Memorable Case

As a Certified Legal Nurse Consultant, I have had a number of wonderful experiences. These are the three memorable ones I want to share with CLNC^® consultants everywhere. After reading this, I hope you’ll agree that we do make a difference.

The first case involved an autistic 19-year-old boy. He was put on a new medication, not monitored properly and ended up being self-abusive to the point of severely injuring himself. He tore his face apart and became septic. His parents were frantic. I was able to pinpoint the issues for the attorney. Before I reviewed the case and made my recommendation, the physician had refused to change this young man’s medication. I was instrumental in getting him the appropriate help so that his behavior returned to baseline. His parents and the attorney were so grateful. The attorney continues to consult with me, and also frequently refers me to other attorneys. This case gave me one of my first opportunities to say, “Ah ha! I see what legal nurse consulting is all about.”

The next experience was with an attorney I have worked with for years. He only does cases involving dog bites. However, in one case, I found that it was not just a personal injury case, I discovered malpractice. The case suddenly got much more intense and the depth of requested information increased. My information provided my attorney-client with a finished product he will never forget. The case grew to voluminous proportions once I uncovered the malpractice. My attorney-client tells everyone how pleased he was with my CLNC^® work product, and how fortunate he feels to have a Certified Legal Nurse Consultant help with his cases. He says this case proved why he cannot do any of his medical-related cases without me.

My third memorable experience is not a case but how wonderful I feel when I meet CLNC^® students. I have such a positive sense of satisfaction when they tell me that the opportunity to speak to a full-time practicing Certified Legal Nurse Consultant helped them make the decision to go forward with becoming a CLNC^® consultant. I feel I am a part of an exciting new start for a fellow nurse, looking for a new way to use his/her nursing knowledge. I know for them, like me, that going through Vickie’s Certified Legal Nurse Consulting program will be a life-changing decision, and knowing I’ve made a positive difference in their lives makes me feel very excited and happy.

I love making a difference as a Certified Legal Nurse Consultant.

Dale Barnes, RN, MSN, PHN, CLNC

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 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.

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.