Case Evaluation

Screening medical-related cases is one of the most important legal nurse consulting services you will provide as a Certified Legal Nurse Consultant. Not only is it one of my favorite CLNC^® services but it is the first CLNC^® service you usually provide for new attorney-clients. Do it well and the attorneys keep coming back for more. Here are 16 screening strategies to keep your attorney-clients coming.

Stay Focused on the Essentials

1. Give the attorney an objective, candid and honest opinion without regard for what you think the attorney wants to hear. Put aside interests in personal gain (e.g., more billable hours) and focus only on what is ultimately best for the attorney, the client and the case.
2. Discuss the issues and theme of the case with the attorney-client and ascertain the date of the incident (when known) to help you focus quickly on the important events. If the case has been filed, request a copy of the complaint or petition. You will screen many cases in which the attorney knows little about the facts and has formed no opinion. If the attorney does have an opinion and you believe he is focusing on the wrong issues or your opinion is different, be sure to communicate your reasoning right away.
3. If you do not have time to do the screening as soon as you receive the case, at least read the cover letter and scan the medical records. This helps you to establish deadlines, determine the basic issues of the case and assure you have all the necessary records. If relevant records are missing, inform your attorney-client immediately.
4. Scan all relevant medical records and, where appropriate, note important observations and opinions. Avoid excessive writing at the screening stage, especially if you haven’t yet identified the essential issues and themes of the case. Your goal at the screening stage is to be efficient, and until you’ve reviewed all relevant records and identified key issues, it is very easy to go down unnecessary rabbit trails.
5. Use the screening form to track all possible defendants, types of experts needed, additional documents needed and recommended research. When you give your screening opinion to the attorney, you can incorporate some of these into recommendations for the next indicated steps.
6. Screening a case is similar to reading a mystery novel. You may even be surprised by the outcome because the focus may shift from something obvious, like a patient fall, to a less obvious issue, such as medication administration or safety policies and procedures. As new and more relevant issues arise, determine their significance and how they impact the essence of the case.
7. Do not overlook the obvious by overanalyzing the records. Likewise do not assume that the issues will automatically jump out at you. If you become overwhelmed by the task at hand or the volume of medical records, walk away for a while, or a day or two, then come back fresh and start again.
8. Do not assume the case has no merit simply because a physician reviewed the records and found no merit. Physicians tend to limit their reviews to doctors’ records and in so doing, they often miss vital information. For example, many MD experts do not review the nursing records and often it’s the nursing notes that shed the most light on what really happened to the patient. Always review the records completely and look for discrepancies in documentation by different providers.
9. If you were hired by the plaintiff attorney, look at the case from the defendant’s viewpoint. (What are the defenses or rationales in this case?) If you were hired by the defense attorney, look at the case from the plaintiff’s viewpoint. (What went wrong, if anything? Could anything have been done differently? Were any standards of care or practice guidelines breached?)

Efficiency Saves You Time and Saves Your Client Money

10. Don’t organize the medical records before you screen and you will save valuable time in the initial review process. If organizing the records is necessary before screening, do not organize them for comprehensive review and analysis, but organize only with the objective of making screening easier.
11. Do not do a formal report during the screening stage – just complete the screening form to facilitate communicating your opinion clearly and concisely. More comprehensive reports are only indicated once you have communicated your screening opinion and both you and the attorney agree that a comprehensive review and analysis of the medical records is indicated.
12. Access relevant healthcare references as needed while you are reviewing but don’t overdo it at this stage. Unless you need some piece of information before you can move on, make a list of topics to search on the Internet and do all your searching at once. This will keep you focused as you read through the record. Narrow your searches to match the factors in your particular case (e.g., octogenarian, female, femur fracture, mortality). Be sure to research any articles and publications authored by all the relevant players in the case.
13. Consider subcontracting the screening if the issues are outside your area of expertise. Make the decision to subcontract quickly, then act on it. Don’t wait until you need a CLNC^® subcontractor to try to find one. Develop a pool of CLNC^® subcontractors who are ready to respond to your needs. All successful CLNC^® consultants know what they don’t know and wisely tap the expertise of their peers.
14. Use a magnifying glass (buy the best one you can afford) so you can read those little squiggles and impress the attorney with your knowledge of hieroglyphics. You may determine the outcome of the case by being able to decipher something illegible to the average eye.
15. Keep a calendar of the year in question close by. Look for weekends and holidays when short staffing is common.
16. Pay particular attention when operative notes, admission history and physicals, discharge summaries and autopsy reports are dictated and transcribed. If an unusually long period of time elapsed between the event and the transcription, note that for future consideration.

