medical malpractice

I asked the CLNC^® Pros to share the websites they use most often for researching their medical-related cases. I invite you to bookmark your favorites.

Agency for Healthcare Research and Quality
Offers links to clinical information and current clinical research.

American Academy of Family Physicians (AAFP)
Offers links to journals, policies, position statements, references and resources pertaining to family practice.

American Association of Critical-Care Nurses (AACN)
Provides clinical resources, standards, journals, education and certification information for the critical care nurse.

American College of Physicians (ACP) PIER^® (Physician Information and Education Resource)
Comprises over 490 modules focusing on clinical topics as well as an extensive drug database and helpful patient information. Free to ACP members.

American College of Radiology (ACR)
Outlines standard of care, quality and safety resources, clinical research and news and publications.

American Heart Association
Provides statements, guidelines, clinical updates, news, continuing education, publications and statistics.

American Medical Directors Association
Supplies links to AMDA’s publications and products, news releases and resource library. Specific sections address the interests of medical directors and physicians who practice in long term care.

American Nursing Association (ANA)
Contains the nursing scope of practice including administration.

American Society of PeriAnesthesia Nurses (ASPAN)
Contains standards, education, links and publications.

Association of periOperative Registered Nurses (AORN)
Contains education, standards of practice and peer networking for the OR nurse.

Centers for Disease Control and Prevention (CDC)
Promotes health, prevention of disease, injury and disability and preparedness for new health threats. Also provides intra-agency support and resource-sharing for cross-cutting issues and specific health threats.

CINAHL
Provides the Cumulative Index to Nursing and Allied Health Literature (CINAHL^®), the most comprehensive resource for nursing and allied health literature.

Code of Federal Regulations – Title 42 – Public Health
Presents Chapter IV – Centers for Medicare & Medicaid Services, Department of Health and Human Services.

Department of Health and Human Services Office of the Inspector General
Allows you to check on the exclusion status of a healthcare provider or facility. Contains the list of sanctions and definitions of exclusions for Medicare fraud and other sanctions.

Elder Abuse Information
Helps you recognize and fight against elder abuse. Discusses different forms of elder abuse, causes and symptoms and gives the legal rights of the elderly.

Elsevier
Contains access to a variety of science and health information, books and journals.

eMedicine
Contains peer-reviewed online medical textbooks. Physicians continually update and revise this site. The standard format for each disease or condition includes diagnosis and treatment, differential diagnoses, and a list of additional references.

Federation of State Medical Boards
Contains a databank of board actions and physician disciplinary actions. Includes links to state medical boards.

Food and Drug Administration (FDA)
Helps you investigate concerns about products in the FDA database.

Harrison’s Online
Features the complete contents of Harrison’s Principles of Internal Medicine, 17th Edition.

Health Medicine refdesk.com
Contains an alphabetical list of health and disease-related links useful as a starting point for finding medical literature and other sites.

The Health Pages
Allows you to search for a physician by name and state or by specialty practice. This site has more current contact information than other physician directory sites, particularly telephone numbers. Links to state medical boards offering physician discipline information and reports on physicians and facilities are planned for this site.

Healthcare Financing Administration
Links to Medicare, Medicaid, SCHIP and other federal search resources.

Hippocrates Magazine
Contains clinical updates in primary care and practice management with access to archives and search features.

Infusion Nurses Society (INS)
Sets the standard for infusion care.

Institute for Healthcare Improvement (IHI)
Provides access to improvement knowledge and trustworthy content focused on healthcare quality across a broad array of topics.

Institute for Safe Medicine Practices
Presents links to newsletters, educational programs, medication safety tools and resources, articles, guidelines, products lists and reports.

Johns Hopkins Division of Infectious Diseases Antibiotic Guide
Provides information about infectious diseases and antibiotics. The site requires registration (free).

The Joint Commission
Accredits and certifies more than 17,000 healthcare organizations and programs in the U.S.

The Journal of the American Medical Association (JAMA)
Offers the most widely circulated, peer-reviewed, general medical journal in the world.

Manufacturer and User Facility Device Experience Database (MAUDE)
Gives links to reports of product and device failure and other information.

Mayo Clinic
Provides online resources for diseases and medical conditions, drugs and supplements and tests and procedures.

