I have been a nurse almost 26 years, with 24 of those years working in critical care. For most of that time I loved what I did. However, the last six years have been fraught with increasing dissatisfaction with the nursing profession. I grew (in my old age!) intolerant of the toxic, disrespectful atmosphere of hospital nursing. I had increasingly grown tired of physicians, nursing administrators and hospital administrators minimizing my knowledge, experience and contributions. What else was there to do? This was it, right? But, Vickie’s ads for the Institute’s CLNC^® Certification Program caught my attention every month FOR YEARS. I thought, “That must be nice!”

In October 2007, I decided I had to make a move. I hated my job. However, due to circumstances resulting from my husband suffering a work accident, I was financially responsible for my family. I enrolled in Vickie Milazzo Institute’s 40-hour CLNC^® Certification Home-Study Program. My goal was to complete the program, and sit for my CLNC^® Certification Exam by December 2007. Viewing the DVDs, and following along with the textbook was like sitting in the auditorium of a live conference. While I didn’t achieve my goal of CLNC^® Certification in December, I did pass the CLNC^® Certification Exam on March 4, 2008. And two weeks later, I attended my first annual National Alliance of Certified Legal Nurse Consultants Conference.

I returned home from the conference energized and motivated and ready to build my CLNC^® business. But was I really? It was so comfortable to go back to what I knew – going nowhere in hospital nursing. Sure, I developed and mailed marketing folders, but contrary to what Vickie taught, I did not follow-up. In December 2008, I finally placed a follow-up call to an attorney to whom I had sent one of my marketing folders. We met for lunch the next week, and I left with a case. The attorney was a plaintiff attorney from an aggressive, successful firm. His specialty is construction accidents and products liability. I was a wreck. What the heck did I just agree to do? That same afternoon, I emailed questions to the Institute’s CLNC^® Mentors, re-read sections of my Core Curriculum for Legal Nurse Consulting^® textbook, and referred to the many real case reports included with the VIP CLNC^® Business System.

After emailing the attorney my completed report, he responded, “This is way more than I expected. We need to talk.” Again we met for lunch. He asked if I would “take control” of working to create a visual to use in court as demonstrative evidence of the client’s damages. “Absolutely!” I responded. On my ride home, my thoughts were, “Where do I start?” Then I remembered I had a business card from a medical illustrator vendor that exhibited at the NACLNC^® Conference. With a budget of essentially nothing, and a timeframe of just two weeks, I worked with a phenomenal team in Florida to create a 2D presentation of our client’s injuries. The presentation was used during the expert testimony portion early in the trial. On the evening of the fourth day, the defense offered a settlement of $4.5 million.

For the next four months, I continued to work for this attorney. His paralegal would email me that there was a case that needed to be picked up. I would develop the case, and, with great anticipation and excitement, wait for the next email. All the while, I was spending most of my time in a hospital position which exhausted me, both physically and mentally.

Vickie’s words resonated in my head: “Go all in.” Summer was approaching, and it was as good a time as any. I emailed my attorney-client, expressing my desire to consult on more medical-legal cases. He responded by asking me to come down for a meeting as he had “an idea that will work for both of us.” I met with the attorney-client, his paralegal and his secretary. He asked me to be his medical-legal coordinator. “Did you just make up this job title?” I asked. “Yep,” he chuckled.

I maintain a consultant status, but completely manage the medical issues of all the attorney’s cases. My most common CLNC^® services include reviewing medical records and developing chronologies, researching and defining alleged injuries, researching past medical history, calculating pain medication requirements post-injury, working with medical illustrators to create demonstrative evidence, writing comprehensive reports and assisting with discovery. I present possible defenses, and suggest the best expert witnesses. I speak with my attorney-clients at least monthly to just “check-in.” My attorney-clients love this! I also attend trials and depositions.

I took a leave of absence from my job at the hospital for the summer and have not gone back! I worked from the beach all summer! My time was totally my own – I could work at the crack of dawn or after midnight. My goal, by the end of 2009, was to bill $8,000.00 for one month. For December 2009, I billed for $10,000.00! And this was just part time!