Use these 16 strategies to make screening medical-related cases one of your most popular and satisfying CLNC^® services. Keep your attorney-clients coming back for more.

Success Is Inside!

The term “sexual assault” refers to forced sexual intercourse. The term used in your state, region or area may be called “sexual abuse” or “rape.” It is important for each person to check the law’s legal definition in their state.

How many of these statements have you heard as a Certified Legal Nurse Consultant reviewing a sexual assault case?

• There was a delay in seeking treatment and/or reporting the assault.
• They know each other and they were on a date.
• There were no injuries.
• They were calm when they arrived.

CLNC^® consultants should focus on the facts in a case, not the assumptions while at the same time being alert to how others might interpret the case.

Many times the survivor may delay seeking treatment or reporting the incident. The delay in seeking care may have been because the victim was in shock. They could have been threatened, unconscious or waiting for a friend or family member to arrive to assist them. The survivor of a sexual assault is a trauma patient; and they will have the same psychological reactions as any other trauma patient. The reactions you may see documented are that they were calm one minute, crying or angry the next and withdrawn or even confused at another time. A Certified Legal Nurse Consultant should not focus on whether or not the victim delayed seeking care or delayed reporting the assault to determine if the case has merit.

Saying the victim knew the attacker so they can’t claim assault is not necessarily a strong defense. According to the Rape, Abuse & Incest National Network (RAINN), 73% of sexual assaults are committed by a nonstranger and 38% by a friend or acquaintance. 93% of juvenile survivors know their attacker. Of the 93%, 34.2% are family members, 58.7% are acquaintances and only 7% are strangers.

Knowing the attacker, being on a date with them or even being married to them does not give the “okay” to be sexually assaulted. “No” means “no” when said to a spouse, dating partner, relative, friend, any kind of acquaintance or a stranger.

A physical examination, even in a child victim, may not reveal any injuries. Factors that can affect the injuries are anatomy, physiology, how much force was used, how much the victim resisted, the time lapsed between the assault and the exam and the grooming of the victims. Everyone’s anatomy is not the same and this is true of the genital area and the hymen also. If there was an injury or difference documented, it is important to know if it is an anomaly or an acute injury. Also, realize there are other types of injuries beside sexual assault that can cause an injury in the genital area or even cause a ruptured hymen. The vagina and cervix are vascular areas and heal quickly. If time has elapsed before the examination, any injury might be healing or healed. If injuries were documented, then you may be able to determine if the injury was acute by checking the records to see if the victim was examined a few days to a week later. If another examination was completed, compare the documentation of injuries. If documentation confirms that the anatomy is the same and no further sexual assault was found to have occurred, then it was probably not an acute injury.

Legal nurse consultants should also be aware that estrogen can play a role in whether there might have been injuries noted with the exam. Estrogen in females makes the cervix thicker and more redundant. Injuries might be less likely to occur during the child bearing years when there is usually more estrogen in the body. The victim’s resistance to the attack and the force and object(s) used have an effect on any injuries sustained. If the victim did not resist the attack, the examiner may not discover any injuries. The victim’s cooperation should not be confused with their willingness to have intercourse. They may have feared for their life, been too traumatized to resist, been drugged, intoxicated or the attacker could have threatened them, a loved one or even a pet.

Child victims may have been “groomed” by the predator. Grooming is the process of desensitizing the child. The predator usually has some type of relationship with the child. This relationship provides the predator with the opportunity and access to the child to engage, entrap, prepare and trick the child into accepting the sexual abuse. The grooming can start with subtle behaviors or statements and once the victim responds favorably, some form of sexual activity begins, and often progresses. When there is less resistance, there may be little to no injury sustained or noted.

