January 2009

My family is pretty competitive. It started with dad beating us out of our lunch money at cards. And, having an athletic twin brother also raised the competition in the family sports department.

During this year’s Great Christmas Migration, we renewed one of our oldest family traditions. Instead of staying inside and watching a bowl game we grabbed a football and created our own bowl – one we call the “Red Beans and Rice Bowl.” We headed outside to play a mean game of “touch football.”

Don’t let the name fool you though – in my family, it’s touch in name only – we treat it pretty much like a full contact sport. Plus, we play football in the street, not on some wussy, grass-covered soft field. Traffic stops while the ball is in play. Gutters form the sidelines, parked cars and curbs become obstacles or advantages.

This was our first family game of football in almost six years – our last ended when my older sister, Karen, tried to throw a cross-body block on a community mailbox (you know – those big ones with about 20 boxes) resulting in no visible destruction of federal property but some very visible bruises and a squashed ball.

It was great to have the family together – my twin Vince, sister Karen, her husband and their sons, our two twenty-something nephews Josh and Matt, Tom and I, all tying on our sneakers and ready to go. Even my dad, Sal, came out to officiate (for a while anyway). We squared off – the three Milazzo siblings versus the guys – Tom, Rick, Josh and Matt. As I said, Vince is the real athlete in the family. I like to tease him that as children, while I read business books he played with his balls. We thought that having Vince on our team would make it fair – three of us versus the four of them.

Vickie and Vince

Karen, Vince and Vickie

The game started and we realized that the last six years hadn’t been exactly kind. Before long, one of us was limping from two torn tendons (he’s currently recovering from surgery), one was holding her hip and two were huffing and puffing from the running (the twenty-somethings). It seemed prudent to periodically stop to let some of the traffic go by, so we could all catch our breath. We weren’t dashing as far (or as fast) for the long passes and the passes weren’t even that long! The twenty-somethings did learn it can be pretty hard to catch someone twice their age any time they went after Vince. They also learned it can be quite easy each time they went after Karen or me. The ball changed hands and we were scoreless until finally Tom beat me in the backfield, making a shoestring catch (stoically thrown by Rick, playing through the pain of his torn tendons) and the only score of the day (he scored again later, too).

Sal immediately declared the game over and we all headed for the house for a cup of healthy green tea (who am I kidding? – cold beers). One of us crawled, one limped and one we had to drag. We were bruised, battered and broken but we were all glowing because we’d gotten out and done it. Even Sal was glowing. Of course, the pot of red beans and rice waiting for us inside added to that glow.

The survivors (sort of) – Rick, Karen, Joshua, Vickie and Vince

We had some great family fun and we did it at our speed. What did I learn that day (other than I still can’t outrun my brother)? An important lesson – you’re never too old to get out and play – even if you have to go a little slower. Sometimes you’ve got to limp to the attorney’s office. Sometimes you’re going to be making a shoestring catch, but no matter what you’ve got to go all the way in your legal nurse consulting business. Enjoy your own Super Bowl^®.

See you in the end zone!

Vickie

For Christmas, I got a terrific present from one of the least likely persons you’d expect. No, not our CPA, but our intellectual property attorney. He settled an intellectual property dispute on behalf of Vickie Milazzo Institute.

I make my living working with litigators. So do Certified Legal Nurse Consultants. We’re all aware of the high cost of litigation, both monetarily and emotionally. That’s why when our attorney was able to settle this case without the necessity of filing a suit, I was surprised and grateful. Potential defendants don’t often come to the table that easily.

Over the past 27 years, I’ve worked hard to create a body of intellectual property. Over those same 27 years, I’ve had to deal with copyright infringement that’s run from the minor lists and jokes to mind-boggling, outrageous plagiarism. When you see one of your creations copied so closely that it includes one of your typos, you’ve got the other party dead to rights. I could point to several examples that are being remedied right now, if our attorney would let me. I’ve never understood people who would try to take a short-cut up the ladder of success by climbing up someone else’s back. I don’t mind honest competition. I just want them to use their own original thoughts – instead of using mine.