I love what I do. I feel appreciated and part of a team again. My nursing knowledge is valued. Thank you, Vickie, for giving me the tools, support and encouragement to be a successful Certified Legal Nurse Consultant. As Vickie says, “We are nurses, and we can do anything!^®”

Guest Blogger Profile

Annmarie Johnson, RN, ASN, 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.

During my 10+ years as a Certified Legal Nurse Consultant, I have been fortunate to have worked with a few of the most prestigious elder abuse attorney litigators in the U.S. Being a member of the trial team is an experience that for me epitomizes the world of legal nurse consulting. It is the high point of my CLNC^® business and I consider it to be a privilege. While I could share many remarkable stories, two experiences stand out.

The first experience was the second time I had been a part of a trial team. As a CLNC^® consultant, I worked the file inside and out, read thousands of pages of medical records, hundreds of pages of deposition transcripts and worked with the testifying experts in preparation for their trial testimony. Finally, we were in trial. I sat in the first row of the audience and, as my attorney-client instructed, passed notes to the bailiff who in turn gave them to my attorney-client. I watched plaintiff counsel put on their case. Finally, the plaintiff’s RN testifying expert was on the stand. Direct examination completed and cross examination had begun. I began to fervently write potential questions on my note pad and passed them along. Then the judge called for a break.

My attorney-client motioned for me to approach the defense table. He said, “Suzanne, take me through this line of questioning.” Point by point; I lead him through what I thought was a convincing defense clinical argument. Our goal was to “poke holes” in the plaintiff expert’s opinion. My attorney-client was so impressed with my argument, he turned to me and said, “Suzanne, you should be an attorney!” I was flattered and gasped all at the same time! I never thought I could use my nursing expertise to help a legal team! I have no desire to become an attorney, but I am sure thankful and excited to be a successful Certified Legal Nurse Consultant!

My second outstanding experience was as a testifying expert. I was asked to render my opinion regarding the nursing standard of care in a nursing home elder abuse case. The case surrounded a fall, fracture, skin tears and bruises. Many hours went into trial preparation. My opinions were laced into my defense-client’s opening presentation.

Finally, it was my turn to testify. The adrenaline was racing through my veins. Boy, was I pumped! Direct examination went well. Now it was plaintiff’s turn. Cross-examination proceeded fairly well. Counsel repeated questions previously asked and tried to change them in an attempt to trip me up. It wasn’t working. I could see he was becoming frustrated. The volume of his voice began to rise. All the while, I sat relaxed (so I’m told) in the witness chair.

Then came the line of questioning surrounding a dog bite that was sustained during routine pet visits. The resident had pet the dog, as he had so many times before, but this time the dog nipped him. The “bite” healed uneventfully. Because the attorney couldn’t rattle my cage, he blurted out the question, “What kind of dog was it, anyway?” I paused, but before an objection could be given, I responded, “That’s irrelevant.” The jury laughed, my attorney-client at the defense table smiled, and the plaintiff’s attorney was left speechless!

When I got the call that the jury had found for the defense, I was thrilled. My attorney-client was also thrilled with the verdict, and was especially thrilled with my testimony and appreciative of my input as a member of his trial team.

Suzanne E. Arragg, RN, BSN, CDONA/LTC, CLNC

My tech tip this week is a spin-off from Vickie’s blog about What Certified Legal Nurse Consultants Can Learn At the Mall. If you’ve been in a movie theater, mall or computer store lately, I’m sure you’ve seen that HP is pushing its Photosmart Premium TouchSmart Web All-in-One printer. Like any other printer, it can be plugged directly into a home network. It also has a built-in wireless connection that can tap into your home wireless network (“Look Honey, no more cables.”), allowing you to place the printer wherever you want. What’s truly novel about this new printer is that it’s “Internet-enabled.” Yes, that’s right, you can use your printer to search the Internet and print what you find – a map, photo, Web page, whatever. If you can stand the small screen, then you don’t even need a computer or monitor to use this printer. Is that the genius or the defect?

