June 2009

People, including my 85-year-old father, who suffer from aberrant heart rhythms received a shock (literally) last year when Medtronic, manufacturer of the Sprint Fidelis leads used to connect electronic defibrillators to their hearts, were malfunctioning at rates higher than those of other leads. The leads were later pulled from the market, but were not pulled from the recipients. Depending on who you believe, anywhere from 87.9%-94.3% of the leads are still functioning in patients. Many of the recalled electronic defibrillators cannot be changed or removed without a risk of harm to the patient.

Earlier this May, the Heart Rhythm Society, a heart-doctor group representing MDs who implant and extract defibrillators and their associated leads, issued policy statements calling for hospitals to better police the experience and training of the surgeons who extract defibrillator leads. They also issued a statement calling for companies that produce the leads to do a better job of tracking their performance once they’re on the market.

A Certified Legal Nurse Consultant participating in a case where there’s suspicion of a malfunctioning cardiac defibrillator, its leads or an injury that occurred while the leads were being removed, should look closely at the experience of the doctor who connected or extracted the leads. While the new guidelines have yet to take effect, the training and experience may be relevant to the injury. Defense Certified Legal Nurse Consultants may be able to raise the level of experience in the defense of the doctor while plaintiff-side CLNC^® consultants will raise lack of experience as evidence of negligence.

The medical-device manufacturers never fail to shock me!

Success Is Inside!

My most memorable case occurred when I testified for the very first time. I had been a Certified Legal Nurse Consultant for about a year. The case was a will contest. The client was the daughter of an elderly woman who had passed away in a skilled facility. About 72 hours prior to her death, the son (the client’s brother) had the will altered so that he would inherit most of the estate. The changes to the will were made by an attorney. The son then took the will to the facility and had his mother sign it with a notary (a friend of his) present and another witness (his sister-in-law). The estate was worth around $1,000,000.00.

My attorney-client hired me to review the medical records to search for evidence that the deceased was under undue influence when she signed the second will (based on the records and that 72-hour window). I reviewed the records and prepared my report. I found the mother was confused, too weak to hold a pen by herself, under the influence of strong sedating medications and hypoxic.

My attorney-client decided that his case depended on my assessment of the mother and her mental state during the time of the second will signing based on my findings in the medical records. I was called to testify. I was nervous so I rehearsed the night before.

There was a jury present to hear the case. The opposing attorney, of course, tried to tear me apart but I looked at the jury and relayed facts from my report in terms they could understand. He could not trip me up no matter how hard he tried. I testified that when the mother signed the second will, she had low oxygen saturations in the 70s and 80s with use of supplemental oxygen (the patient was a DNR by her choice). The impact of hypoxia on the brain, the effects of large doses of morphine and Ativan IV in regards to sensorium, the fact she had to be fed as she could not hold a fork or spoon and probably not a pen on her own, and the nursing and rehab staff repeatedly charted the patient was confused and disoriented painted a picture of her mental state. I also pointed out the doctor who testified earlier that the client was alert and oriented was not the doctor who had seen her last based on the signatures in the chart. Furthermore no physician had assessed her during the 24 hours prior to her signing the second will. Thus, the testifying physician, although he was the PCP, would not have had first hand knowledge of her mental status at the time in question as did the nursing staff and rehab staff who actually assessed her during the time frame in question.

The final question that the opposing attorney asked was, “How much does Mr. M. pay you for your services?” I answered his question and he then said, snickering with a smug look on his face, “That is a little steep, don’t you think, for a nurse?” I started to reply and he cut me off. I looked up at the judge and asked calmly if I could answer the question. The judge told me to go ahead. I proceeded to tell the attorney that I had 24 years of nursing experience and had taken care of hundreds of dying patients. I explained what a CLNC^® consultant does and how I received my training, and I offered to give the opposing attorney my contact information. The jury was smiling at me. I then left the court room.

Later that evening I received a phone call from my attorney. He said, “You were fantastic, we won. The jury said your testimony sealed the case in our favor. By the way, on my way out, I patted Rob (the opposing attorney) on the shoulder and told him that is why I pay your consulting fee. He wasn’t laughing anymore, but fuming mad.” The daughter received her half of the estate as directed in the original will and the court determined the mother was not competent and was under undue influence when she signed the second will thus it was null and void. I have since worked for the opposing attorney.