Remember that a calm victim does not indicate whether assault did or did not happen. A Certified Legal Nurse Consultant needs to review and consider all information and documentation – the subjective and objective data obtained during the physical exam and the history of what occurred. Gather all records from other disciplines that might have spoken with or examined the victim after the assault. Review the records to be sure the examination was conducted thoroughly, to learn what type of practitioner performed the exam, that all evidence was collected and stored properly and that the chain of evidence was followed.

Most areas have at least one hospital and sometimes several that have a sexual assault nurse examiner (SANE) or sexual assault response team (SART). A SANE is a registered nurse who has had specialized education to provide comprehensive care to sexual assault patients and demonstrates competency in conducting a forensic exam and who has the expertise to give effective courtroom testimony. SARTs are set up in a similar style with a multidisciplinary and community-based approach to caring for and assisting the victim. The teams usually consist of local law enforcement, prosecutors, judicial members, a victim advocacy group, the hospital, SANE members and any other professionals with a vested interest in assisting victims of sexual assault.

With a thorough review of all the information, a definite response to the question of whether the victim was really sexually assaulted still cannot always be given. The response that can be given is the results of the examination, the injuries sustained and any behaviors noted that were or were not consistent with the history obtained.

Guest Blogger Profile

Cheryl Garrison RN, CEN, SANE, CLNC has 18 years of emergency nursing experience and has been a SANE nurse for 8 years. She is cofounder of Class Act Consulting Services, LLC in Kansas specializing in emergency and abuse cases. Her company has assisted the local district attorney in the victims unit on various abuse cases. Her company partners with an elite group of Certified Legal Nurse Consultants who specialize in various nursing specialties including labor and delivery to hospice, home health and Medicare fraud cases.

Our CLNC^® Pros deliver their top techniques to boost the efficiency and thoroughness of your medical research.

1. Use only authoritative websites for medical research. Accessing research studies may require a fee which is billable to the attorney.
2. As a member of the NACLNC^® Association, Certified Legal Nurse Consultants have free access to the Internet’s preeminent legal nurse consulting resources including CLNC^® resource links, a peer-reviewed collection of hundreds of the best Internet links on medical, nursing and scientific research.
3. Simplify your medical research with the National Library of Medicine. From this site you can enter MedlinePlus^®, a comprehensive database of article summaries from international medical literature and also search biomedical journal literature from MEDLINE/PubMed.
4. Subscribe to MD Consult and conduct a minimal search for general and specific information. The site contains many authoritative and up-to-date text and journal references. As you review individual journal publications, you can search for more articles on specific topics, instead of starting a new search. This time-saver allows you to cross-reference pertinent literature and identify key search words during your original search. You can even identify literature that is critical of the researchers or their methods, sometimes with notes citing conflicting results from other studies.
5. Screen the case to analyze and prepare a brief overview of the essence of the case. This helps you focus on the relevant injuries, treatment protocols and causation issues when researching.
6. Always review the standards of any pertinent professional organization. You can identify the relevant associations through the Healthcare Standards Directory (HCS) Online. This ensures that you include these standards in your research so you don’t miss professional standards that aren’t found in your online search. For example, for an emergency room case, contact the American Board of Emergency Medicine. For an obstetrical case, contact the National Association of Neonatal Nurses and The American Congress of Obstetricians and Gynecologists. These sites offer a wealth of information. Request the information these associations publish for consumers as well. The references cited in the bibliography of any standards are also useful.
7. Decide whether you want to conduct broadly defined research or narrowly defined research. This will shape the words that you use for your research. For example “GI bleed” is more broad than “stress-related mucosal bleeding manual ventilation.”
8. Keep your beginning search simple, then do a more complex search. Sometimes the simple things are the most pertinent to the case. Don’t make it harder than it has to be. Ask yourself what you really need to find, verify or compare. Recognize when enough is enough. Gain a sense of when you’ve got enough material and move on to applying the research to the case.
9. When searching for a primary subject, such as diabetes, remember to search at the same time for related issues relevant to the case, such as decubitus. This helps you avoid duplicating your efforts later.
10. Always check the bibliography of any journal article for additional research sources. While searching for general information in texts and Internet sources, make a list of the authors who are most widely published or referenced. This list could provide additional literature sources or potential testifying experts.
11. Make note of the medications and medical products used. Then search for any drug interactions or medical device incidents that could have contributed to the case in any way. Systematically reviewing this information keeps you from overlooking any potential product liability issues resulting from defective products. If you need to research a particular drug, or medical device, don’t overlook company sponsored websites.
12. Provide copies of the research articles to the attorney and highlight relevant information in the article to emphasize what is significant and to expedite the attorney’s review.