Obviously this printer isn’t designed to replace a computer. Certified Legal Nurse Consultants still need to create documents for their legal nurse consulting businesses, send emails to attorney-clients and do lots of other things on a computer. So what exactly is the purpose of a device that prints without need of a source other than the Internet? Well, it has slots for camera memory cards, but does anyone want to edit photos on the printer versus a computer? Yes, you can print Fandango movie tickets, maps from Google, parts of USA Today and coupons. But, do you really want to surf the web on a 4″ screen and more important, what kind of virus protection will it have? I played with this printer at my local movie theater and if this is the future, you can include me out.

Don’t get me wrong, HP makes great printers and their new printer is getting good reviews. But as a fax and scanner, it’s missing something absolutely necessary in my opinion – an automatic document feeder. So what’s its purpose other than to sell more ink cartridges by getting you to print more color documents?

That, my CLNC^® amigos, is the question. The lesson to be gleaned from this printer is pretty clear. If you have to go to great lengths to explain to an attorney-client or attorney-prospect why they need a particular service (or an Internet-enabled printer, refrigerator or beer cooler), they might not really need it. Certified Legal Nurse Consultants all know that there are 32 legal nurse consulting services you can offer your attorney-clients and attorney-prospects that they really, genuinely need. But not all of them need all 32 CLNC^® services. Plus, if you’ve come up with the killer 33rd or 38th service and nobody (and I mean nobody) gets it – maybe that’s because THEY DON’T NEED IT. You could be ahead of your time or your legal nurse consulting career may have jumped the shark.

Remember what Vickie’s taught you – do your research and market to the needs of your attorney-clients and attorney-prospects. If there’s a CLNC^® service they’re not using yet, make sure it’s one that fits them before you pitch it to them. Market smarter, not harder.

In the meantime, if anyone has any other candidates for useless or even useful “Internet-enabled” devices or appliances (besides really big screen TVs) comment and let me know.

Keep on techin’ and I’ll see you next year!

Tom

That’s a pretty powerful question with many different answers. Back in June, I tweeted about a high-profile case that involved an MD who was blogging about his medical malpractice trial as the trial was in progress. I used this as an example to illustrate why Certified Legal Nurse Consultants should recommend that their attorney-clients check out social media (and the blogosphere) for postings by opposing parties (and their own parties), before and during a trial. That case ended in a substantial settlement for the plaintiff after the MD was shown to have exposed trial strategy, ridiculed the case and made generally inappropriate postings for which he was confronted during the trial.

Another MD blogged about a recently concluded medical malpractice trial. His blogging initially raised all sorts of HIPAA questions (which became a nonissue once the suit was filed and anything happening at trial became public). Just to be safe, the MD allegedly changed some of the “facts” as you can read in his disclaimer. This raises issues of what sort of information should or should not be exposed, even after a trial. Granted you can sit in a courtroom, listen to the testimony and see the evidence, but you are not privy to the thinking, reasoning and strategy decisions of the attorneys and the parties they represent. Perhaps that’s something an attorney wouldn’t want his defendant or plaintiff blogging about. Read the articles and analyses on both these cases and make your own decisions. Keep in mind that attorneys are under their own ethical restrictions that we’ll discuss below.

A famous poker player won’t appear on those poker television shows that televise a player’s hand. He doesn’t want people to see how he plays, bluffs or calls on certain hands because they could develop a strategy to beat him. Trial attorneys might feel the same way about having their strategies exposed.

That being said, let’s look at a different set of potential bloggers, the jurors and/or courtroom spectators. In our electronic age no one, and I mean no one, likes to be “off the grid.” Spectators blogging from the courtroom are the equivalent of news reporters and don’t present a problem.

Smart phones with easy Internet access like the Blackberry^® or iPhone^® have created modern day courtroom issues. Judges have always admonished jurors not to read about a case or view television trial coverage, but how many judges give jury instructions regarding blogging? Tweeting (micro-blogging) and even researching the basis of the parties’ claims raises issues during a trial. Even something as simple as texting can be problematic. Remember, jurors are supposed to make their decisions based solely on the information they receive in the courtroom – only the evidence introduced at trial. So if a juror reads a blog about the trial, that would be the same as viewing a news report about the trial or Googling the underlying claims. That sort of behavior risks prejudicing the case or raising the possibility of a mistrial. Attorneys should search social media and the blogosphere during and after trial for traces of this type of misconduct. Some people are shameless about what they post, so armed with a few keywords and content of text messages sent during a trial, it can be quite simple to discover and possibly render a juror liable for contempt.