P.S. Please comment and share your most memorable CLNC^® case.

Guest Blogger Profile

Stephanie D. Stanley, RN, CLNC owns SDS Legal Nurse Consulting Services, LLC in Virginia. Stephanie consults with attorneys on a variety of medical-related cases.

People often compliment me and tell me what a great memory I have. While my memory’s respectable, what’s even better is my note-taking prowess. That’s my real secret. I am a voracious note taker in every business situation.

One executive at Vickie Milazzo Institute boils it down to, “The person with the best notes wins.” With that thought in mind, I not only always have a legal pad and pen handy, but also a stack of sticky notes, even in the most informal of meetings. They serve as my external memory, one that doesn’t get erased by sleep, an office crisis or a box of hot glazed donuts.

Have you noticed that as a society we are becoming less skilled at listening? As a legal nurse consultant you can’t afford to be or risk becoming a poor listener.

When you’re talking with an attorney, they must be the center of your attention and you should appear smart and “all in” the conversation. Think about the last time you were talking to someone who was looking past you over your shoulder, checking her Blackberry or appeared to be day-dreaming. Remember how you felt? That’s exactly how the attorney-client will feel – unimportant – if you appear to not be “all in.” You also risk missing a key communication, such as an important issue on your medical-malpractice (or personal injury…) case or worse yet, a deadline. Just like taking notes during the CLNC^® Certification Program increased your exam score, taking notes when you are speaking to your attorney-client will dramatically improve the points you score with that attorney.

Whenever you are in your attorney-client’s office, pull out your Mont Blanc pen (or “be like Vic and buy a Bic”) and your notepad (legal size of course) and take notes as you discuss the case or a future assignment.

If you switch conversations to a different case, switch to a different page. You might be killing an extra leaf on a tree or slaying a forest, but it’s a lot simpler and ultimately more efficient to have only notes for one case per page. That way when you get to your office, you can just file your notes with the corresponding case without having to rewrite a single note.

The more you practice note-taking, the more natural it becomes and soon you can talk, maintain eye contact, smile and take notes all at the same time. The same people in my office who see me take notes all day, every day in every meeting or hallway conversation, are the same people who credit me with a great memory. The notes have become invisible and all they remember is that somehow, day after day, I remember everything we discussed.

Note-taking is a powerful business tool for Certified Legal Nurse Consultants. Start today.

Success Is Inside!

A couple of months ago I jumped on an airplane to Las Vegas for the Institute’s CLNC^® 6-Day Certification Program. I normally work on flights. I carry my own water, jack my iPod^® Classic into my Bose^® sound-reducing headphones and crank up Prince. I’m so self-contained that the only thing that can ruin my flight is when the guy in front of me leans his seat back into my lap so he can sleep.

Even before we take off, I have my laptop on my lap waiting for the double bell that allows real business travelers to work and fake business travelers to sleep (or suck down as many free drinks as they can if they’re in first class). Vegas can be 3½ hours from Houston and this time I got lucky – no sleepers. I cranked up the laptop, got to work, didn’t look up until final approach into LAS and I didn’t think anything of it.

In Vegas, I was comparing flight notes with another staff member who told me her laptop conked out somewhere around West Texas, about 1½ hours into the flight. We have the same model laptop so I was a little confused why I could work for 3 hours and she couldn’t (no it’s not just stamina). I volunteered to take a look at her laptop (it makes me look good even though it’s my job). After two minutes, I figured out her issues, at least the ones related to her laptop. One of those issues was the strain on the laptop’s battery.

Based on this experience, here are some steps and tips to extend the life of your laptop batteries whether you’re flying across the country, working in the medical library or soaking up the free Wi-Fi at Starbucks^®.

Keep a Low-Power Profile

• Right click My Computer on your desktop, click Hardware and click Hardware Profiles. If you’re undocked, copy the profile you are in and rename it to Undocked-Normal.
• Click Start, Settings, Network Connections and Panel and disable your Wireless Network Connection. (When you’re in the air or out of range of the wireless Internet, the computer will keep trying to connect and runs down the battery trying).
• Highlight the current profile, click Rename and name it Undocked-No Wireless.
• Dim the laptop screen a couple of notches. You don’t need a tan while you work, so maximum brightness is not necessary.
• Click Start, Control Panel and Power.