MDLinx.com
Contains links to 40 medical specialty websites for the latest developments and access to top journals. Also offers an email subscription service to alert you to news in specialties you select.

MedBioWorld
Contains links to publishers of medical and nursing journals in all fields and a complete list of all available journals worldwide.

Medical Library Association (MLA)
Provides educational opportunities, supports a knowledgebase of health information research and works with a global network of partners to promote the importance of quality information for improved health to the healthcare community and the public.

Medical Matrix
Provides ranked, peer-reviewed and annotated clinical medicine online resources for a variety of journals, texts, diseases and medical conditions.

Medical News Today – Litigation/Medical Malpractice News
Includes news and articles published daily on lawsuits, legislation, compensation claims, pharmaceutical company disputes and more.

Medicare
The official U.S. government site for Medicare.

MediLexicon
Contains searches, information, news and resources for the medical, pharmaceutical and healthcare professional, including medical abbreviations, medical dictionary, medical news, ICD-9 search, drug search, medical equipment and surgical instruments and other searches.

MedlinePlus^®
Presents health information from the National Library of Medicine.

Medscape
Supplies medical news, full-text journal articles and resource centers.

MedTerms
Clarifies difficult medical language as defined by doctors in easy-to-understand explanations of over 16,000 medical terms.

Merck Manuals Online
Contains links to search the Merck Manual of Medical Information, Merck Manual of Geriatrics and Merck Manual of Diagnosis and Therapy.

Merck Medicus
Contains information specific to your specialty, including clinical tools, specialty textbooks, journals and professional societies.

Micromedex Healthcare Series
Contains information on drugs, diseases, acute care, toxicology and alternative medicine.

Mosby’s Nursing Consult
Offers a vast array of information relevant to nurses including 38 leading nursing textbooks, 38 leading full-text nursing journals, evidence-based nursing monographs, drug information and calculators, over 370 practice guidelines, 8,000 patient handouts, 8,000 images, “Best Practice” clinical updates, dictionary, MEDLINE, Mosby’s Index and nursing and medical news.

National Association for Home Care & Hospice
Represents the interests and concerns of home care agencies, hospices and home care aide organizations.

National Cancer Institute
Contains information on cancer topics, clinical trials, cancer statistics, research and news.

National Center on Elder Abuse (NCEA)
Helps national, state and local partners in the field be fully prepared to ensure that older Americans will live with dignity, integrity, independence and without abuse, neglect and exploitation.

National Council of State Boards of Nursing (NCBSN)
Offers links to most U.S. nurse practice acts, regulations and state boards of nursing.

National Guideline Clearinghouse
Serves as a public resource for evidence-based clinical practice guidelines.

National Hospice and Palliative Care Organization (NHPCO)
Promotes access to palliative care and to maintaining quality care for persons facing the end of life and their families.

National Patient Safety Goals (NPSGs)
Delivers outlines and chapters for all applicable programs published by the Joint Commission.

National Pressure Ulcer Advisory Panel (NPUAP)
Contains online resources for pressure ulcer staging and links to public policy, education and research of pressure ulcers.

The New England Journal of Medicine
Contains a variety of clinically relevant medical information, including clinical and research articles, analysis and opinion articles and materials for both learning and teaching.

Occupational Safety and Health Administration (OSHA)
Presents comprehensive information about OSHA regulations, services, safety programs and employee training manuals with news and an online library.

Oncologic Nurses Society (ONS)
Represents over 37,000 registered nurses and other healthcare providers dedicated to excellence in patient care, education, research and administration in oncology nursing.

Pam Pohly’s Net Guide – Medical Academies & Healthcare Professional Associations
Contains links to hundreds of healthcare societies, academies, professional organizations and associations.

PubMed
Comprises more than 19 million citations for biomedical articles from MEDLINE and life science journals. Citations may include links to full-text articles from PubMed Central or publisher web sites.

Spine Universe
Contains detailed information involving conditions, treatments and wellness surrounding the spine. Additional resources include links to clinical trials, glossary of terms, recommended textbooks about spinal anatomy, videos and animations.

STAT!Ref
Offers access to cross-searchable, full-text medical, nursing and pharmacology electronic textbooks from a wide variety of reputable authors, publishers and societies.

Surgical-Medical-New Terms Glossary
Offers the most complete list of medical products, devices and pharmaceuticals, with links to manufacturers’ websites and Food and Drug Administration information on each product.