There’s a great quote by Denis Waitley to the effect that “A life lived with integrity – even if it lacks the trappings of fame and fortune is a shining star in whose light others may follow in the years to come.”

Thankfully, the Certified Legal Nurse Consultant graduates of the Institute are some of our best police. You all are the best at helping us spot copyright issues. Thank you for your support over the last 27 years.

Success Is Inside!

A lot is being said now about the newest form of laptops – the netbook. Laptops were originally designed to be semi-lightweight, portable computers that a legal nurse consultant could easily carry from home to the medical library, to work, to wherever. Soon form was forgotten and notebooks became larger, more powerful and screens became wider. Before long, laptops were “desktop” replacements and almost as heavy to carry.

My old Compaq laptop had such a small form factor that I could easily open it on an airplane and work even if the hospital administrator slacker in front of me decided to crank his seat all the way back and sleep on the flight from Poughkeepsie to Sioux City. My new Dell hardly fits on the seat tray and Vickie has to belt my elbows to my waistline before I can type. Sure I’m envious of your Apple^® MacBook^®, but I can’t wait to see you try and open it up while seated next to me in steerage.

Netbooks and mini-notebooks are the backlash. These are tiny laptops usually weighing under three pounds with 10-inch screens, Windows^® XP and Microsoft^® Works (Linux and OpenOffice, if you’re daring), a relatively small hard drive, 80 GB or so, or a 40GB SSD (solid state drive), 1GB of RAM and a 1.6-GHz Intel Atom processor. They are priced at just over $400. That sounds like a pretty good deal – but is it? Sure, it is a computer but they’re not designed to be used by a hard-working, multi-tasking Certified Legal Nurse Consultant. These are designed with one purpose in mind – portability.

They’re great if all you want to do is surf the web. You can do research for your legal nurse consulting business, stay in touch with your attorney-clients via email and maybe do a little word processing (such as drafting that report at the library or taking notes while interviewing a potential plaintiff). Do not, however, expect much performance from one of these. They’re better than trying to surf the Internet on a smart phone, but don’t try to edit photos, include graphics in a report or render a report into a PDF. Netbooks generally do those tasks – but you’ll spend a long time watching the onscreen hourglass. And, if you’ve got big hands or thick fingers, the tiny keyboard will make you crazy. You may also need to consider an external CD/DVD drive if you plan on installing software other than what’s preinstalled.

But, you can tuck the netbook in a backpack or purse and travel fast and loose. We have an old Fujitsu P-series Lifebook (yeah – it’s old and slow) that’s about the same size and weight as a netbook that we carry on vacation. With my Verizon Wireless Internet card or the hotel’s wireless, it keeps me on the Web, in the know and weighs a little over three pounds (and it’s paid for).

If you’re considering a netbook purchase, here’s some basic specs:

• Windows^® XP.
• 80-120 GB hard drive (not solid state) running at 5,400 rpm or higher.
• 1-1.5 GB of RAM.
• Largest keyboard supplied by that maker (92% is great!)
• Built in Wi-Fi card (802.11b/g) and an 10/100 Fast Ethernet jack.
• 6-cell battery, if you’ll be traveling or using your netbook away from your office.
• Built-in speakers.
• VGA-out so you can plug in an external monitor at home.
• Two or more USB inputs/jacks (one for your USB hub at home).
• Microsoft^® Works with the Office 2007 Compatibility Pack.
• Norton or MacAfee Internet security software.

If you have money for just one computer this year – buy yourself a full-fledged notebook as a desktop replacement and skip the netbook. Then get yourself a dock and all the other stuff discussed in my earlier Tuesday Tech Tip Extend Yourself with a Hub, published December 23, 2008. You’ll have a better experience and get more out of it.