• Next time you boot up your laptop it will give you a choice of which profile to select so if you’re out of range of wireless, pick the Undocked-No Wireless and your laptop battery will get extended life.

Stick It in Your Ear

• Don’t listen to music on your laptop – get an iPod or Zune^® and use the ear-buds or a Bose headset.

Empty It Out

• Don’t watch DVDs or listen to CDs on your laptop and make darn sure you don’t have a CD or DVD hiding in the built-in player.

Ditch It and Stick It

• Pull out the CD/DVD player and replace it with a second battery.
• Buy the battery with the highest number of cells (6-12) and look for a high watt-hour (WHr) rating. The more cells and higher WHr, the longer it will last.
• You probably won’t be listening to CDs or watching DVDs on the road but if you think you will, just toss the modular player in your computer case and only use it when plugged into a wall jack.
• Some computers have portable battery packs you can attach – consider one.

Juice Up Every Chance You Get

• Use your charger right up to the last second in the airport or Starbucks. Any time spent on the ground using your battery is less time in the air on your battery. Don’t be afraid to top off unless you have an older non Li-ion battery.
• Once you’re on the ground, run the battery(ies) completely down and charge them overnight. Do this each night. It’s always good to run through a full power cycle as often as possible.

Make New Friends at the Airport (You Won’t See Them for Long)

• I carry one of those goofy power plugs from my local hardware store that allows me to plug three cords into one wall plug. If I need to juice it at Starbucks and some sandaled, goatee-type is already plugged into the wall socket I can usually talk him (or her) into letting me share by plugging in the adapter so we can all make nice.

I’ve flown New York City to San Diego on one charge using the above methods and highly recommend them. The only problem is my batteries last so long I can’t use the dead-battery excuse so I can shut down and dig deep into the latest Lee Child thriller.

Here’s one last tip. If your airport doesn’t have free Wi-Fi (a lot do), find the closest airline club, one club-member benefit is usually free, unsecured, wireless Internet. You’ll locate it quickly by looking for the laptop owners crouched against the club’s wall desperately downloading email.

Keep on Techin’, (and I’ll see you at the wall socket!)

Tom

In nursing school I worked with heroin addicts – not exactly the most fun or inspiring bunch of people to be around. Not having an addictive personality myself, I couldn’t understand the forces that drove them. I wanted to tell them just because you’ve inserted the needle doesn’t mean you have to inject the heroin, but I knew it wouldn’t mean anything to them.

Does it mean anything to you though? As a Certified Legal Nurse Consultant did you ever start something knowing it’s wrong, or find out in the middle that it’s a bad move, but you keep going with it? Have you ever taken a case that’s not in your area of expertise; start to research it to do it on your own instead of bringing in a CLNC^® subcontractor? Then the further you get into it, the more you realize you’re in over your head but feel like you’ve got to finish it anyway?

Then a sudden flash of insight – the moment when you realize that just because you inserted the needle doesn’t mean you have to inject the heroin. So now you’re going to have to pay someone to get familiar with the case. Someone is going to eat it (your wasted hours), and it better not be the attorney-client. It’s going to have to be you.

I mentored a student who made that mistake. She thought she’d save some money by not subbing the case out, and jumped into it head first all gung-ho to research and work it up. When she realized she was way in over her head and was going to bust the attorney-client’s budget, she asked me what she should do. I knew she wasn’t going to like my answer (and she didn’t). I told her the right thing was to stick with the original budget and pay a CLNC^® subcontractor out of her own pocket. After all – it was her mistake, not the attorney-client’s.

I even used my heroin analogy, and because we are both nurses, my advice instantly connected. We can all be guilty of injecting the heroin, not just in business, in our personal lives too. Our head tells us what our heart doesn’t want to hear. We volunteer to lead a fund-raising committee at church or to help out at our child’s school when we know there’s a big project coming down that will make us regret the decision. When was the last time you said “yes” to family or friends when your conscience was screaming “no?” Then the event, shower, reunion or bill arrives and you realize how big a mistake it was, JUST LIKE LAST TIME YOU DID IT!

The next time you feel yourself inserting the needle, take a minute to think about what it is you’re about to do and ask yourself, “Do I really need to inject the heroin or is there a better way to do this?” You might be surprised when you find the better way. Remember the old campaign – Just say no! You don’t always have to say “no.” Just find a smarter way to say “yes.”