UpToDate
Provides evidence-based, peer-reviewed-information resource for clinical knowledge and improved patient care. Available by subscription.

Wound Care Strategies
Contains products, education and news related to wound care.

Wound, Ostomy and Continence Nurses Society
Represents an international society of nurses who are experts in the care of patients with wound, ostomy or continence problems.

Wrong Diagnosis
Contains links to symptoms, diseases, diagnosis, videos, tools, misdiagnosis, doctors, hospitals, drugs and articles.

Thank you to Suzanne Arragg, RN, BSN, CDONA/LTC, CLNC; Laura M. Averette, RN, MSN, CPHRM, CLNC; Dale Barnes, RN, MSN, PhN, CLNC; Nikki J. Chuml, RNC, CCE, FMC, CLNC; Larry Frace, RN, CLNC; Margaret Gallagher, RN, BSN, MSN, CLNC; Dorene Goldstein, RNC, CLNC; Sandra Higelin, RN, MSN, CS, CWCN, CLNC; Jane Hurst, RN, CLNC; Camille Joyner, RN, CCM, CLNC and Mildred Mannion, RN, BSN, CNOR, CLNC for sharing the websites they use most to research their legal nurse consulting medical-related cases.

Success Is Inside!

My experience in hospital nursing was filled with mixed emotions. The frustration level was one that I have never experienced anywhere else. But I kept being a nurse, and I kept going to work. Nursing jobs paid the bills but did not contribute to my soul.

When I saw Vickie Milazzo’s ad for the CLNC^® Certification Program, I wondered if this was a nursing career that I could be passionate about. I saw the ad several more times after that. Each time I felt a tremendous pull. The woman in the ad looked like no nurse in my facility. Vickie personified a victorious nurse dedicated to her profession, unlike other ads where the model-like woman leaps through the air with her hair blowing in the wind.

Little did I know I was implementing a business plan by showing the ad to my husband and proclaiming, “What an investment this would be for our future. We need to choose the VIP CLNC^® Business System and take advantage of all the available resources.”

My fear of flying could not hold me back. Several months later, I looked out of the airplane window after take-off. Dark thunderheads hung over the mountain tops. Lightning flashed sending streaks of light all around the plane. Down below, hundreds of colorful hot air balloons lit up Balloon Fiesta Park waiting for their early morning launch. My overwhelmed senses were full of expectations yet to come and I was calmed by the knowledge that I was so lucky to be the lead character in this new adventure.

That was the calm before the storm. WOW, is how I describe the CLNC^® 6-day Certification Seminar. I was amazed by Vickie and the course content. Then the 2-Day NACLNC^® Apprenticeship followed. I was brain-dead by the time it was over. I assumed the hardest and most challenging part was behind me. I went home and began implementing everything I had learned right away.

I went on my first marketing campaign in my hometown. I had seven promotional packets. Each one contained a personalized introduction letter to the attorney, a brochure, a business card and a professional profile. I marketed to all seven offices, but it took every ounce of courage I had. My husband went with me to the first office. I’m sure “amateur” was written all over me. I decided taking my husband wasn’t a good idea. The next office I went to was torturous. I stood there knowing I had to go in, but wishing I didn’t have to. My palms were wet and my mouth was dry. My husband reassured me from the sidewalk and I took a deep breath and went in. I met four attorneys that day. Each time I felt out of my element and left the office thinking, “There has to be another way.” I felt as wanted as a telemarketer.

I did the “busy thing” for awhile after that. We built an office and I set that up. I reviewed the advanced resources in my VIP CLNC^® Business System. Then I went to the NACLNC^® Conference in March. I talked with Certified Legal Nurse Consultants about their strategies for overcoming fears. Nothing clicked for me. I did discover other strategies to beef up my promotional packet and implemented them as soon as I got home. I went on several more marketing campaigns, but I could not overcome the fear of meeting attorneys. I went to their offices hoping I wouldn’t see any. I could relate to the office staff and break ice with them, but not the attorney. How was I going to get business with this mindset? The fear of meeting attorneys was bordering on a phobia.