If you have the money and the need to buy yourself a $400 convenience – consider a netbook. It’s a convenience you won’t regret.

Keep on techin’,

Tom

A headline in the January 8, 2009, issue of The Wall Street Journal “Hospital Scrubs Are a Germy, Deadly Mess,” caught my eye. The article discusses how hospital scrubs and other garments carry infection, not only around the hospital but outside it too.

A headline in the December 2008 issue of Lawyers USA reads “Hospitals Face Infection Suits.” This article covers, guess what, the increased number of infection suits facing hospitals.

The Center for Medicare and Medicaid Services (CMS) adds certain SSIs and other infections to its list of nonreimbursible “Never Events.”

And, can you guess what the cover article is in the January 2009 issue of Nursing Management (the journal of excellence in nursing leadership)? It’s an article discussing the debate over nursing uniform colors, combinations and identity (as well as patient preference and perception).

Give me a break. I don’t care what you wear as long as you’re not killing me with it. I cannot stand to see a doctor, nurse or even someone who’s probably a med-tec standing around my local Starbucks in their scrubs. Even worse –
a healthcare provider in scrubs or lab coat fondling the veggies in my local supermarket. I can’t assume she’s taking that cucumber to work, so I’m guessing she’s just spreading germs on her way home.

The CDC estimates that more than 2,000,000 hospital-acquired infections result in over 90,000 deaths. What about the civilians who are being infected outside of the hospital? Talk about an issue ripe for Certified Legal Nurse Consultants – I feel like a pig at a feeding trough.

When I entered nursing the color was white (the color of purity). Nurses wore clean white uniforms. We shined our shoes (not “Crocs”) and yes, even wore (anyone remember this?) caps. What’s the point? We looked clean, we were clean and you didn’t see a nurse in white outside the hospital. I constantly tell Tom those nurses you see collecting money outside the mall AREN’T REALLY NURSES.

Today, we’ve got multiple piercings, exposed midriffs and our choice of uniform – if you can call it that. I call some of it inappropriate wear.

I’m not calling to revert back to aprons (although they are being tried in Britain). But I am asking that hospitals go back to laundering scrubs and not allowing them out of the hospital.

The same nurse who won’t touch the door handle in the restroom thinks nothing of wearing those Ebola-ridden scrubs when she picks up her kids to hug them.

Study after study shows that where docs and nurses go infection follows. Why aren’t our nursing executives discussing a real issue – infection, disease and death – instead of the colors of our scrubs? You tell me. And, if you’re one of the offenders, stay out of my neighborhood Denny’s.

Success Is Inside!

Thanks to all of you who joined Vickie and me at my surprise birthday party Saturday night. Today’s really my birthday but to get 80 adults and miscellaneous children to stay out until the wee hours on a work night is pretty hard, so she planned it for January 17, the Saturday before.

Did I mention it was a surprise party? I really mean SURPRISE party. I had no idea whatsoever that Vickie had schemed, plotted and planned (not to mention gone wine tasting during a workday) for so long with so many to pull off my surprise.

Special shout-outs to those who were kind enough to come in from out of town, the two who ran in the Houston Marathon the next morning and to someone who had to work Sunday (I hope that sermon came out well). Thanks too, for those who came from all over town, arranged sitters, etc. I was, and am, overwhelmed by your generosity (and don’t get me started on the gifts).

For those of you who know Vickie, the party didn’t just end Saturday (well, really Sunday) – she kept it going for the better part of Sunday and even Monday. I think I’m the luckiest guy in the world (now that the headache is gone and Vickie moved the recycle bin full of wine bottles into the neighbor’s yard).

I hope to see you all there again next year, in the same place, for even more fun.

Tom

Whether you are screening medical malpractice cases for plaintiff or defense, as a Certified Legal Nurse Consultant, you should be on the lookout for those obvious meritorious cases. When you see them, the red flags go up as long as there is significant injury or death. For example, maternal death gets everyone’s attention. The plaintiff CLNC^® consultant’s response is – this is one the plaintiff attorney should absolutely represent. The defense CLNC^® consultant’s initial response is – the defense should settle and settle fast.

