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 August 25, 2002 Hospital Rigors Push Some Nurses Into Legal Consulting Texas firm builds $6 million business preparing RNs for second careers as entrepreneurs who assist lawyers in medical cases. By Judith VandeWater  OUSTON -- After a 12-hour shift on an understaffed hospital unit, a middle-aged nurse with an aching back and a 30-year mortgage might long for a career change.If she's looking for a way to use her health-care knowledge, to make more money and to avoid working another weekend, Vickie L. Milazzo has a business opportunity for her: medical legal consulting. Milazzo, a registered nurse with a Texas law license, has built a $6 million continuing-education company by preparing nurses for second careers as entrepreneurs. Her company, Medical-Legal Consulting Institute Inc., offers seminars, videos, tapes and mentors to train and to support nurses who assist lawyers in medical-malpractice, personal-injury, products-liability and toxic-tort cases. She was in St. Louis last week leading 166 registered nurses from 32 states through a six-day seminar at the Marriott Pavilion Downtown. As experts warn that quality patient care is threatened by a national nursing shortage, the medical-malpractice industry is attracting nurses who have become disenchanted with hospital jobs. Plaintiff and defense lawyers hire registered nurses to comb through medical records to determine if mistakes in care were made. Because good medicine can produce unintended consequences, a bad treatment outcome is not proof of malpractice. Legal nurse consultants are charged with differentiating between standard medical practices that result in bad outcomes and mistakes caused by callousness or by lack of reasonable knowledge. No central registry exists for legal nurse consultants, so no way exists to determine how many of them practice across the country. But lawyers and nurses say the use of legal nurse consultants is widespread. Candor, not comfort David Zevan, a St. Louis malpractice attorney, said every lawyer involved in malpractice litigation is likely to use a nurse or a medical expert to screen or to build cases. Zevan, who represents plaintiffs in suits against doctors and hospitals, said he and two associates employ a full-time nurse to translate medical records into laymen's terms and to offer insight into what might have gone on or gone wrong with a client's care. "These are very difficult cases to put together. I want someone who has been in the trenches to tell me what the doctor was thinking and what the nurse was thinking," Zevan said. "In the vast majority of cases we look at, it's not malpractice. But we're always dealing with a tragedy," he said. "The people who come here have suffered tremendous loss, and nobody is talking to them about what happened. They say, 'If this is malpractice, I don't want it to happen to somebody else.'" Zevan wants an objective nurse to tell him what is not malpractice rather than what is. Caregivers tend to be people pleasers, but Milazzo tells her students that as legal nurse consultants, they are being paid for candor, not comfort. Malpractice lawyers work on contingency, and they want to know upfront which cases are frivolous and which are winnable. She tells her students that nurse consultants should leave the legal judgments to lawyers and should confine their observations to deviations from accepted standards of care. "We are talking about nursing practices here." Milazzo, 48, pioneered the field of medical legal consulting when she began teaching seminars 17 years ago. Since, a number of competitors have entered the market. At her seminar in St. Louis last week, nurses paid about $1,900 tuition for the basic course that culminated in a certification exam. The certification isn't recognized by any state licensing boards, Milazzo said, but it carries credibility with lawyers. She said about 4,400 nurses hold active certifications from her Houston company. A certificate doesn't transform a nurse into a businessperson. Professional caregivers might need continued support as they cold-call and network to build a client base. Seminar graduates are entitled to one free phone consultation a month through Medical-Legal Consulting. They can use it to get a pep talk, marketing tips or technical advice on a case. Those who prefer more guidance can buy a $3,500 executive-level membership that includes two consultations a month, and a $5,000 membership offers unlimited consultations. The premium memberships come with videos and support materials. St. Louis registered nurse Patsy Howard, 53, was certified as a legal nurse consultant by Medical-Legal Consulting in 1994. She began building her business while still working as a home-care nurse. The first year was slow: She got two or three assignments a month and logged five to eight hours per case. About four years ago, she took a full-time job with Brent Baldwin, a malpractice defense attorney with Lathrop & Gage. "I am treated as a professional, with respect. Many times, I wasn't as a nurse," Howard said. She misses patient care but believes that nurses are the undervalued workhorses of health care. "Nurses have to be innovative, intelligent, flexible and physically strong, yet they are not considered worth paying well," she said. "A lot of times, you can go anywhere else and get paid two times as much for 9-to-5 work." "We can do anything" Milazzo's message to nurses is that it's OK to be self-promoting, self-rewarding and successful. She leads her audience in a rallying cry: "We are nurses, and we can do anything." Most people in the St. Louis audience appeared to be in their late 30s to mid-50s -- a life stage where the physical demands of nursing can begin to take a toll. The average age of a registered nurse in 2000 was 45 in Missouri and 46 in Illinois. Nursing is a profession dominated by women, and the seminar audience -- six men and 160 women -- reflected that demographic. Milazzo said nurses in their 40s and 50s came of age before many careers opened to women. They need support and encouragement to take risks in middle age. Her brochures exhort them to "transform your nursing experience into a money-making adventure." Legal nurse consultants generally charge $75 to $150 an hour, Milazzo said. By comparison, surveys put the range of hospital RN salaries in St. Louis between $14.50 and $30 an hour, with the average being $21.20. Milazzo said her seminars are beginning to attract younger nurses who are disillusioned with hospital working conditions that don't support the level of patient care they want to give. "The younger nurses are sharp, they know what they want and, when they find themselves in a situation they are unhappy with, they make changes," she said. Copyright 2002 St. Louis Post-Dispatch |
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