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

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

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

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

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

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

One of the first things all Certified Legal Nurse Consultants learn in the CLNC^® Certification Program is the 30 CLNC^® services you can and do provide to your attorney-clients. In today’s video blog, one of our CLNC^® Mentors shares a brand new CLNC^® service she is providing to attorneys. Watch this video to add one more service to your own CLNC^® business.

Success Is Inside!

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

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!