Thanks to Suzanne Arragg, RN, BSN, CDONA/LTC, CLNC; Laura M. Averette, RN, MSN, CPHRM, CLNC; Dale Barnes, RN, MSN, PhN, CLNC; Nikki J. Chuml, RNC, CCE, FMC, CLNC; Larry Frace, RN, CLNC; Margaret Gallagher, RN, BSN, MSN, CLNC; Dorene Goldstein, RNC, CLNC; Sandra Higelin, RN, MSN, CS, CWCN, CLNC; Jane Hurst, RN, CLNC; Camille Joyner, RN, CCM, CLNC and Mildred Mannion, RN, BSN, CNOR, CLNC for sharing their strategies for researching medical-related cases.

Success Is Inside!

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.

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!

Vickie,

I am reviewing records on a case and I am summarizing them into a written chronological report for my attorney-client. I have received multiple records from different facilities and I noticed that some of the facilities’ records are duplicates of records I received from other facilities. Do I still include them in my report even though they are repeats?

Tracy Z., RN, CLNC

Hi Tracy,

First establish that the records are truly duplicate records. In your chronology, list only the original source document one time.

e.g. Martin Hope Hospital p. 35

e.g. Dr. James p. 14

Unless the duplicate record has relevance (e.g. the provider states they were not aware of something when they had records containing that information), I would suggest attaching all the duplicate records as a separate section labeled “duplicate records from other facilities and providers.” Confirm with your attorney-client that this approach works for her.

Success Is Inside!

Vickie

I doubt any of us, as CLNC^® consultants, ever forget our first case. Mine is most memorable for several different reasons. I learned so much, some of it the hard way. I had earned my CLNC^® Certification a few months earlier and used Vickie’s advice regarding marketing myself by mailing out my resume with my qualifications and a cover letter, then followed up with a phone call. One attorney had a case on his desk, which had been referred to him by another attorney. The case involved a potential client who lived out of state. The attorney drove approximately six hours one way to interview the potential client and his wife. He felt there was probable merit to the case but he needed someone to review the records. He had filed the proper notices to all the possible defendants of a medical malpractice lawsuit.

I was so excited the day the records arrived at my home. There was a large amount of records as the potential plaintiff had a five-week hospital stay with numerous complications. So I began the screening process.

The potential plaintiff, Mr. Smith, had recently been diagnosed with Hodgkin’s disease and had a mediport placed for chemotherapy treatments. However, the symptoms of a pre-existing esophageal diverticulum had become so pronounced that he decided to have an elective excision of the diverticulum with a myotomy before starting chemo treatments. Mr. Smith had an extensive medical history including a previous heart attack with placement of a stent, hypertension, hyperlipidemia, three back surgeries and diabetes.

Mr. Smith experienced several complications after the first surgery, one of which made it necessary for placement of a chest tube, which was done at the bedside by the surgeon. Mrs. Smith alleged she had not been called at home for permission so proper consent was not given for the procedure and it caused Mr. Smith excruciating pain, which resulted in a second heart attack and a transfer to ICU.

The dots just weren’t connecting. Something wasn’t right. Mr. Smith had a second heart attack which was confirmed by the medical records, but how could I prove what happened to him? How could pain from the chest tube insertion, etc., cause the second heart attack? He already had a stent resulting from the first MI, combined with the high cholesterol and diabetes.

So here I go, back to my Core Curriculum for Legal Nurse Consulting^® textbook. It almost jumped out at me, as if a light bulb had suddenly come on in my head! In Module 3, “Theories of Liability and Defenses Used in Medical-Related Cases,” it discusses the four legal elements, which must be satisfied to prove negligence: duty, breach of duty, damages and causation. The definition for causation pretty much says it all: “A reasonable connection between the acts of negligence and the alleged damages.” I felt the other three elements of duty, breach of duty, and damages were satisfied, but not the element of causation. So I read further. Under, “Factors to consider when evaluating causation,” it lists as one of the factors, “Past medical history and pre-existing conditions.” And I continued to read and in Module 5, “How to Screen Medical-Related Cases Effectively and Efficiently,” Vickie discusses defensible cases which plaintiff attorneys frequently reject because of pre-existing conditions.