So far we’ve discussed the plaintiffs, defendants and jurors – what about the plaintiff and defense attorneys? Any Certified Legal Nurse Consultant will remember from the Institute’s CLNC^® Certification Program that attorneys are ethically prohibited from disclosing certain confidential client communications without the client’s consent. This applies to the blogosphere both during and after trial. But what about statements made in advance of trial or while selecting the jury that might tend to influence a well-read jury pool? A few attorneys make money writing books about their high-profile clients but that’s well after the client’s gone to jail (or not). A gag order by a judge can preclude an attorney from blogging about an ongoing trial. Attorneys may use hypothetical postings as long as there is no reasonable likelihood the client or situation can be identified. With all this in mind, blogging, texting and even list serve postings will be an issue to watch (or read about).

Judges, like attorneys, are ethically restricted from discussing pending or ongoing matters being litigated. So, if you think you see the judge texting from beneath the bench, let your attorney-client know. They may not want to risk the ire of a judge who’s simply discussing dinner plans, but might infer the judge wasn’t fully present during trial.

Finally, there’s you – the legal nurse consultant. As you work closely with the attorney-client and the litigation team, you’ll have inside information about the case, the parties, strategies, etc. As an agent of the attorney you are also precluded from disclosing certain confidential information. If you value your legal nurse consulting business you must refrain from tweeting and blogging about a trial in progress (“The defense expert is getting blown away – we’re moving in for the kill with my questions on SOC.”) without your attorney’s knowledge and permission. In fact, I recommend you not discuss your cases at all on the Internet. Frankly, it’s poor business practice.

Social media and blogging are emerging parts of cyberspace and both sides in the legal arena need to explore and monitor their usage. It’s a brave new world of communications and communicability for legal nurse consultants and the legal profession. If you use your mind (while others around you are losing theirs), you’ll successfully avoid any amateur mistakes.

Success Is Inside!

Jane Hurst, RN, CLNC has become the first international legal nurse consultant, consulting with a Swedish medical device company. Her consulting business has taken her to Sweden and this summer she’ll be presenting on legal nurse consulting and medical device cases at a European conference.

Jane has been a CLNC^® consultant for 17 years. On behalf of more than 6,000 Certified Legal Nurse Consultants and the NACLNC^® Community I’d like to celebrate Jane’s international success.

Wherever there are attorneys, there are opportunities. I challenge all legal nurse consultants to think globally about your legal nurse business and market internationally to take your entrepreneurship to the next level.

Success Is Inside!

Read Part 2. Read Part 3.

For the first time in my memory nurses are getting laid off in significant numbers. The deteriorating health of our economy is affecting almost every U.S. job – this includes nursing. But as I am hearing from the registered nurses I’ve trained, a career as a Certified Legal Nurse Consultant is a recession-proof choice.

My sincere gratitude to Dale Barnes, RN, MSN, PHN, CLNC for taking the time to talk with me about how the economy has affected the health of her CLNC^® business. Dale has been a CLNC^® consultant since 1999 and specializes in medical malpractice, bad faith insurance and general personal injury.

How is today’s economic climate affecting your CLNC^® business?

Dale: Vickie, I’m here to tell you working with attorneys is recession proof. I’m busier than ever. Everything a CLNC^® consultant does is related to medical issues and healthcare, and those cases are still pouring in. During a tough economy, some people look at a lawsuit as another revenue stream. So attorneys are busy. Even when I tell my attorney-client, “There’s no merit here,” I still get paid, plus it keeps nonmeritorious cases out of the system.

Are new attorneys approaching you?

Dale: Just last week a new attorney called and hired me as a legal nurse consultant for his bad faith insurance case. When people are financially strapped, an insurance claim becomes an asset. The claimant expects the insurance company to cover everything so when a claimant feels undercompensated or cheated, they call an attorney.

What other kinds of medical-related cases are you seeing?

