse I see on a daily basis the family trauma caused by a lack of end of life planning. Conflicting medical decisions, guardianship battles, divided families, financial concerns and in some cases no family at all. If only we would all make our wants and needs known before it’s too late.

As CLNC’s we can help you determine if your client is of sound mind when there are concerns related to disease progression or medications being taken that may affect mental status. We can help decipher complicated medical histories and explain future options. We can help with life care plans for those who have extensive medical needs. Call today to see how we can help you provide the best solutions for your clients.