The turning point came when a legal secretary called my office after receiving my promotional package and left a message for me to call. As usual, I contacted Vickie Milazzo Institute for mentoring. I listened carefully to the CLNC^® Mentor and followed up with the appropriate phone calls and sent a follow-up letter. Three weeks later, the legal secretary called to set up my first appointment with the attorney. I was thrilled, but it was short-lived as fear began to well up inside of me, again. I contacted Vickie Milazzo Institute for mentoring yet again. I was probably over-prepared for this meeting, but it was important to get it right. I would have to do this in spite of the fear.

I had no idea what to expect, but I was well prepared in every way right down to the power suit. I arrived at the office early to find out the attorney would be late. “That’s okay,” I thought, “I can wait.” There were a couple of gentlemen also waiting. We made small talk until the attorney arrived. After she arrived, she took one of the gentlemen in her office for about twenty minutes. He left and then the legal secretary ushered me and the other gentleman into a small conference room.

“What is this?” I thought. I was led to believe it would be the attorney and I, only. Everyone was introduced. It was very formal.

The attorney said, “This is Mrs. Schmitt. She is an expert and she is going to tell us how to proceed. Go ahead, Mr. Jones (not his real name), tell her your story.”

I felt my eyes bug out. My inner voice said, “Wait! I didn’t practice this! No time for a mentor request.”

The man started talking, but I could not understand him. His lips were moving and I could hear his voice, but I was so paralyzed with fear that I wondered what I looked like to him or, horror of horrors, what did I look like to the attorney?! I thought, “I better snap out of it because the attorney is going to expect something intelligent from me!”

Thank God this drama was only going on inside my head and not in the room. In a split second, I realized that sitting in front of me was a patient, Mr. Jones. My nursing instincts kicked in. I forgot about the power suit I was wearing and immediately began to assess his physical condition and his words became crystal clear. “The other guy dropped the air conditioner causing me to fall and hurt my back and knee,” he continued.

The 30 services that Certified Legal Nurse Consultants offer with a risk-free guarantee faded away as I asked, “How many days after the surgery did you notice the redness and swelling?”

My sample work products became forgotten when I told the attorney, “The infection that your client acquired after surgery was not the result of mismanaged care because they did a culture and treated it in a timely manner.”

The attorney asked numerous questions: “How can you tell if it was the hospital’s fault? What can you tell from the medical records?” The attorney mysteriously became a patient as well. She wanted to know what I knew. I answered all her questions demonstrating how I, the Certified Legal Nurse Consultant, could help with her medical-related cases. I stated that in my opinion there was no medical malpractice in this case and that she should only pursue the personal injury claim. I explained vocational and functional capacity evaluations that could strengthen her case. As the conversation went on she was amazed at the information I provided. She was a criminal defense attorney and had people ask her about taking medical malpractice cases. She said she had five potential medical malpractice cases and set up an appointment with me for the next case.

That experience changed me. I had heard other success stories that sounded too good to be true; a CLNC^® consultant goes into an attorney’s office and walks out with armloads of cases. But this attorney was truly sincere.

I now remember that I’m a nurse when I market to attorneys, which is what I should have been doing all along. I am not a salesperson, I am proud to be a nurse. Now, when I go into attorneys’ offices, I hope I meet them and ask if they are in so I can meet them. I look forward to educating them about how I can cost effectively consult on their medical-related cases. The expertise of registered nurses is as important to attorneys as it is to patients. Thanks to Vickie Milazzo and the CLNC^® Mentors, this expertise is available to every attorney through all of us Certified Legal Nurse Consultants. It is our job to educate attorneys in every creative way we can.

Guest Blogger Profile

Diana Schmitt, RN, BSN, CLNC has 24 years experience in the health care industry and is the owner of Diana Schmitt & Associates Certified Legal Nurse Consultants. Her firm specializes in merit review, expert witness location, and medical literature research for medical malpractice cases.

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!

Hammurabi was a ruler of ancient Babylon from about 1790-1750 BC. He’s most famous for writing down one of the first and most comprehensive listing of laws that existed during his reign. Hammurabi’s writings covered both civil and criminal law ranging from general to quite specific. His code isn’t a code in the legal sense that we’ve come to think of; the laws are not broken down by subject area and some refer to fees to be paid to specific occupations.

His code was published in every city that he ruled and believe it or not, was not the only set of laws in existence in that time period. Just about every king or ruler promulgated their own laws (but didn’t have the Commerce Clause of the U.S. Constitution to even out trade). The Code of Hammurabi wasn’t just his own proclamations, it also codified common laws that existed during that time.

