Articles by Guest_Blogger

I choose not to engage in stinking thinking. Thoughts like “I can’t do this…I can’t do that…I wish I could but I can’t” never enter my mind nor do I say them. Positive thoughts and spoken words attract positive happenings in my life and in my CLNC^® business, while negative thoughts and spoken words attract negative happenings in your life. I also choose not to listen to dream squashers – you know who they are – individuals who tell you that your ideas or goals are no good and that you are not going to succeed. “Dream squashers be gone” is my motto and it has served me well in my legal nurse consulting business.

I choose not to use nurses who are not CLNC^® consultants as subcontractors. A group that sings from the same page (same training) is strong and harmonious. As Certified Legal Nurse Consultants we were trained by the best (Vickie) so why look elsewhere for CLNC^® subcontractors?

I choose not to get in a rut in my CLNC^® business as I try new things along the way. Perhaps a new way of marketing my CLNC^® business is in order or overdue. Perhaps locating expert witnesses as part of my CLNC^® services to attorney-clients or revamping my newsletter makes sense at this time. Whatever it is, not becoming stagnant is important to me and my business. Other business owners might not look at things differently or take the time to step back and reflect on where they want to take their businesses, but not me. Even if you have setbacks along the way remember, Thomas Edison tried 10,000 ways to make his light bulb light before he hit the jackpot. When he was asked how it felt to fail 10,000 times, Edison replied that he did not fail 10,000 times, but rather found 10,000 ways in which his light bulb would not light. My vote is for the Edison way of looking at things. How do you go about looking at things in your life and in your CLNC^® business?

Guest Blogger Profile

Lawrence H. Frace, RN, CLNC is an independent CLNC^® consultant with more than 30 years of nursing experience. He is the founder of Spectrum Medical-Legal Consulting in central New Jersey and specializes in medical malpractice cases.
 

I was referred to an attorney by a medical testifying expert I know. Because of that referral, I got right through to the attorney and thought “this is going to be easy.” I couldn’t have been more wrong. After briefly discussing my CLNC^® services, he responded “I have been doing this for 35 years myself.” I acknowledged his expertise as the attorney and then proceeded to explain how I could save him time and money by screening his cases first before he sent them to expensive MD experts. He didn’t bite.

Not one to give up, I next offered to send him a sample of my work product. He agreed. A week later, I called him to follow up. He was very complimentary of my work product but still didn’t hire me for a case.

I decided to focus on something specific to get his attention, so I mentioned that I frequently attend independent medical exams (IME) for attorneys. I shared that attorneys appreciate my ability to point out inadequacies in the exam. Finally, I got his attention.

Three days later, the attorney contacted me and requested that I attend an IME. I did so, and he was impressed by my evaluation and the things I pointed out that the MD did not do during the IME. He had considered settling the case, but after hearing what I had to say he decided the case was stronger than he originally thought. That single IME led to a case and then another.

I consult on many cases for him and attend all of the IMEs. It took awhile, but he finally saw me for the professional I am and how he benefits from my CLNC^® services. I felt like I had run a marathon, but it was worth it in the end.

Nikki J. Chuml, RNC, FMC, PRN, CLNC is an independent Certified Legal Nurse Consultant in California with more than 25 years of nursing experience. She works as a consulting expert in a variety of specialties and as an OB testifying expert nationwide. Nikki is a CLNC^® Mentor and a guest faculty member for Vickie Milazzo Institute.

One of the most important strategies I use to build successful attorney-client relationships is to remain available and accessible to my clients. Even when things are extremely hectic and busy, I never let my attorney-clients sense that I am too busy for them. When they request something, I respond promptly with a short answer or suggest a time to talk. Mobile devices make it easy for me to reply to all requests.

The second strategy I use for building and maintaining successful relationships with my attorney clients is a “courtesy call”. This comes in very handy with my existing clients and doubles as a marketing strategy! I am in various stages of litigation with my cases, so if there is a lapse in workload on a case I make a courtesy call. Checking in with a friendly hello and calling for a status update on the case reminds the attorney that I am committed and thorough, and it is one of the best ways to discuss new cases and referrals to other attorneys. I love it when the attorney says, “I was just going to call you about a new case that I want you to review.” I would say eight out of ten times the “courtesy call” results in more work on the existing case, a new case or a referral to a new client. It’s a win-win situation, which brings me to my third strategy.