So here I am feeling pretty good about myself. I am ready to type my letter to the attorney advising him that in my opinion, his case does not have merit. I used one of the samples provided in the Core Curriculum to ensure my opinion sounded professional. I relayed to the attorney that I felt Mrs. Smith had some legitimate complaints regarding Mr. Smith’s hospital stay and that while it was sad he had experienced numerous complications, it was my opinion that the element of causation could not adequately be satisfied due to Mr. Smith’s past medical history and pre-existing conditions and then I went on to list all the pre-existing conditions.

The attorney very politely informed me that he wanted me to list the deviations from the standards of care and then he would make the decision whether the case had merit.

In a much later phone conversation, the attorney stated, “Ms. Holmes you were right in the first place.” Well, needless to say, this made me feel pretty good.

There are many things I learned from my first case. One of the most important things is to communicate thoroughly upfront with your attorney-client. Don’t assume anything. If in doubt, ask questions. I think there are many attorneys, especially attorneys in small firms who have not worked with a CLNC^® consultant before and really do not know how much help we can be to them.

I have twenty-two years of nursing experience and am confident regarding my nursing skills and judgment, but I am still building confidence as a Certified Legal Nurse Consultant. Owning a legal nurse consulting business is entirely different from what I have been accustomed to doing for a paycheck. This case did boost my confidence. My first conclusion was correct and the attorney finally agreed. If we are not honest with our attorney-clients about our findings, we both will come out losers in the end.

I believe everything we need to be a successful CLNC^® consultant is included in the Core Curriculum for Legal Nurse Consulting^® textbook and the lectures that go along with it. Vickie’s CLNC^® Mentoring Program is invaluable. Each time I have used the mentoring program, my questions were answered in a very timely manner, sometimes within a couple of hours. I live in a small town and I feel isolated at times. With the mentoring program, no matter what the question is, support is readily available.

We have to make the decision to take the plunge. For me, I thought about it for approximately four years. And you know what, it’s scary. But I believe with Vickie’s help and persistence it’s possible to be a successful CLNC^® consultant.

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

Guest Blogger Profile

Peggy Holmes RN, ONC, CLNC owns and operates Holmes Legal Nurse Consulting in Arkansas. She has 22 years of nursing experience and currently works part time in The Women’s Center at the local hospital. She consults on medical related cases and specializes in orthopedics, pediatric and med-surg cases.

As a young baby boomer, I have to face the fact that one day I’ll be old. Not tomorrow and not the next day, but sooner than I want to admit. One good thing is – I’ll have lots of company. The bad thing is – all those Generation Waste kids that will be taking care of us (you know the ones with piercings, tattoos and bad work ethics).

What brought this up? The Center for Medicare and Medicaid Services (CMS) has released a rating system for nursing homes. What a genius idea! Now we can pick our nursing homes the way we pick our vacation hotels (no, they’re not on Priceline yet). The system goes from one to five stars based on factors including inspection records, number of patients developing pressure ulcers, complaint inspections and more (including staffing).

It seems the non-profit facilities had a higher number of five-star nursing homes (I never, ever thought I’d say “five-star” and “nursing home” in the same sentence) that was double the number of five-star for-profit facilities. Interestingly, the number of one-star for-profit nursing homes was double the number of one-star non-profit nursing homes. In other words, these owners put profit before people.

You can read more about this at Medicare’s website and while you’re there, download a handy “Nursing Home Checklist” to take with you when you start looking for your own nursing home. It’s got a fun nursing home locator with a variety of search options so you can see what’s available in your area.

On a serious note, as a Certified Legal Nurse Consultant working on cases involving nursing home residents, I’d be very interested in the rating for the defendant facility and any quality data you can drill down into about that facility. CMS has given the plaintiff’s bar another effective weapon in the fight against evil. The defense bar can use this too – if their facility is highly rated.

Check it out now – before you have to.

Vickie

P.S. If you want to spend your breaks reading an excellent, and moving, novel about nursing homes pick up “Old Friends” by Tracy Kidder. It will make you laugh and cry – sometimes at the same time.

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.

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