See you in recovery!

Success Is Inside!

P.S. Comment and share how you avoid injecting the heroin.

The original Impressionists were considered radicals in their day as they departed from what was considered the “old-school” of artists. Time after time, impressionist painters would submit their work to juried art shows but their paintings would be rejected in favor of lesser artists who painted in the “approved” style of the times.

In order to exhibit their own works, these revolutionary artists rejected the establishment and formed their own society of painters – the Société Anonyme Coopérative des Artistes Peintres, Sculpteurs, Graveurs (Cooperative and Anonymous Association of Painters, Sculptors, and Engravers). Their first show was met with a firestorm of criticism and the term “Impressionist” was given to their artistic style as a derogatory term. The artists chose to adopt this derogatory term “Impressionist” and proceeded to make art history.

The “Impressionist” school captured the scenes they were painting without the strictures placed upon painters by the “Realism” school that was dominant at the time. They focused, or unfocused, on a new way of painting light into scenes of everyday life, rejecting the minute details of realism. When you look at an Impressionist painting up close, there is no detail – there are only short thick strokes and unmixed colors. When you stand back from the painting you see, with a realism not present in the “Realist” paintings, the diffused sunlight on a haystack, people strolling down a boulevard or partying on a Sunday afternoon in a park. The works come alive from a distance.

When an attorney-client is presenting a case to a jury, too many details can bog it down, distracting the jury and leading them down rabbit trails. Your job as a CLNC^® consultant is to help the attorney present the picture with the broad strokes and bold colors needed to show the case in its best light. Sure the underlying details will need to be there to back up your opinions and the attorney-client’s case, but sometimes it’s best to present an Impressionist view of a case to an attorney-client and then to the jury before breaking it down to the details.

They say you never get a second chance to make a first impression. What sort of Impressionist impression are you making on your attorney-clients?

Success Is Inside!

I just finished Eclipse, the third book in Stephenie Meyer’s Twilight series. My sister, Karen gave me the first book and got me started on the 4-part series. Reading Meyer’s books is like eating a bag of salty, hot, buttered (real butter) popcorn – once you start, you can’t put them down and often consume more than you should.

What’s funny though, is that about the same time I started the first book in the Twilight series, I was already reading Richard Russo’s incredible book Bridge of Sighs. The books are as different as their authors. I love reading Russo because his work is deep, rich, analytical, thought provoking and has some of the best character development in literature today. But I also love an author like Meyer whose books, arguably written for the female teenager, are swift, shallow and riveting all at the same time. While I appreciate and enjoy both authors, I’ve completed three of Meyer’s books and have yet to finish Russo’s. So should I be skipping Meyer for the more challenging Russo?

It’s arguable that reading of any kind improves one’s mind. We want to feed our minds a healthy diet, but a little mental junk food once in a while is actually a good thing. When I first met Tom I was only reading business books and serious literature. He brought me a frivolous book and said, “If you put yourself on a diet of nothing but turkey, rice and broccoli, you’ll soon lose your enthusiasm for eating.”

Whatever you choose to read, be sure to read every day. Feeding your mind a steady diet of nothing but TV in lieu of reading is like feeding a Kentucky Derby thoroughbred a diet of Lay’s Potato Chips and Cheetos^®. After a point, your mind will start to lose its edge and you’ll no longer be the competitive legal nurse consulting machine you once were. You’ve got to train that brain muscle, just like any other muscle in your body. If you don’t use it, you’ll lose it.

In addition to the tchotske souvenirs from our global vacations and the family photos in our library at home, you can find a good mix of literature, philosophy, fiction, history and just plain old fun. On those shelves, my Harry Potter books reside comfortably with books by the Dali Llama, Bernard Fall, Sir Edmund Hillary, Alice Hoffman and Martin Cruz Smith. If you poked around you’d find science fiction in the form of a first printing of Frank Herbert’s magnificent Dune, a Bible illustrated by Salvodor Dali and a copy of Good Night Moon. Bill Gates, Seth Godin, Tim Ferriss and other gurus hang out in my home office. They seem to enjoy debating each other from a separate bookshelf of business, marketing, legal, medical and nursing books comfortably out of my sight.