Dale: Everything. I just finished a large home care defense case. A man’s wife had multiple sclerosis, and he was her sole caregiver, refusing to have anyone else in their house. Over the years, as his wife’s health deteriorated, the home care nurses noted that he was noncompliant with instructions for his wife’s care. He wouldn’t turn her every two hours, as directed, and she got one decubitus ulcer after another. She had a Foley catheter for a time and got a urinary tract infection. When she finally turned septic and died, the husband filed a suit, claiming that the wound care supplies the nurses used had caused her infection. This was off base, but the case went on and on. He was obviously trying to make a buck. I helped the defense put together a strong case, and the husband struck out.

You must have felt like a CLNC^® champion on that case.

Dale: Absolutely. I had another case recently that involved using restraints on a hospital patient. The nurses had orders to use restraints but decided not to. The woman fell out of bed, suffered a subdural hematoma and died. A terrible situation, in which fault and liability are not clear.

So the types of cases run the gamut. I’ve had a number of motor vehicle accident cases. I have one attorney-client who does nothing but dog bites, and he sends me several cases every week. They take a long time to come to fruition, because the cases usually involve children, but this attorney’s business isn’t down one bit, and I’m still getting all of it.

Do you handle more cases for defense or plaintiff attorneys?

Dale: About equal. Whichever side I’m on, if I see a weakness, I tell my attorney-clients up front. And, as you teach, Vickie, we are saving our court systems time and money by keeping nonmeritorious cases out of court – another plus in a down economy.

Do you use a network of CLNC^® consultants as subcontractors to help you with your busy caseload?

Dale: Yes. I use CLNC^® consultants for two reasons: 1) to leverage my time during those periods when my caseload is just too much for me to handle, and 2) when I get a case that is out of my area of expertise. Being part of the National Alliance of Certified Legal Nurse Consultants is the best place to look for my CLNC^® subcontractors.

Success Is Inside!

Lawyers USA, one of my favorite legal publications, reported that Fosamax^® lawsuits are set to take off in 2009. Fosamax^®, manufactured by Merck is used for treatment of osteoporosis.

700 plaintiffs are alleging that Merck failed to warn users of the potential risk of osteonecrosis of the jaw which causes the jaw to deteriorate. The plaintiffs also allege that the FDA upon approval in 1995 requested Merck to perform further testing and place a warning on the package.

Another reported alleged complication of Fosamax^® is atrial fibrillation.

Certified Legal Nurse Consultants interested in Fosamax^® litigation should research on the Internet both the plaintiff and defense attorneys representing these cases. Fosamax^® cases will undoubtedly increase in number, and will create a long-term legal nurse consulting opportunity.

The 30 CLNC^® services Certified Legal Nurse Consultants provide are relevant, and here are some examples of how you can apply these 30 CLNC^® services to Fosamax^® cases.

1. Assess all relevant prior medical records for causation and risk of osteonecrosis unrelated to Fosamax^®. (Example – history of receiving chemotherapy.)
2. Provide a detailed history regarding the plaintiff’s use of Fosamax^®.
3. Assess and provide a summary of medical records for evidence of osteonecrosis or atrial fibrillation and related injuries and damages.
4. Research, summarize and create a “library” of all relevant, peer-reviewed articles on Fosamax^® and its relationship to osteonecrosis and atrial fibrillation. Educate the attorney about the mechanism of Fosamax^®. Avoid nonauthoritative Internet services.
5. If working with an attorney who represents numerous plaintiffs, identify the percentage of plaintiffs who have osteonecrosis, atrial fibrillation or both osteonecrosis and atrial fibrillation.
6. Develop a plaintiff interview form focused on Fosamax^® to interview plaintiffs quickly and consistently.
7. Locating medical experts, i.e., pharmacologists and dental surgeons who are qualified to testify to alleged defect and causation issues. Communicate with experts on behalf of your attorney-client.
8. Analyze and summarize all medical expert testimony for accuracy, and both favorable and unfavorable opinions.

Fosamax^® cases will be a hot topic for years to come. This is the time to jump in and be part of this very interesting litigation. Incorporate these eight specific services when you market your legal nurse consulting business, and attorneys handling Fosamax^® cases will instantly see how you can save them time and money.

Success Is Inside!