Several copies of the Code of Hammurabi exist, but the most complete and most famous is in Paris, safely ensconced in the Louvre. That specific stele was discovered, in what is now Iran, in 1901 by Gustav Jequier. It didn’t originate there, it had been taken to Iran as plunder during the 12th century BC. Not only did we have collections of laws during that period but we also had early art collectors.

The Code of Hammurabi

Louvre Museum Paris

What makes the Code of Hammurabi interesting to me and hopefully to Certified Legal Nurse Consultants, is that Hammurabi caused some of the first personal injury, medical malpractice and wrongful death laws to be “written in stone,” so to speak. Laws, which if they were on the books today, might make some doctors and nurses think twice about the quality of their practice. Disciplinary procedures for healthcare providers were pretty tough in those days!

Here’s some of my favorite examples from L.W. King’s 1910 translation of the Code of Hammurabi:

Personal Injury:

• If a man put out the eye of another man, his eye shall be put out.
• If he break another man’s bone, his bone shall be broken.
• If he put out the eye of a freed man, or break the bone of a freed man, he shall pay one gold mina.
• If he put out the eye of a man’s slave, or break the bone of a man’s slave, he shall pay one-half of its value.
• If a man knock out the teeth of his equal, his teeth shall be knocked out.
• If a free-born man strike the body of another free-born man of equal rank, he shall pay one gold mina.
• If a freed man strike the body of another freed man, he shall pay ten shekels in money.
• If the slave of a freed man strike the body of a freed man, his ear shall be cut off.
• If he knock out the teeth of a freed man, he shall pay one-third of a gold mina.
• If during a quarrel one man strike another and wound him, then he shall swear, “I did not injure him wittingly,” and pay the physicians.

Wrongful Death:

• If the man dies of his wound, he shall swear similarly, and if he (the deceased) was a free-born man, he shall pay half a mina in money.
• If he was a freed man, he shall pay one-third of a mina.
• If a man strike a free-born woman so that she lose her unborn child, he shall pay ten shekels for her loss.

Medical Malpractice:

• If a physician make a large incision with the operating knife, and kill him, or open a tumor with the operating knife, and cut out the eye, his hands shall be cut off.

Hammurabi also created the first medical care reform system by regulating the pay doctors would receive for certain operations.

• If a physician make a large incision with an operating knife and cure it, or if he open a tumor (over the eye) with an operating knife, and saves the eye, he shall receive ten shekels in money.
• If the patient be a freed man, he receives five shekels.
• If he be the slave of someone, his owner shall give the physician two shekels.
• If a physician heal the broken bone or diseased soft part of a man, the patient shall pay the physician five shekels in money.
• If he were a freed man he shall pay three shekels.
• If he were a slave his owner shall pay the physician two shekels.

Finally, Hammurabi also dealt with judicial or legal malpractice.

• If a judge try a case, reach a decision, and present his judgment in writing; if later error shall appear in his decision, and it be through his own fault, then he shall pay twelve times the fine set by him in the case, and he shall be publicly removed from the judge’s bench, and never again shall he sit there to render judgment.

It seems to me that Hammurabi in some respects was a man ahead of his time.

Success Is Inside!

For the first two months, nothing was happening. What was I doing wrong?

My husband said, “Give it a chance, Melanie. Let me help.”

He began calling the attorneys I had sent postcards to, and he got results. He booked me for presentations at law firms where I discovered that face-to-face interaction is my strong suit. Once an attorney agrees to a presentation, and I show what I can do, closing the sale is a given.

My first big client, however, came by way of a referral from my insurance agent. My agent’s neighbor is an attorney who referred his medical malpractice and personal injury cases to another attorney. That’s when I found out how useful it is to know people who know people who know people. He passed my name along, and I got a call.

“What can you do for us?” the attorney asked.

Boy, did I answer that question. Amazingly, their firm hadn’t used legal nurse consultants. Their paralegal was pulling her hair out, unable to provide what they needed.

In closing I asked, “When may I come to your office and show you what I can do?”

The Work Started Flowing and We Replaced My Husband’s Salary

I handle all of that attorney-client’s cases, including medical malpractice, personal injury and workers’ comp. This single attorney-client can keep me busy full time, but my goal is to grow big enough to hire CLNC^® subcontractors. We’re almost there. We have four attorney-clients now – and the work keeps flowing.