Plaintiff attorneys usually want to see significant injuries, even in obvious cases of medical malpractice. They have to weigh the cost of litigation against the return. They must consider if it makes sense. They don’t want to spend $150,000 to win back $250,000.

The Centers for Medicare and Medicaid Services (CMS) recently made it so easy for plaintiff attorneys to successfully litigate 13 types of medical malpractice cases that plaintiff attorneys may be more willing to take on these 13, even if the damages do not meet their usual expected criteria.

To start at the beginning, the National Quality Forum (NQF) endorses a list of 27 serious, preventable and reportable “Never Events.” CMS, issued a ruling last year, effective October 1, 2008: CMS would no longer reimburse for 10 selected “Never Events” – events that should never happen and which are clearly caused by the hospital and/or its staff. Then, effective January 15, 2009, CMS issued another ruling adding three additional, surgery-related “Never Events.” In other words, CMS is trying to save lives by saving money.

Cases involving “Never Events” account, according to AON, for a large percentage (12.2% or more) of medical malpractice claims and will be difficult to defend and easy for the plaintiff attorney to settle fast, thus reducing their litigation costs. Insurance companies will fear taking these cases to trial and losing at great expense. They can settle out of court cheaper.

“Never Eventland” provides the perfect playground for a law firm’s new, young and inexperienced associate attorneys to practice on.

Add these 13 CMS “Never Events” to your “Plaintiff Alert Signal” list.

1. Unintentional retention of a foreign object after surgery.
2. Air embolism.
3. Blood incompatibility.
4. Pressure ulcers (Stages III and IV).
5. Hospital-acquired injuries from falls and certain traumas (fracture, dislocation, intracranial injury, crushing injury, burns and/or electric shocks).
6. Manifestations of poor glycemic control.
7. Catheter-associated urinary tract infections (UTI).
8. Vascular catheter-associated infection.
9. Deep vein thrombosis (DVT) or pulmonary embolism following total knee replacement and hip replacement procedures.
10. Surgical-site infections following certain orthopedic procedures, mediastinitis following coronary artery bypass graft (CABG) and/or following bariatric surgery for obesity.
11. Surgery on the wrong body part.
12. Surgery on the wrong patient.
13. Wrong surgery performed on a patient.

Educate your attorney-clients about “Never Events.” Offer to do a 20-minute presentation for all of the attorneys in the law firm. Even with attorneys, small wins are good.

Success Is Inside!

Dear President Obama,

Congratulations on becoming the 44th president of the United States. Americans have hired you to manage our country and to fix the economic crisis you have inherited. To accomplish this, you need to act like an entrepreneur – not a politician. Entrepreneurs thrive on crisis, knowing that from the center of it huge opportunities arise for growth and profit.

Break the Succession of Bad Ideas

Entrepreneurs witness their executive managers clinging to their ideas – even bad ones. Once ideas are entrenched it is painful to shake free of them, no matter how harmful they may be to the business. I have had to compel executives to abandon projects in which we invested thousands of dollars and uncountable hours. It is a dirty deed, but it is my job to lead the company in the right direction. Your job, like mine, is to recognize and break the succession of bad ideas.

To right the economy, I recommend you start with the worst idea of all – the bloated, loophole-ridden Tax Code that is unintelligible to even the most expert tax preparers, the IRS itself and especially the small business owner. Just keeping up with my equipment depreciation schedule gives me a migraine. On top of that, thinking about the amount of tax I owe on inventory I haven’t sold, and on accrued income from installment payments I haven’t yet collected, plus the reporting and compliance requirements makes me wonder why I got into business in the first place. Entrepreneurship, like the presidency, is not for the faint of heart. Fortunately for the twenty-five people I employ and the Certified Legal Nurse Consultants I service, my entrepreneurial spirit forges on.