In short, as much as I’d like to read Twilight from dusk to dawn to dusk, I need to read other things and so do you. It’s fun to read light fiction and it’s a great way to stimulate your learning muscles. Just mix it up a bit. Balance the Dennis Lehane with the Geoff Colvin and you’ll keep your mind in its best shape.

So yes, reading Twilight will make you smarter than not reading Twilight – as long as that’s not all you’re reading.

I’m off to start number four in the Twilight series and vow to finish Bridge of Sighs this week.

Success Is Inside!

As a Certified Legal Nurse Consultant, do you use Google^® to search on a regular (or exclusive) basis? If you’re like me, you’re tired of seeing only 10 results per page. You know, scan the page, click next on the Gooooooooooogle link and then see the next 10 links, repeat – next 10, repeat – next 10, repeat – ad nauseum and if you’re as tired as I am of that basic white Google homepage that offers little in the way of excitement other than an occasional logo change, it’s time to take matters into your own hands. Open your Internet Explorer^® or Firefox^® browser and point it to Google. Next, create an account with Google. It’s quick, easy and it’s free (plus they know all about you anyway – they’re Google after all).

After you create your account, go back to Google and click on iGoogle (in the top right corner of the page). You may not need to, it may take you right to iGoogle^TM. When you get to iGoogle (you’ll know) you can select a theme from the “Create your own homepage in under 30 seconds” box. Check a few of the options in the Select Interests box. You can change them later. When you’re done click on “See your page.”

Once you do you’ll see that your new iGoogle homepage has changed considerably. There will be new content like a useless clock, perhaps weather, news from CNN or perhaps your local paper or The New York Times. Ignore these changes for now, we’ve got important work to do.

First, go to the top of your new iGoogle homepage and click on either Preferences or Search Preferences (depending on which one you see). You can then tell Google to display 100 (really 100!) search results per page. You can also tell it to open search results in a new window. This is way cool – your original 100 results remain in place and each link opens in a new window. This way, as you evaluate each result for a case you’re working on for your CLNC^® business, you don’t lose the original results and can close each page (or follow its links) as you wish. Save your preferences and go back to iGoogle.

Next, you can select your theme or change your theme. You’ll have pages and pages of customizable themes (header images and page colorations) that will change the way you look at Google forever (or at least until you change themes). Vickie loves trekking and hiking in the mountains so she selected a cool theme that reminds her of the Bhutanese Himalayas. I’ve got an electro-techno-looking theme that charges me up. Some themes are static – the same all the time. Other themes change throughout the day. (Try Pocoyó for a fun, changing theme). You can search the themes by keywords to find one you like.

The Institute has also developed a theme specific to Certified Legal Nurse Consultants. You can get the iGoogle CLNC^® theme by logging into the NACLNC^® Community. Once logged into the Community, click Member Seal and Other Downloads. Select the iGoogle CLNC^® theme to easily upload it to your iGoogle homepage.

Now that iGoogle’s looking different, your next step is to address the new content that’s been added to your homepage, courtesy of iGoogle’s Gadget APIs (you’ve learned a new tech word. Now, instead of saying “I can’t go out with you Friday, I’m washing my hair,” you can say “I’m staying in Friday to use Core JavaScript Features and Standard XMLHttpRequest class objects to customize the APIs for my iGoogle homepage.”)

The APIs allow you to drag and drop, add and delete and even resize feeds on your iGoogle homepage. To take advantage of this, the first thing to do is navigate to Vickie’s Blog and click the Subscribe to Feed link at the top left. Now, instead of subscribing by email, select the option under Subscribe Now! to read the blog with your iGoogle or My Yahoo! web-based reader. It’ll then take you back to your iGoogle homepage and should show a box listing the last four headlines. You can then grab the “Vickie’s Blog” box with a left click and drag it anywhere on your page. Use the little icons in the top right of each feed box to delete a feed from your page or to move it around your iGoogle homepage.

Now visit other blogs, news sites (NYTimes.com) or alert sites (FDA.gov) and add their feeds to your homepage. Do a Google search for medical-malpractice news and feeds or other types of cases that interest you to find a wealth of news, facts and opinions. Almost all of these information sources for your Certified Legal Nurse Consulting business can be added to your new homepage. On mine I keep the local weather, a stock market ticker, global and local (Houston Chronicle) news and legal feeds. As you learn of new, interesting feeds you can add them, deleting the feeds you no longer need.