I say “we” now because my husband left his job and came to work for me full time as an office manager. That was one of the smartest moves I made. A disabled veteran, he’s able to take care of our children and still help with our marketing. He also answers the phone, which means an attorney gets a live voice, not an answering machine.

Being responsive is one important reason our business has grown so fast. We make $5,000-$6,000 per month and have already replaced my husband’s salary.

I Like Educating Attorneys – Once They Know You, They Need You

The most amazing thing happens when I give a presentation at a law firm: attorneys pay attention. I wow them with the CLNC^® services I can provide to help them win cases and they treat me as a professional. I use their feedback to refine my presentation for the next time I deliver it.

After attorneys learn what a CLNC^® consultant can do for them, they see the value. Later, when I actually work with them, they begin to rely on me in more and more areas, on more and more cases. Just recently, our biggest attorney-client emailed us to say we had become their best friends and they cannot function without us.

One thing I learned from Vickie is to hold my ground on nonmeritorious cases. That principle is working for me. After I review a case, my client will ask, “Melanie, what’s your recommendation? What do I do with this?”

If the case has merit, fine. I lay it out. But I sometimes have to say, “I understand that something bad happened, and your client is upset about it, but I don’t see merit here.” In the long run, the attorney saves money by not pursuing cases he can’t win.

My attorney-clients listen to me and respect my judgment. That makes me feel that my nursing experience and knowledge are making a difference.

While taking my CLNC^® training, I came up with the slogan we use in our marketing: We make you look best. My attorney-clients love it.

I Enjoy What I Do Every Day

Being a nurse is important to me, and my CLNC^® business makes me happy in many ways I never expected. I enjoy my attorney-client relationships. I enjoy feeling that I’m still helping people, even though it isn’t at the bedside.

On every case, I learn something new, which I can then use on future cases. That’s exciting. While I’m teaching my attorney-clients about medical records and the healthcare side of a situation, they’re handling the legal side and I’m learning from them, too. Together, we make a brilliant team. I help identify issues that will help them look good in the courtroom and win the cases that deserve to be won.

I also enjoy knowing that my children are not spending time at daycare. I used to feel guilty about leaving them, but now they’re getting the best care at home with their father. My CLNC^® business has positively impacted our entire family.

After serving his country in Iraq, my husband came home with limitations that make it hard for him to work outside the home. I created a job for him, and he’s a valuable asset to my CLNC^® business. No one could do a better job running the office, and I love working with him. This could never have happened if I’d stayed full time at the hospital. I’m proud that ours is a family business, that we can grow it together.

Recently, I’ve begun traveling for my attorney-clients, which is another exciting aspect of what I do. On one case, the attorney requested that I meet with his client who needed to be assessed for a life care plan. When I asked the attorney if he wanted me to find someone local to assess his client in order to save on travel cost, he insisted that I go myself because of the quality of my work. I was flattered. My office-manager husband made all the travel arrangements for me to fly in early one morning and come back the same day. This was a wonderful experience! I had never had a frequent flyer card before now. I feel professional!

We Keep Marketing Smart to Attract New Attorney-Clients Like Vickie Taught Us

One day we drove past a billboard for a law firm that specializes in personal injury cases. I told my husband, “We should call on them.” He called and booked me for a presentation.

That’s the sort of marketing that gets big results at low cost. This month we’ll be mailing out and following up on a hundred postcards, which is also low cost.

We offer a discount on the first case. Attorneys are like anybody else when it comes to saving money, they expect to get value for their dollars. The discount encourages them to take a chance, and it costs us nothing until a prospect actually hires us. We do a great job, the client is impressed and hires us again at our full rate. Marketing can be effective without draining your bank account – Vickie taught me that too.

Vickie Made It All Possible

I feel very lucky to have been trained by Vickie Milazzo. She’s amazing. When I came home from the CLNC^® 6-Day Certification Seminar, I told my husband, “She’s a tiny lady but powerful. She looks at you like you’re the only person on the planet. The world around her stops and she listens to you, giving you her time and all her attention.”

It has been a year now since my CLNC^® Certification. A very happy year. I think back to those first two months, when I doubted myself, and I have to laugh. My life has changed in so many wonderful ways since I became a Certified Legal Nurse Consultant.

