One of the marketing strategies I teach in the CLNC^® Certification Program is to network with everyone who comes within three feet of you. In this quick video, Catherine Cass, RN, CLNC shares how she used this marketing strategy right out of the Core Curriculum for Legal Nurse Consulting^® textbook to land a lucrative testifying expert position – even before she’d left the CLNC^® 6-Day Certification Seminar in Las Vegas.

It doesn’t get any better than this.

Success Is Inside!

I started my legal nurse consulting business with the intention of testifying, but working behind the scenes with attorneys was how I really built my business. Despite that fact, I was always open to testifying and did so occasionally. And that’s exactly what you should do when your attorney-client asks you to testify. That’s right, go ahead, say yes!

Testifying is free advertising and an instant credibility-builder with attorneys. When you’re up against the opposing attorney remember: that attorney is not the enemy, he’s just another potential prospect. If you do a great job, that attorney will never want to go up against you again. The result? He will be sure to hire you first on his next case.

Next time an attorney asks you to testify in a case don’t reject it outright, go for it all the way! Remember who you are, a registered nurse with valuable knowledge and years of nursing experience. And if you start to panic, remember that 95% of the cases will settle before trial anyway so your likelihood of reaching court is exceedingly low (really).

When you “just say no” to testifying, you’re not only missing a huge opportunity to demonstrate your proficiency, but missing out on the opportunity to gain new attorney-clients for life!

Success Is Inside!

P.S. What are your biggest fears about testifying? Comment here to share.

Video conference facilities have long been used to allow witnesses to offer testimony in different types of court cases; however, use of this technology can be costly. We’re now seeing the first instances of witnesses testifying in court via Skype^®. In a Georgia criminal case, a defense witness was allowed to testify via Skype over objections from the prosecution, and in a Pennsylvania child custody case, the deported parents of two small children were allowed to testify from Mexico via Skype.

I’m sure we’ll continue to see more courtroom use of low-cost technologies such as Skype in the future. But courtrooms aside, are you using Skype in your Certified Legal Nurse Consulting business? We use Skype here at Vickie Milazzo Institute to connect with subcontractors and CLNC^® Mentors, hold meetings and cut down on long distance conference call costs.

It’s time you added Skype to your legal nurse consulting business. It’s simple to use. Once you download the Skype program, install your webcam/microphone, establish a broadband Internet connection and you’re ready to go. You can conference with attorneys on a case, discuss a case with your CLNC^® subcontractors and stay in touch with the Certified Legal Nurse Consultants in your alliance just to name a few.

Smart Certified Legal Nurse Consultants know to incorporate new technology into their legal nurse consulting businesses. It’s time to count yourself in!

Success Is Inside!

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!^®”

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

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!

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.

Every Certified Legal Nurse Consultant knows that after a patient has a stroke, the care they receive in the first 3-4 hours is the most crucial. The type of stroke influences the treatment so proper recognition and diagnosis are essential. Despite this knowledge, the National Quality Forum (NQF) recently rejected a proposed guideline that would have called for a CT scan within 45 minutes of a patient presenting to the ED. Why is this important? The NQF sets the medical guidelines that are used by the Centers for Medicare & Medicaid Services (CMS) to evaluate (and reimburse) hospitals. So, with no reimbursement, the likelihood of a patient getting a CT scan drops pretty dramatically.

Hospitals receiving Medicare funding will soon be reporting how well they comply with guidelines for stroke treatment, even though one of the most important diagnostic tools for stroke (a CT scan) was not done.

The American Association of Neurology pushed strongly for the guideline and the American Stroke Association’s (ASA) guidelines for stroke care include the recommended 45-minute standard for scans. According to the ASA nearly 700,000 Americans incur a stroke annually, with 170,000 fatalities. In other words, an American suffers a stroke every 45 seconds and every 3 minutes, one of these stroke victims dies, so it’s very likely you’ll run into a case involving a stroke at some point in your legal nurse consulting career. As a CLNC^® consultant working on stroke cases, you should establish whether the standards of care for diagnosing and treating stroke were adhered to by the potential defendant hospital and healthcare providers. Establish not only whether or not a CT scan was done, but how timely it was ordered, completed and interpreted. Despite NQF, who looks like they had a stroke (not a stroke of genius) reputable testifying experts will be testifying in medical malpractice cases that a CT scan within 45 minutes of presenting to the ED is the standard of care.

Success Is Inside!

P.S.     Comment and share your vote on NQF’s decision.