Business cannot thrive on outdated systems, nor can successful entrepreneurs afford to make business more complex than it needs to be. To repair the economy, apply the entrepreneurial art of simplicity by eradicating the Tax Code. Replace it with a simple national sales tax, and eliminate all other taxes, including corporate and individual income, payroll, capital gains and estate taxes. This would wipe out layers of bureaucracy and save taxpayers billions of dollars. Give refunds back to lower income families to keep them whole.

Don’t Stifle Ambition

Americans are greedy and that’s not all bad. Entrepreneurs are too. The desire for more and better drives us to innovate, making us the strongest country in the world. Give entrepreneurs their credit back so that they can focus on what they do best – create jobs, generate income and stimulate the economy.

Aspiring and active business owners who have great credit histories are being denied the credit they need to launch and grow businesses. This unavailability of credit is crippling innovation and productivity. America cannot afford to drive entrepreneurs out of business. Small businesses and the people they employ cannot wait six to twelve months for a trickle of credit.

Give some of that bailout money to the entities that are making loans and make sure that it is used towards affordable loans for entrepreneurs with strong business plans and good credit. Small business creates more jobs than any other sector of the economy. Americans will feel safe to go shopping, buy a new car or invest in a home when the companies they work for are flourishing again.

Stop the Stealing

Americans expect to pay taxes, but we are no longer willing to bankroll the government’s mismanagement and self-interest. It is time to stop the stealing – the excessive, irresponsible spending and ever-increasing federal budgets. Do not make a commodity of the American people who struggle to buy groceries and pump gas. Take the pork away from the pigs.

Entrepreneurs all over America are slashing their budgets by as much as 30% to stay profitable. At my company, if a project cannot justify its budget, it is gone. We budget for results – not for a bigger budget the next year. It is time to skip the buzzwords and feel-good phrases. Americans have heard the rhetoric, now we want results. Prove that you can run our government as lean and clean as a successful entrepreneurial business.

Today when you take office, implement a plan to assure the bailout is handled responsibly and with accountability. The kind of behavior that occurred in the lending industry would never have been tolerated or even possible in a small business. Make sure that individuals benefit from the bailout – not just the companies that created the problems. Use the money for what it was intended for and don’t dilute it with unintended uses and handouts to companies on the fringes of the issue.

Every Act Counts

You have brought hope and inspiration back to the people of the United States. You have four years until your first real performance evaluation. That is a luxury few entrepreneurs enjoy. Even so, you have a responsibility to act quickly and decisively. Make every act count. Then we’ll decide whether or not you get to keep your job as head of the most important business in the world.

Vickie L. Milazzo, RN, MSN, JD

Important events in DC are occupying my attention today. If you want, you can click over to CNN.com and watch the inauguration coverage. Or, you can read last week’s Tech Tip! Look for my Tuesday Tech Tip on Netbook or Notebook next Tuesday, January 27, 2009.

About an hour after the photos below were taken, just a block from my home, the street was filled with runners from the Houston Marathon. Over 23,000 participants showed up to run. Some finished in just over two hours while others were still running (or had dropped out) when the six-hour time limit expired.

Before the marathon

Here’s a picture of the front runners at the half way point including the winner, Deriba Merga who collected $45,000 for finishing the marathon in a record time of 2:07:52 beating the previous men’s record of 2:10:04.

You may remember him from the 2008 Olympics marathon. Deriba entered the tunnel of the Bird’s Nest stadium in third place, 50 meters ahead of his Ethiopian teammate, Tsegaye Kebede.

Tom and I were at a friend’s house watching the race. As Deriba came into the stadium I said, “He’s not going to get the medal.” Tom asked “How do you know?” and I pointed out how Deriba was struggling. Sure enough in the last 400 meters, Tsegaye passed him and Deriba finished fourth. It was tragic to watch a world-class runner fade before your eyes and everyone else’s in the Bird’s Nest that day, and be overtaken with the finish line in view.