Guest Blogger Profile

Melanie V. Paquette, RN, BSN, CLNC is co-founder with her husband of Paquette Legal-Medical Consulting Services LLC based in Texas. She has more than 13 years of clinical experience in emergency care, intensive care, level 1 trauma, cardiology, interventional radiology, neurology and has hospital and insurance experience as a case manager.

One thing every Certified Legal Nurse Consultant knows is that a simple apology by a healthcare provider often goes a long way in disarming anger in patients. But what if a doctor or representative of a healthcare facility were to apologize to a victim of medical malpractice? Do you think that might reduce the number of lawsuits and the associated costs of litigation? It actually does (and that saves us all money)!

“Sorry Works!,” a self-professed “advocacy organization for disclosure, apology (when appropriate) and upfront compensation (when necessary) after adverse medical events” has been successfully implementing laws in 34 states which allow doctors and/or facilities and their representatives to make apologies for medical errors. Those same laws make those apology statements inadmissible in court in order to encourage settlements. Admitting a mistake to keep someone from suing you seems a little odd, but experience and research proves it actually works.

Providers disclosing medical errors to patients and, at the same or a later time, offering a sincere apology, and often compensation, results in decreased numbers of lawsuits. The New York Times reported that as little as thirty percent of medical errors are disclosed to the patients (or their survivors). It is often the concealment of the error and an accompanying unrepentant attitude that feeds the injured party’s anger and results in the filing of lawsuits.

The “apology” program proved successful at the University of Michigan Health System – lawsuits were reduced 68% over the period tracked and at the University of Illinois – lawsuits were reduced almost 50%. Both facilities also experienced drops in legal-related expenses (including settlements). The National Quality Forum in 2009 published an updated practice statement of safe practices that included standards for disclosure of unanticipated outcomes. In a terrific review article, the New England Journal of Medicine has discussed the effectiveness of such disclosures and even the Joint Commission, as far back as 2001 (when they were still JCAHO) adopted the first standards for disclosure. Since then, similar standards and guidelines have been adopted by organizations and facilities across the country. (Here’s a bibliography of articles on disclosure from the Joint Commission.)

So why aren’t more facilities allowing doctors to apologize in order to deter litigation? Part of it is reticence. Would it surprise you to know that according to the Journal of the American Medical Association doctors are either unwilling or afraid to apologize? Insurance companies and facilities still prefer to “deny and defend.” Also defense law firms, whose livelihoods depend on continued and protracted litigation, have no incentive to quickly settle a potential lawsuit.

As a legal nurse consultant working with a case involving an injured plaintiff you will want to discover whether a defendant facility had a disclosure policy in place and whether or not that policy was followed. As a defense CLNC^® consultant you may wish to do the same. It may also be time to involve your facility in this type of program as a cost-savings measure.

Here’s an interesting thought, if these types of programs work so well in medical-related cases, what other types of cases might be able to use an apology system? Perhaps you might see this in toxic torts (chemical spills) or products liability (medical-device) cases? How about simple personal injury cases? The possibilities are endless.

Success Is Inside!

P.S. Comment and share your opinion on “Sorry Works.”

I’m not a pack-rat, but I’ll admit a couple of bookshelves in the business section of my “library” are a bit overrun by books I’ve read, plan to read and some books I will probably never read. The other day Tom was doing some unsolicited (and unwanted) Spring cleaning and ran across a book given to me by the marketing guru Seth Godin. Tom looked at the cover and asked me “Vickie, what the #&%* is a meatball sundae?” He held the book up and I laughed because it does indeed have a photograph of a pretty unappealing meatball sundae (as well as a funny shot of Seth in a chef’s cap).

Still laughing I explained that, according to Seth, a meatball sundae is what results from a disconnect between your marketing and your message. In other words they are totally out of sync – you get a meatball sundae when you mix together two good ideas, like meatballs and sundaes, and the combination results in one bad idea. In my 27 years of managing Vickie Milazzo Institute, as well as teaching and certifying legal nurse consultants, I’ve seen a lot of meatball sundaes cross my desk. Some were my own (or at least my marketing department’s), others came from legal nurse consultants I was mentoring.