My third strategy is to update my communication on a case even if I’ve already written the report. No matter how much you research a case, you will wake up with those bright ideas and ah-ha moments. When I get those bright ideas, I communicate them to my attorney-clients. They are always grateful to know that I am still thinking about their cases, keeping them current and guiding them down the right path.

Guest Blogger Profile

Julie Somen-Becker, RN, BSN, CLNC owns and operates Chicago Legal Nurse Consultants, Inc. She has been a nurse for 14 years specializing in neonatal intensive care, clinical education and management. Julie’s CLNC^® business specializes in neonatal cases and resuscitation issues.

The business relationship with the attorney who gave me my “breakout” case has developed in a way that I did not envision because it has resulted in my consulting almost exclusively for this one attorney-client. I know if I do a great job and maintain a successful relationship with this attorney, other attorneys in his law firm will also hire me.

One of the first things I did to strengthen my relationship with the attorney was to establish a relationship with his paralegal and assistant. It’s through them that I know when new cases come in, and I contact my attorney-client to ask not if I will jump in, but when. I also get information on discovery deadlines and then contact my attorney-client to offer help with locating the medical experts and initiating requests for their reports. I often personally pick up and drop off medical records to get my foot in the door. As a result, I have met many of the other employees in this large firm – down to Eddie in the mailroom!

I have made it a point to learn some personal information about the attorney, and use it in casual conversations. For example, I know his son participates in sports so when I came across a pair of tickets to an NFL game, I gifted those tickets to him. Periodically I visit the firm’s website for updates on cases that other attorneys have either settled or are actively working on. When I pick up or drop off records, I can engage these attorneys in conversation regarding their cases and offer my CLNC^® services.

I have permission from my attorney-client to touch base with his plaintiff clients and call them monthly to get updates on medical issues, new care providers, etc.  As a result, the attorney stays up-to-date on his clients and the medical records are always current. He loves this because it impresses his clients too!

While reading a local magazine article about a man who offered woodworking classes, I recognized one of the highlighted students as an attorney at my attorney-client’s law firm. The next time I was at the firm, I asked a paralegal where the attorney’s office was located and stalked the area until he finally came out. We exchanged hellos, at which point I began a conversation regarding the article. He invited me into his office to see other woodcrafts he had completed while attending these classes. I officially introduced myself by name and left his office with a case!

Guest Blogger Profile

Annmarie Johnson, RN, BSN, CLNC owns and operates Bucks Medical-Legal Consulting. She has been a nurse for 26 years, 24 specializing in critical care. Annmarie’s CLNC^® business specializes in construction accidents and products liability.

An email titled Send This to Everyone in New York Who Handles Nursing Malpractice Cases was forwarded to me by one of my attorney-clients. The author was the managing partner of New York City’s largest medical malpractice firm. For the last six years, I had been trying to think of a creative way to get referrals from this firm. Vickie’s blog on intuitive vision was still fresh in my mind. I knew immediately that I had to stop reviewing a complex medical record, put the day’s usual business on hold and focus on this potential opportunity.

This partner described a complex home health care case that had been won by the defense and just reversed by the appellate court. Essentially the court opined that the RN who administered an IV steroid as ordered by the physician was negligent for failing to ensure that epinephrine, which was not ordered by the physician, was available in case the patient experienced anaphylactic shock. I decided to get a little playful and titled my email My Two Cents. I started my opinion in a succinct, professional manner.

To my surprise, the response came in the form of an immediate phone call from the partner himself. My CLNC^® education from Vickie Milazzo Institute prepared me to deliver my two-minute unique selling position (USP). I was thrilled to be invited to discuss my experience with nursing chain-of-command issues at the law firm.

The attorney scheduled a full hour with me prior to the presentation, and after 15 minutes, he called the RN in charge of coordinating nurse expert reviews. He said, “Put Margaret at the top of the list for expert reviews.”

The presentation was attended by 74 attorneys who work solely with medical malpractice cases. Within a week of that presentation, I started to receive referrals and cases.

Acting on my intuition that day not only opened the door to an ongoing opportunity, but also helped me to grow my CLNC^® business even more.

