From the Trenches

Whom do you invite into the trenches? Some cases require several professionals for the trench work. I am one of the professionals often invited to lend a hand when cases involve medical issues. As a certified legal nurse consultant, my professional experiences are often intellectually challenging and varied. Consider the following:

I recently attended an educational seminar for nurses. During the lunch break, I sat with a table of staff nurses. When they learned that I am also a nurse, they asked me for suggestions regarding a dilemma that they have faced in their daily practice. They wanted my thoughts on how to respond when physicians ask them to use a piece of equipment in a manner contrary to the instructions of the manufacturer. They identified a particular piece of equipment for which they are often instructed to use in a contrary manner. I remember this luncheon discussion as I review cases involving this piece of equipment.

I have been working through the medical records on a case located in a neighboring state. I noticed that the patient received a medication that I know has caused alarm in the local medical community. Several local hospitals have issued temporary moratoriums on the use of this medication. I advised counsel that he may want to verify whether the hospitals in his community had taken similar action during the time at issue in his case.

One of my most amazing experiences involved an internationally recognized expert on amniotic fluid emboli. After long hours of reviewing medical records, research and preparation of a medical chronology, I had identified the appropriate physician to review the case. My client had requested a nationally recognized expert due to the complicated medical issues and the case's high dollar value. I sent the expert three large volumes of carefully organized medical records and a medical chronology by overnight mail. I received a telephone call from this expert two days later. To my astonishment, he had completed his work and was ready to discuss his opinion. With a note of wonder in my voice, I asked the expert how he had completed his review in such a short amount of time. He laughed and said, 'If only you could see some of the records I receive. You wouldn't believe what some folks send me or how long it can take me to make some sense out of the chaos.' To my amazement, he told me that he had never reviewed a case that had been as well organized or clearly presented (via the medical chronology).

Some cases require determination and a dedication to detail. One of my current cases arrived in a large box of assorted medical records from several nursing homes and hospitals. The records had been produced by the opposing counsel and appeared to have been sorted by the wind. With years of reviewing medical records plus an understanding of the types of records to anticipate, I was able to organize the box of records into volumes representing four distinct facility admissions. The volumes are being paginated, tabbed and bound. I will soon have a workable set of records and can move on to my client's first request: a set of proposed questions for upcoming staff interviews.

I received a call from a frustrated client last spring. Her repeated efforts to locate a physician expert in a nearby community to review her case had received a chilly reception. As soon as my client identified herself as an attorney, she had noticed that the temperature of the telephone receiver dropped several degrees. She asked if I could try to speak with some of the physicians. I called my client's first choice and carefully explained who I was and why I wanted to speak with the physician. As I listened, I could hear the receptionist put down the phone and call out: 'It's some kinda nurse and she wants to talk with Dr. X.' Shortly thereafter, I did.

I am 'some kinda nurse.' I am a certified legal nurse consultant (LNCC, Legal Nurse Consultant Certified). I am a registered nurse involved in a specialty practice. I apply my health science education and clinical expertise to the medical issues in a variety of cases and claims. Sometimes I am an interpreter, explaining the language, expectations and culture of a foreign system. Sometimes I am a medical sleuth searching for the physiological clues that might have been factors in a case outcome (Could he have been dehydrated at admission? What was his specific gravity?). My clients work in the legal, insurance, healthcare, risk management and workers' compensation systems. My LNCC colleagues can be found in a variety of settings, including law firms, independent practice, insurance companies, TPAs, risk management departments and government offices.

LNCCs contribute in a variety of ways. In addition to the examples described in my anecdotes, LNCCs: assist in evaluating the merits of a case, identify issues related to standards of care, causation and damages, interview clients and other individuals, conduct research and summarize medical literature, identify and prepare trial exhibits, assist with depositions and trials, prepare life care plans, provide medical/legal education to healthcare providers and much more.

As an LNCC, my clients are assured that I have met specific criteria regarding education, knowledge and experience as both a registered nurse and legal nurse consultant. The specialty practice of nursing (there are a number of nursing specialty practices, with legal nurse consulting being one) is similar to the specialty practice of physicians. A physician may receive a specialist certification by a member board of the American Board of Medical Specialties (ABMS) after they have met educational standards and successfully completed comprehensive examinations which assess knowledge, skill and experience. The LNCC certification program of the American Legal Nurse Consultant Certification Board (ALNCCB) is accredited by the American Board of Nursing Specialties (ABNS).

The LNCC credential is an indicator of experience and knowledge. It serves as an assurance that the nurse specialist is a skilled professional. Some cases require several professionals in the trench. When my clients contact me or any of my LNCC colleagues, they know they can rely on the nurse specialist in their trench. +

ABOUT THE AUTHOR

Peggy Woodward, JD, BSN, RN, LNCC, is a member of the Oregon State Bar, a registered nurse and a certified legal nurse consultant. She is vice president of The Medical Resource Network Inc., a local legal nurse consulting business. Woodward is a member of the American Legal Nurse Consultant Certification Board.

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