What does running a marathon have to do with being a Certified Legal Nurse Consultant? In marathons, like business, you have to pace yourself. If you shoot off the starting line too fast, you’ll lose steam and won’t have the energy to finish the race.

The big difference between marathons and legal nurse consulting (all that running for 26+ miles aside) is that in business, there is no finish line. You must keep your pace as long as you want to keep your business. This means that sometimes you run slowly, sometimes you sprint and sometimes you stop and catch your breath. The trick for each of us is to find our pace and keep it. Knowing my pace and sticking to it are two of the reasons I’ve stayed in the legal nurse consulting business since 1982 and the biggest reason I still love my business after 27 years.

I’ve seen legal nurse consultants who start their business full of fire. They market themselves at a sprinter’s pace and then suddenly get tired and quit. Others plug successfully away, day after day after day. Business can be like a Venti^® Peppermint Mocha Twist Frappucinno^® from Starbucks^®. Those 660 calories and 116 grams of carbs (not to mention the 55 mg of caffeine) fire you up and set you off at a sprint. Soon though, you’re in a carb-sag and need a nap. It’s hard to keep the fire burning on artificial stimulants.

For the first week of January our gym, where I’ve been a member for 20 years, is full of newcomers throwing weights around like Arnold and nearly flying off the treadmills and elliptical trainers. By the second week in January, the gym’s back to normal because those newcomers went at it a little too hard at first, got stiff and sore and lost their steam for the long term. I see this in yoga (stretched a little too vigorously the first day back) and in dieting (after a week of steamed broccoli and turkey, a hamburger sounds really good).

Your personal life and your business life are like marathons. The key is to manage the pace at which you run them. You need to pace yourself to maintain your energy level for the long run. For my business, sometimes I go fast, sometimes I go faster and sometimes I stop and smell the sneakers. I do take 12 weeks off each year for renewal time. But even on vacation I keep a certain pace – exercise, diet and sleep. That’s what gives me the energy to keep me in business. Are you running at a pace that will keep you successful in your CLNC^® business or will your pace put you out of business before the finish line?

See you at the CLNC^® finish line!

Read Part 1. Read Part 2.

How has your income level changed in this economy?

Dale: Vickie, I’m proud to say that last year I was a little ahead with my legal nurse consulting business compared to the prior year – which is saying something when so many other types of businesses experienced a downturn. I’m going to be away for most of January, on a trip to East Africa. People are amazed that I can afford to leave my business during this economy.

Every attorney I have a case with or who I am on the verge of getting a case from will have a contact number to call me directly, if I’m needed. I also have someone for them to call if they need a live body to take care of something while I’m gone. And I’ll be in contact with everyone by email. I’ll never disappear so that a client can’t find me, which gives them a level of comfort yet doesn’t keep me anchored to my desk. That’s one of the joys of being a CLNC^® consultant.

Do you still love being a Certified Legal Nurse Consultant as much as you did in the beginning?

Dale: More. I’m 60 years old and I can’t imagine ever retiring. Every case is different. Every situation is different. People often ask me what a typical day is like. There isn’t one – and that’s what I love about what I do. I feel like Columbo putting the pieces together in a puzzle that deserves my special kind of CLNC^® expertise, and it’s fun.

I think being a CLNC^® consultant is the best of all worlds for RNs. We get to use our nursing experience and expertise, we get to use our brains and we also get to be independent. We interact with people who appreciate us – working with attorneys is much better than working with physicians. Attorneys think we’re terrific.

Any CLNC^® consultant who is feeling bombarded by bad news in the media should just ignore the economy and keep doing what they’ve been taught by Vickie Milazzo Institute. The legal nurse business is out there, perhaps more than ever before. Attorneys need us, perhaps more than ever. Keep marketing, keep the lines of communication open and you’ll get where you want to be.

Success Is Inside!