Guest Blogger Profile

Margaret M. Gallagher, RN, BSN, MSN, CLNC has been a staff nurse, RN educator and senior nursing and hospital administrator for over 30 years. She founded Patient Care Executive Consulting in 2004 and became a Certified Legal Nurse Consultant in 2005. She is an assistant professor at Wagner College in Staten Island and has reviewed over 800 medical malpractice cases.

I have been an RN for well over 35 years and became a Certified Legal Nurse Consultant last year. I now have my own very successful CLNC^® business.

I learned about legal nurse consulting by seeing Vickie Milazzo Institute ads for 15 years. During that time, I thought of becoming a Certified Legal Nurse Consultant but the timing was never right for one reason or another. Early in my career I felt I wasn’t experienced enough and midway through my career, life was happening with family and financial responsibilities. Last year, I saw the ad with Vickie’s photo once again and something just clicked inside me. Instinctively, I knew this was my next career move. Having worked in the home health care field for seven years, I loved the autonomy, the field work and the attachment to my patients and their families. However, I was getting quite tired of the constant bureaucratic demands. I was at the brink of burnout so the timing for me to pursue a career change was right. I quickly enrolled in the VIP CLNC^® Business System with financing.

I watched the DVDs for a total of 65 hours and soon scheduled my CLNC^® Certification Exam. Throughout the process of my newfound education, I was excited at the prospect of using my extensive nursing knowledge and experience, creating a business of my own, educating attorneys and others on medical issues (I love to teach) and continuing to help people.

I took the CLNC^® Certification Exam at a Prometric Testing Center, and I was so happy when the screen on the computer displayed my passing score that I cried for about 10 minutes. I was now a Certified Legal Nurse Consultant. I went home, immediately put all my marketing materials together and mailed out 25 packets. Within three days, an attorney at the biggest law firm in my county called me to meet with him and his paralegal. He was very excited that I was so close. This firm does only personal injury and medical-malpractice cases. A few days later, I went to my first attorney meeting to sell my CLNC^® services. Unbeknownst to me, there were nine attorneys, three paralegals and three executive assistants waiting for me at this meeting. If this was a test for how I would do under pressure, I am proud to say I passed with flying colors.

During my interview, I focused on them and how I could help solve their problems (just like Vickie teaches). I asked several questions about what their biggest challenges were and how they were currently dealing with those challenges. I then explained how my CLNC^® services would enhance what they were already doing because I had the benefit of knowing the ins and outs of the hospital structure, workflows, hierarchy, etc. I emphasized that I have always analyzed, assessed, evaluated and made critical decisions about nursing and medical care. I addressed each of their challenges with confirmation that “this is why you need me” (sound familiar?). I emphasized the unique involvement of the paralegals and executive assistants and shared how I could help free them up to focus on their respective duties. After 45 minutes, I walked out of the office with nine cases to review. I worked on the three most urgent cases first and returned them within five days. My attorney-clients were very impressed at my timeliness, professionalism, ability to work with their staff and the quality of the reports I provided. I completed the other six reviews within seven business days and again they were very impressed. After the initial reviews, I helped prepare those nine cases for litigation and acquired new cases as well.

Incredibly in the first two cases, I discovered tampering of the medical records. The two attorneys working these cases were awed at my discovery. Both cases settled for significantly more than was previously anticipated. The ability to detect medical tampering has catapulted me to success with this law firm.

I was not at all afraid to put myself out there because I felt so confident with my clinical background, my experience and the education I received from Vickie in the CLNC^® Certification Program. Having prepared myself to market also helped me feel confident. I think preparation is key to anyone’s success. I know in my soul that I have a lot to offer any attorney who is willing to work with me, and with that mindset, I can’t fail. My standard of excellence gives me great confidence as well. You have to believe in yourself and what you are offering in order for others to believe in you too. Being focused, self-directed and clear in what you want to accomplish is absolutely crucial for success.

Transitioning from my full-time home health care job, where I was earning $120,000/yr to full-time CLNC^® consultant at $225/hr took me exactly four weeks. I consult with 12 attorneys in this firm, billing $8-10,000 a week on average. I have built a potential $500-600,000 a year business in the last six months. My goal is to create a $1 million business within the next two years.

My life has changed forever, in more ways than I can include here. These are just some of the highlights:

• I work from home: no commute, no traffic, no weather issues, no burnout!
• I built a brand-new 10,000 sq. ft. home.
• I created my own financial freedom.
• I built a successful CLNC^® business with a high profile in the legal community.
• I gained an abundance of new friends and business associates.

