Savvy CLNC^® consultants have realized that smartphones are their mobile office and use them not just to talk with their attorney-clients, but also to keep up with their appointments, contacts and important email. No more waiting until you get to your computer to check your email or respond to an attorney-client.

However, smartphones have a darker side, especially when people are talking or texting while driving. In motor vehicle accidents (MVA) cases attorneys are now requesting the opposing party’s cell phone records for the time period of the accident. Those records will show whether the party (plaintiff or defendant) was talking or texting and that fact will not go down well with the jury. For a defendant, cell phone use will be labeled as negligence despite the fact that it is so ubiquitous. For the plaintiff, cell phone use can cause the jury to determine that the plaintiff was comparatively negligent.

Further adding to that already dangerous mix are the increasing complexity of automobiles with in-dash DVD video playback and GPS-aided driving direction systems that can be programmed while driving. As the technology available in our cars increases so does the complexity of MVA cases. They’re getting more and more interesting by the mile and by the minute!

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I have to admit, unlike Tom, there are not too many devices that give me “gadget envy.” One that does is the iPad2^®. I’m sure there’s an iPad in my future – if for no other reason than to allow me to read magazines and books while listening to music or to watch my own choice of movies on long international flights. Other than the obvious email, web-surfing and entertainment uses, I’ve been trying to find professional uses, so I surveyed attorneys and Certified Legal Nurse Consultants to ask how they use their iPads. I also spoke with a friend who has a company that creates demonstrative evidence for law firms to see how he’s using his iPad.

Attorneys and CLNC^® consultants are well aware that with an iPad they can easily access the Internet to research an expert or other subject during a deposition or trial, or email their office for help, documents or vital information.

There’s also a rapidly growing world of legal apps that attorneys find useful, such as The Deponent App. This app links to a database of sample deposition questions that are grouped by question type. Of course, each case is different so attorneys will want to customize and add their own questions and the app lets them. But here’s the best part: Deponent allows you to link a particular question to an exhibit – so long as the exhibit is stored in an Adobe^® pdf format. This popular feature can help keep the attorney from losing track of an exhibit or an expert’s CV during the deposition process. Of course, to enter exhibits such as documents, photographs or other demonstrative evidence, etc., into the court record, attorneys as of today still need to have paper copies that can be properly marked and admitted into evidence.

Attorneys and Certified Legal Nurse Consultants can also use Deponent to take deposition notes on the iPad instead of on a trusty legal pad and to annotate an exhibit with comments or follow-up questions. All that aside, Deponent does have some limitations, but it’s a good start and an evolving app.

Another must-have for attorneys is a file-management app that helps organize and keep track of files and allows remote access to a desktop computer to retrieve documents (in case she forgets a document, exhibit or her depo notes).

My friend with the demonstrative evidence company is an early-adopter and loves his iPad for making sales calls and especially for reviewing trial graphics in an attorney’s office. He can examine, blow-up and, in some cases, annotate an exhibit if it’s in pdf format. His creative staff can then edit that graphic or create new ones and get them to him on-the-fly. He and his attorney-clients have great discussions over which demonstrative evidence will enhance their position in the case.

My friend brought up another logical use, one that I must admit I hadn’t thought about, and that is the ability to view accident scenes and other locations using Google^® Earth. From that “view,” they can also discuss how to present evidence visually, create supporting animations and to make an initial (and often subsequent) site visit without what can sometimes be a fruitless and time-consuming trip from the office.

CLNC^® consultants can use the iPad in a fashion similar to my friend’s – for showing sample work-product, graphics, etc., during sales calls to attorney-prospects. When consulting with an attorney-client on a case, the ability to research something or illustrate that point without the need (or wait) to boot up a laptop is priceless. Like the attorney, you can take notes during deposition and trial and also access copies of the medical record, X-rays and other stored documents as you follow an expert or party’s testimony. You can also use it to keep up with your email from other attorney-clients during breaks. But the best part is that at the end of the day, you’ll look wicked cool and cutting-edge in the attorney’s eyes, which can only help with your branding.

iPads are certainly making increased penetration into the legal and legal nurse consulting worlds. Are they a necessity? Not yet. Are they a great accessory? Yes. As more and more legal-related apps are developed, I’m sure that Certified Legal Nurse Consultants will find new ways to use them to expand their CLNC^® practices. Hmmm, I wonder if I should get mine now?