I haven’t tried this in IE8 yet, but in my Firefox browser I have multiple tabs that open each time I start Firefox. My homepage and primary display tab hold legal feeds, my secondary is tech feeds (natch!) and the last is news and current events (like movies). Every time I open a browser, I take 2-3 seconds to scan the headlines and then get to searching. One more tip is to use both IE8 and Firefox. I’ve set IE8 to Google, and Firefox to Yahoo!^® and I’ve got different content on each browser. My ultimate search destination (legal, news or research) helps me select which browser to open.

This blog has primarily been about Google but, with the exception of themes and colorizations, you can customize Yahoo! just as easily as you can Google.

Remember, use a combination of search engines to get the best results. You’re cheating yourself out of information gathering otherwise. Customizing your homepages will put more information at your fingertips. Just make sure it’s useful.

Keep on techin’,

Tom

I’m sitting in Paris in one of my favorite bistros. I’ve just finished a lunch of healthy red wine, a hot baguette and some luscious stinky cheese such as you can only find in France. I’m looking at the first thing that usually comes to mind (well, maybe the second thing) when you think of Paris – the Eiffel Tower. Tom says he thinks of pomme frites and just having indulged, I’d say pomme frites are right up there for me too, but the “Tour Eiffel” is the instantly identifiable iconic image, which undeniably brings Paris to mind.

On May 15 of this year, just 12 days ago, the Eiffel Tower turned 120 years old. A week ago, I had the pleasure of dining in the Tower. Now I’ve seen it from the inside, too.

Believe it or not, the Tower has not always been as treasured as it is today. The Tower was originally built by Gustav Eiffel to be the entrance arch and centerpiece of the 1889 Paris Exposition Universelle. Although he won the design competition, not everyone was enamored of the railway bridge engineer’s vision for what was then the world’s tallest structure. From the time Eiffel began construction in February 1887 through its completion (really opening) on May 15, 1889, the Tower was met with a firestorm of criticism and attack and was decried as an eyesore and an embarrassment by some of the most famous and powerful people in France. A petition they signed stated, “We, the writers, painters, sculptors, architects and lovers of the beauty of Paris, do protest with all our vigour and all our indignation, in the name of French taste and endangered French art and history, against the useless and monstrous Eiffel Tower.” When its original 20-year lease expired in 1909, it was almost torn down but was saved simply because it provided a platform for radio antennas. As late as 1909, no one but Gustav knew what the Tower would one day mean to France and to the world. To our benefit, the misunderstood Tower, and Gustav Eiffel’s magnificent vision, survives 120 years later.

When I pioneered legal nurse consulting in 1982, attorneys didn’t know what a legal nurse consultant could do for them. My friends, family and colleagues thought I was hallucinating to believe that I could succeed in a business that had never been tried before. To make matters more challenging I was up against Texas good ole boys in communicating the services of a legal nurse consultant.

The first good ole boy attorney I called was exhausted from trying to do the nursing analysis by himself and gave me a shot with my first medical malpractice case. I felt so proud for our nursing profession when he shared that I made him a better attorney. Like him, attorneys nationwide have caught on to what Certified Legal Nurse Consultants can do for them and today can’t imagine working a case without a CLNC^® consultant! In fact, I believe that it borders on legal malpractice for an attorney to represent medical-related cases without consulting a Certified Legal Nurse Consultant.

Twenty seven years after I called my first attorney (and almost had a heart attack when he answered the phone) more than 6,000 Certified Legal Nurse Consultants are available nationwide to devote their broad range of skills to a wider and wider range of cases. One of Vickie Milazzo Institute’s CLNC^® graduates is working with a firm in Sweden and is presenting on legal nurse consulting in Germany at a very large conference later this year. Talk about spreading our wings and flying! Congratulations Jane.

I’d like to think that on the 120th birthday of legal nurse consulting in 2102, Certified Legal Nurse Consultants will be their own iconic images of nursing and the law. I also hope that I’m around to see it! (Just kidding – that wouldn’t be pretty.)

In the meantime, what are you doing for your attorney-clients to make you the iconic image they call on when they think of Certified Legal Nurse Consultants?

While you’re thinking about that, I’ll have a second glass of red wine!

Success Is inside!