Of course, no success is possible without a support system. First and foremost, I thank God every day for my blessings. Many thanks to my husband and my mother for their endless support. Equal appreciation to Vickie for the amazing preparation I have been so privileged to obtain. As Vickie says: “We are nurses and we can do anything!”^®

Guest Blogger Profile

Carmen Stine, RN, BSN, CCM, CLP, CLNC has more than 35 years nursing experience in critical care, ER, Burn ICU, managed care, longterm care, home health care, hospice care, risk management, case management, and utilization management. Carmen specializes in medical-malpractice and personal injury cases. She is also a Certified Case Manager and Certified Life Planner.

I seriously could write a book about this case. I met the attorney of this memorable case at a legal seminar. I was asked to review the medical records and fetal monitoring strips of a baby who was severely brain injured. An OB/GYN expert reviewed the records and found no deviations to the standard of care by the physician or the labor nurses. It was the OB/GYN’s opinion that the fetal monitoring strips showed no distress.

The attorney, a very accomplished medical malpractice attorney, was then led to believe that the cause of the baby’s injuries was a negligent resuscitation after delivery, with a “0” Apgar score as “proof.”

The attorney hired me to review the records with a focus on resuscitation. After reviewing the records, my opinion was that there were significant hyperstimulation and hypertonus causing a brain compression injury to the baby during labor. I developed a 50-page chronology that detailed every aspect of the labor and delivery, complete with a section that compared and contrasted the documented interpretation of the FMS to mine. I addressed the standard of care for nurses and physicians for staffing guidelines, Pitocin^®, intrauterine pressure catheters and amnioinfusion. The hospital had gone against its own protocols in the use of Pitocin^® and amnioinfusion. Because the heart beat of the baby showed no “sentinel event” and did not look “ominous,” the original OB/GYN who reviewed the case missed the six hours of hyperstimulus and hypertonus of 50 mmHg. The nurses continued the amnioinfusion and increased the Pitocin^® despite the ominous contraction pattern which are both deviations from the SOC and against hospital policy.

The attorney reviewed my interpretation of the case and when we met again, she greeted me with “Okay, I get it! I’m filing this case”, and that was the beginning of one of the best cases of her career. It became as satisfying for her as it was for me.

I was able to secure top medical experts – one of whom she had contacted before on another case but who said he was too busy. When I contacted him he said, “As long as you’ve determined it’s a viable case, I’ll review it”. This wasn’t the first time an expert had agreed to take on a case for me when they had said no to the attorney.

In addition to providing the chronology, educating the attorney and finding several expert witnesses, I flew to Houston to meet the attorney in a labor suite and operating room to teach about all of the equipment used on the mother i.e., IUPC, fetal monitor, IVs, cardiac monitor, pulse oximeter, O2, etc., during labor and delivery and the resuscitation of the newborn.

The defense had their usual arguments explaining why the injuries couldn’t have happened during labor – infection causation, prenatal causation, no sentinel event. The defense also tried a Motion in Limine to prevent the theory of hyperstimulus and hypertonus causing a compression brain injury during labor. All to no avail.

Because of the detailed chronology and up-front, early and thorough education provided to the attorney, the case actually settled prior to any disclosure of expert reports or expert depositions – which is unheard of in brain-injured baby cases.

The impact on my financial status is immeasurable and this attorney-client has referred me to other attorneys. I would not make any changes to the way I prepared this case. My advice to other Certified Legal Nurse Consultants is to follow your instincts about what you think will help your attorney-clients the most.

My mission statement as a CLNC^® consultant is to make medicine safer for all. This baby, while injured, will have his life care plan fully funded and will have the most satisfying life possible because of my involvement. My attorney-client continually expresses her gratitude saying: “We never would have gotten here without you. It was because of you that we won this case.”

Becky Mungai, RN, BA, CLNC

Last week my attorney-client invited me to meet a potential plaintiff at the office of a referring attorney. He needed to catch a flight immediately after this meeting, so we were on a tight schedule. I offered to drive us to the meeting and take him to the airport afterwards, giving me an opportunity to have his undivided attention for a period of time.

This particular attorney-client was my “break-in” client, and the one for whom I still do more than 90% of my work. He has been a very successful attorney in a prominent plaintiff firm for about 20 years, winning big awards for his clients. However, I was growing frustrated with what I felt was his tunnel vision when it came to damages in his cases. I wasn’t sure he was really reading my reports or just picking out what he wanted to see.