Here’s a great legal nurse consulting example. You’ve done your research on the Internet, browsed the attorney-prospect’s website pretty closely and are ready to send your first batch of marketing materials. Instead of positioning yourself properly and marketing to the attorney-prospect’s strengths and core business (personal injury cases), you send materials including and discussing medical malpractice cases; you also emphasize your experience in the ED without explaining its relevancy to the attorney. You just sent the attorney-prospect a meatball sundae, a perfect serving of a mix of bad ideas. Not only did you send the wrong materials to the attorney-prospect, you blew any chance of appearing to be savvy and sophisticated by sending him materials that won’t interest him from the beginning and will put him off from reading the rest of your promotional packet. So, no matter how appealing (and tasty) your promotional materials are, if the attorney-prospect doesn’t have the appetite for the meatball sundae you just served him, you’re not going to get his business.

As a Certified Legal Nurse Consultant you’ve been trained by the Institute not to send meatball sundaes to your attorney-prospects. We’ve taught you how to research attorneys, their practices and their firms to be sure you’re properly targeting your market. We’ve taught you positioning strategies that keep you in the mind of the attorney-prospect. We even mentor you on the proper responses for the interview questions you’re likely to be asked.

I can’t be there to stop you from stuffing a meatball sundae into an envelope and addressing it to an attorney-prospect or heading into the attorney-prospect’s office for an interview and dropping a meatball sundae on her desk during the interview. So I thought today is a good day to remind you to get out there, get cooking on your marketing and make sure you know what you’re serving to attorneys.

Personally, I prefer my meatballs with spaghetti and my sundaes with hot caramel.

Success Is Inside!

P.S. Comment and share how you avoid sending attorneys meatball sundaes.

When I was a young girl, my father didn’t eat leftovers (still doesn’t). That caused my mom to be very careful about how much food she would prepare for meals. My sister, Karen, still jokes with me that mom would prepare only five pork chops (one of our favorite dishes) and not one more (despite our pleas). I hadn’t really thought about pork since my letter to President Obama or pork chops since the last time Karen and I talked about Mom’s pork chops.

That all changed this week when I was having a skylight repaired in my bathroom. The ceiling is pretty high so it required a long ladder and two repairmen – one to do the work and one to steady the ladder. Naturally the guy holding the ladder got bored quickly and became quite chatty. At one point, apropos of nothing, he mentioned that he couldn’t wait for lunch. I overheard him and asked him if he’d had breakfast (healthy green tea and a healthy breakfast is an important way to start your day). He told me he’d had a small one – his wife didn’t cook him any bacon to go with his eggs. I replied that he was lucky on two fronts: (1) his wife cooked him breakfast (I was glad Tom didn’t hear him say that) and (2) she’s helping him watch his diet.

He replied that it wasn’t his diet she was worried about, it was catching swine flu from the bacon. I laughed and told him he could safely tell his wife that you can’t get the swine flu from eating bacon or other pork products. In fact, I went on to tell him that unless she was sleeping with an infected pig or had a sick pig running around the house she was safe. Just as I was getting started on a lecture regarding the facts surrounding swine flu, I noticed his eyes began glazing over (just like an attorney’s do when a legal nurse consultant goes on too long about their services without engaging in their positioning strategies). I cut to the chase and said, “Tell your wife that the best way to beat the H1N1 Influenza A virus (we can’t call it swine flu anymore because we’re apparently offending pigs) and just about any superbug, is to follow the hygiene practices championed by that 19th Century nurse, Florence Nightingale. Her practices are still valid today: vigilantly wash your hands and stay clear of anyone who is ill.”

For attorneys who are reading this blog, before you call our office, any Certified Legal Nurse Consultant can tell you there is no product liability suit against a pork producer for an H1N1-infected piggy. Those same Certified Legal Nurse Consultants also know that there might be a medical malpractice case for failure to diagnose, since the symptoms of H1N1 Influenza A are so close to those of “normal” flu.

As RNs we can and should contribute to this public health issue by reminding everyone around us (not just our spouses and children) to wash their hands. We should also remember that nursing and medical personnel can be a source of infection.

I’ll be washing all the way up to the elbows for a long time to come. Stay clean and healthy!

Success Is Inside!

P.S. When I walked over to Starbucks this morning for my “free” coffee, the staff must have read my blog about them because they had my tall “red-eye” (bold coffee with a shot of expresso) on the counter by the time I got to the register (darn)!

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.