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Plaintiff and defense attorneys have been given an incredible gift by Mark Zuckerberg and the Facebook team. I’m not sure that Facebook had the plaintiff or defense bars in mind when they added the upgrade that allows Facebook users to download a “complete” copy of the postings to their profiles. This tool captures messages sent back and forth by members using the messaging function and captures postings to your profile, video, photographs, etc.

I’ve blogged in the past about the discoverability of postings on Facebook and other social media sites. Prior to today, when it’s been claimed that content on a site like Facebook is subject to discovery, judges have gone to great lengths, including extremes such as “friending” a party in order to do an in-camera review of that party’s Facebook page to determine whether or not the content is relevant to a lawsuit. In other cases where a Facebook profile was provided, discussion threads may not have been fully expanded so information was left out and there were other anomalies that occurred which interfered with full discovery. Today, an attorney can simply request that a party’s entire Facebook profile be downloaded and ask for the full profile or just the relevant portions. The other party cannot object or claim that it would be a burdensome or impossible process.

We all know Facebook can be a place where people let down their guard, speak freely and, unfortunately, sometimes behave badly. In your legal nurse consulting cases you may want to bring your attorney-clients into the loop about Facebook and the wealth of information available there. At the same time, let’s all remember that we’re all creating a vast and permanent digital footprint. Let’s set good examples by keeping ours clean.

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Most Certified Legal Nurse Consultants consult with attorneys behind the scenes and never testify on a single case. Despite the fact that you can build a very successful CLNC^® business without serving as an expert witness, I always encourage CLNC^® students to be open to this amazing and challenging experience.

I wanted to share how three Certified Legal Nurse Consultants regard testifying. These three experiences literally took their breath away.

I remember how scared I was to take on being a testifying expert when I became a Certified Legal Nurse Consultant. I knew that I could support my opinion, but was I ready? Having been an obstetrical nurse for over 15 years, I was sure that I was an expert. I just had to do it. I met with my attorney-client the day before I was to testify and we went over what to expect. This was my first deposition and he knew it. I asked him questions until I felt like I was ready.

The next day I arrived ready, but nervous, for my deposition. The deposition was over three hours long. I felt very confident and kept saying in my head, ‘I know so much more than the attorney does about fetal monitoring strips.’ When the deposition ended my attorney-client looked at me and said, “Wow! That was great. I don’t know how you prepared for this but you did a great job!” It was at that moment that I knew my training from Vickie and her Institute had really paid off. I truly believed I could do anything. I had given my first deposition and now I had the fever! Bring on the next one!

– Dorene Goldstein, RNC, CLNC

I was defending a nursing home as an expert witness. The plaintiff attorney had been a nurse. The expert witness for her case was also a nurse with impressive credentials. What she lacked that I possessed, however, was real, on-the-job experience working as a nurse in nursing homes. I was able to demonstrate actual knowledge of nursing responsibilities, documentation and experience with the nursing home medical record. I was able to prove to the plaintiff attorney that the allegations were not substantiated by the medical record. She was clearly frustrated and embarrassed during the deposition. The case settled.

I cannot express in words how exhilarating it is when you experience these breathless moments. They make me realize what a great profession legal nursing consulting is. As a Certified Legal Nurse Consultant I have chosen to make a difference in this world.

– Sandra Higelin, RN, MSN, CS, CWCN, CLNC

For three Administrative Law Judge Medicare hearings, the testifying physician was called away unexpectedly. The attorney elected to go ahead with the hearings without the testifying physician, provided that the Administrative Law Judge in question was willing to allow it, which, under the circumstances, he did. The RN testifying expert was unable to attend and the substitute nurse froze. So, I stepped up and agreed to be sworn in to testify. It was a matter of putting surgical procedures and the ramifications for the particular patient into layman’s terms for the judge to understand. Since this is done telephonically, there were no visual aids. My testimony helped us win all three cases!