As a result, I believed he was missing an opportunity for bigger awards for his clients. During the ride I honestly discussed this, using medical issues from his cases on which I am presently working. He was “blown away” with some of the issues I presented, to which I responded, “Did you not read my report?” At the meeting with the potential plaintiff and referring attorney, my attorney-client introduced me as his nurse expert and “the brains of the team!”

Guest Blogger Profile

Annmarie Johnson, RN, BSN, CLNC owns and operates Bucks Medical-Legal Consulting. She has been a nurse for 26 years, 24 specializing in critical care. Annmarie’s CLNC^® business specializes in construction accidents and products liability.

I was asked to be the speaker at the February meeting for the Massachusetts Academy of Trial Attorneys. I arrived early to get prepared. Several people were late due to the weather. Only 10 attorneys braved the cold, rainy, snowy night to attend.

I began my presentation with information about legal nurse consulting, the CLNC^® services I provide and my nursing expertise. After my presentation, they all took my contact information and brochure. Then, they spent a lot of time talking about their cases.

The next day I got a call from one of the attorneys who had attended. He was looking for a wound care specialist. The day after that I got a call from another attorney for a case review. The phone has not stopped ringing since that night and the referrals from these attorneys have also been great.

What I want Certified Legal Nurse Consultants to know is that no matter how small the crowd, it will pay off!

Guest Blogger Profile:

Mildred Mannion, RN, BSN, CNOR, CLNC is the owner of M3 Legal Nurse Consulting, Inc. in Massachusetts. She has 22 years of nursing experience and currently works in the operating room of a large teaching hospital.

As a Certified Legal Nurse Consultant, I focus on helping hospitals reduce Medicare denials and win more Medicare Part A appeals. My photo and short bio on my websites generate four to five calls from hospital attorneys each month.

Hospitals want to be paid and I’ve learned that the first level of preventing Medicare denials is the assessment of the patient and the physician’s documentation of medical necessity. It’s usually the lack of this information that triggers a Medicare denial of payment.

The first rule to get the physicians to buy into what you are trying to teach them is to feed them. So, I contact the hospital administrators in question and explain that I have a plan that will help them reduce Medicare denials and change their doctors’ bad documentation habits. If lunch is not within the facility’s budget, then I work with ancillary vendors who might want to participate and provide lunch.

I use exhibit posters and flip charts to present during lunch (provided by the hospital). I also use a dry-marker board and include actual excerpts from Medicare’s denial documents. The exhibits show what was missing and how to correct it. My program includes hand-outs with the information from the posters, dry board and flip charts.

This educational approach usually works and I receive calls from physicians with questions for some time after each event. The marketing benefit is that people from different hospitals talk to one another, which often generates calls from other facilities wanting presentations and I get more clients.

My marketing strategies include:

• Bulletin board teasers with movie ad-like messages: “For Doctors: Coming soon to your hospital…” posted a couple weeks before the presentation.
• Hand-outs placed in facility mail boxes at least two weeks ahead of time.
• Posters on stands just inside the entrance to the presentation room at least 30 minutes before start time.
• Enlargements focused only on the most important pieces of Medicare rules on the subject that affects physicians.

One of the most rewarding experiences occurred while I was auditing a telephone conference regarding Medicare appeals with corporate attorneys for two of my hospital-clients. One hospital administrator on the call wondered why two facilities seemed to be doing much better than the others in overturning denials. The attorney explained, “That’s because they have a Camy,” as though I were a product brand name.

Another time a different hospital-client armed with the education and hand-outs I provided, was able to make enough immediate and lasting changes that they, effectively, stopped their denials cold. Most hospitals make changes slowly and with a lot of kicking and screaming. This hospital’s collective, firm resolve made the changes using the education they paid me to give them – and won big!

Medicare is my specialty and marketing, as I learned from Vickie Milazzo, is what sells my CLNC^® services.

Guest Blogger Profile

Camy Joyner, RN, BSN, CCM, CLNC, CEO and co-owner of C. Joyner and Associates, LLC. Consults/manages Medicare Part A appeals for acute general rehabilitation hospitals. Consults for records review/audit for physician medical pertinence. Also consults in non-Medicare negligence cases.