– Camy Joyner, RN, CCM, CLNC

I’m excited to have Dorene, Sandra and Camy share their expert testifying experiences with nurses everywhere. It is clear they love what they do as Certified Legal Nurse Consultants. “We Are Nurses and We Can Do
Anything!^®”

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Making a list,

Checking it twice,

Don’t want to kill a patient,

That wouldn’t be nice…

According to Dr. Atul Gawande, the average patient in an ICU requires “a hundred and seventy-eight individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them poses risks. Substantial parts of what hospitals do – most notably, intensive care – are now too complex for clinicians to carry them out reliably from memory alone. ICU life support has become too much medicine for one person to fly. Any of us who’ve worked in the ICU shouldn’t be surprised by Dr. Gawande’s assertations. But what to do about it?

Here at Vickie Milazzo Institute we use checklists for everything. There’s not a major project, including the National Alliance of Certified Legal Nurse Consultants (NACLNC^®) Annual Conference (801 action items) that doesn’t have a major checklist. We find it not only keeps us from reinventing the wheel each time we start a new project (saving us time and money) but it also ensures that no moving parts are missed when we put something together. We even joke that we have checklists to make sure we have all our checklists!

Think about your life – you probably send your hubby to the grocery with a checklist. (Car keys – check. Checkbook – check. Grocery list – check). You (at least I do) pack for a trip with a checklist. (Bathing suit – check. Sunscreen – check. Mirrored shades to check out the hunky lifeguards – check). Checklists are part of everything I do and probably a large part of what you do on a daily basis also. Tom even has a checklist to make sure that he’s included all the proper clauses in the contracts that he writes (yawn).

How about using checklists to ensure safety instead of making sure you’ve got the loaf of bread, pound of pastrami and jar of mayo? This really isn’t a new idea. Since 1935 pilots have been using checklists to cover just about every aspect of flying an airplane, starting with the pre-flight inspection, taxiing, take off and landing. (Wings on – check. Wheels down – check. Dinner reservations at destination – check). Millions of passengers are delivered safely to their destinations each day thanks to simple checklists.

Now ask yourself as a Certified Legal Nurse Consultant, “how many patients are harmed because doctors (and maybe even nurses) don’t use checklists when doing complex medical procedures or simply treating patients?” The answer is, too many. Consistent protocols for patient care have been advocated by physicians since 1600 B.C. (Linen robe on – check. Snake-headed staff in hand – check. Leeches on patient – check.), but it wasn’t until 2003 that Dr. Peter Pronovost came up with a simple checklist to help reduce line infections in the ICU. That list was so successful that line infections in his hospital were reduced to almost 0%. Buoyed by this success he created other checklists which eventually were adopted by the state of Michigan for use in its ICUs. The results from implementation of those lists were so successful that Dr. Pronovost ended up publishing them in The New England Journal of Medicine in 2006.

In the almost three years since that study, not much else has happened with checklists. Apparently simple common sense just isn’t exciting enough for cutting-edge healthcare providers. You’d think that the medical and nursing professions would have expanded the use of checklists, but this hasn’t happened on a wide scale other than when you check-in at the hospital. (Insurance card – check. Ability to pay – check.)

That might be about to change though. The New England Journal of Medicine recently published the results of a study that involved using a simple, 19-item surgical checklist. The results were stunning: mortality rates in surgical patients were reduced by almost 50% and the same reduction was mirrored in nonlethal complications. With these sorts of results I hope that we’ll see a profusion of checklists in healthcare. The cost savings alone should get the attention of somebody. Perhaps checklists might be a simple way to reform healthcare. (Patient on table – check. Correct patient on table – check. Anesthesiologist sober – check.)

We know here at the Institute that a simple printed list can make a big difference, in time and money. Now healthcare providers are learning that checklists can save lives too. It’s time for healthcare to catch up with grocery shoppers. Next time you work up a case, have your attorney-client ask the healthcare providers for any checklists used in treatment of the patient. They should also ask each provider during deposition, how they ensure that they take each and every one of the proper steps in treating that patient. With such a line of questioning I can guarantee the jury will wonder why, in a world where a pilot won’t land an aircraft based solely on “memory,” a healthcare provider would do a risky procedure (e.g. brain surgery) on memory alone.

When you are consulting with attorneys on medical-malpractice cases helping to prepare interrogatories, requests for production and deposition questions be sure to ask about the use of relevant checklists in the healthcare setting.

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P.S. Comment and share checklists used in your healthcare facility.