medical malpractice

Gina D’Angelo, RN, BSN, MBA, NHA, CLNC shares how, after getting in front of 60 attorneys at a medical-malpractice conference, her CLNC^® business has grown so much she’s now using CLNC^® subcontractors to keep up!

Watch and learn her secrets to CLNC^® success.

Congratulations, Gina!

Success Is Inside!

I seriously could write a book about this case. I met the attorney of this memorable case at a legal seminar. I was asked to review the medical records and fetal monitoring strips of a baby who was severely brain injured. An OB/GYN expert reviewed the records and found no deviations to the standard of care by the physician or the labor nurses. It was the OB/GYN’s opinion that the fetal monitoring strips showed no distress.

The attorney, a very accomplished medical malpractice attorney, was then led to believe that the cause of the baby’s injuries was a negligent resuscitation after delivery, with a “0” Apgar score as “proof.”

The attorney hired me to review the records with a focus on resuscitation. After reviewing the records, my opinion was that there were significant hyperstimulation and hypertonus causing a brain compression injury to the baby during labor. I developed a 50-page chronology that detailed every aspect of the labor and delivery, complete with a section that compared and contrasted the documented interpretation of the FMS to mine. I addressed the standard of care for nurses and physicians for staffing guidelines, Pitocin^®, intrauterine pressure catheters and amnioinfusion. The hospital had gone against its own protocols in the use of Pitocin^® and amnioinfusion. Because the heart beat of the baby showed no “sentinel event” and did not look “ominous,” the original OB/GYN who reviewed the case missed the six hours of hyperstimulus and hypertonus of 50 mmHg. The nurses continued the amnioinfusion and increased the Pitocin^® despite the ominous contraction pattern which are both deviations from the SOC and against hospital policy.

The attorney reviewed my interpretation of the case and when we met again, she greeted me with “Okay, I get it! I’m filing this case”, and that was the beginning of one of the best cases of her career. It became as satisfying for her as it was for me.

I was able to secure top medical experts – one of whom she had contacted before on another case but who said he was too busy. When I contacted him he said, “As long as you’ve determined it’s a viable case, I’ll review it”. This wasn’t the first time an expert had agreed to take on a case for me when they had said no to the attorney.

In addition to providing the chronology, educating the attorney and finding several expert witnesses, I flew to Houston to meet the attorney in a labor suite and operating room to teach about all of the equipment used on the mother i.e., IUPC, fetal monitor, IVs, cardiac monitor, pulse oximeter, O2, etc., during labor and delivery and the resuscitation of the newborn.

The defense had their usual arguments explaining why the injuries couldn’t have happened during labor – infection causation, prenatal causation, no sentinel event. The defense also tried a Motion in Limine to prevent the theory of hyperstimulus and hypertonus causing a compression brain injury during labor. All to no avail.

Because of the detailed chronology and up-front, early and thorough education provided to the attorney, the case actually settled prior to any disclosure of expert reports or expert depositions – which is unheard of in brain-injured baby cases.

The impact on my financial status is immeasurable and this attorney-client has referred me to other attorneys. I would not make any changes to the way I prepared this case. My advice to other Certified Legal Nurse Consultants is to follow your instincts about what you think will help your attorney-clients the most.

My mission statement as a CLNC^® consultant is to make medicine safer for all. This baby, while injured, will have his life care plan fully funded and will have the most satisfying life possible because of my involvement. My attorney-client continually expresses her gratitude saying: “We never would have gotten here without you. It was because of you that we won this case.”

Becky Mungai, RN, BA, CLNC

In my 29 years of business experience, I’ve learned that I don’t need to take a majority vote on every issue. I can be in a meeting full of staff members and if I make a decision that’s contrary to what the majority thinks, somebody will pipe up and joke, “It’s unanimous!” But I’ve also learned that I care more about being successful than being right. That requires listening, collaborating and even seeking opposing viewpoints. When we shortchange collaboration, we’re missing an important piece of the performance process. As we discuss diverse opinions, ideas spark new thoughts and one plus one suddenly equals a lot more than two. We arrive at a place none of us would have reached alone, and the project rises to a new level. Even if I disagree with someone’s viewpoint, I try to extract something of value from it.

In my early legal nurse consulting business practice I was sitting in a conference room with two high-powered attorney-clients. We were discussing a medical malpractice case and one of the attorneys disagreed with me. There was a cloud of cigar smoke in the air, my knees were shaking under the table and my first impulse was to argue and defend my position. But I couldn’t so I didn’t. Instead I listened to the attorney’s point of view and agreed that he was on to something significant. Surprise – he didn’t take me to task or talk down to me. We just moved on with our discussion and to years of many more cases together. If at that moment I had needed to be right I would have failed to be successful with those two attorneys. They didn’t expect perfection, but they did expect me to have the insight to know and admit when I was wrong.

Think about your communications with your attorney-clients, CLNC^® colleagues, friends, family and co-workers and ask: Is it more important to be right or to be successful? Think hard about your answer.

Success Is Unarguably Inside!

Vickie,

I am learning how to breathe again. You will never believe what happened. I called an attorney’s office last week to get an appointment. I spoke with a receptionist who accidently sent the attorney-prospect a note saying I needed a consult for a medical malpractice case. He called me and left a message giving me his direct number. So when I heard his message I couldn’t pass up the opportunity. I returned his call, got him on the phone and explained that I was a Certified Legal Nurse Consultant and explained the CLNC^® services I could offer. His firm had just lost their legal nurse consultant. He asked me to come and make a presentation. So I am going to knock this out of the park.

After I hung up the phone the mind-numbing fear set in. I requested mentoring and the CLNC^® mentor at Vickie Milazzo Institute was incredible. There are 20 attorneys in this firm and not all practice medical malpractice or personal injury. I also wonder if all 20 will be in the meeting. In preparation for my CLNC^® presentation, I am practicing my answers to the questions on the NACLNC^® Association membership section of the LegalNurse.com website, and I think I am ready.

Vickie, do you think I should start now to call on other Certified Legal Nurse Consultants who might be willing to subcontract? I want to share my blessing if any of the cases are outside my area of expertise.

Sandra M., RN, CLNC

Hi Sandi,

Congratulations on your awesome news! Be prepared for 20 attorneys, but do not express disappointment if only one or two show. My best law firm started with one attorney and one case. Once he saw what I could do for him he recommended me to the other attorneys in his firm. 

For the attorneys who attend, be prepared to focus on the types of cases they manage. In other words, keep the presentation focused on them and their needs. You can follow up with the other attorneys in the firm at a later date, but for now it is imperative that you are relevant to the ones present.

Following your presentation and discussion with these attorney-prospects, you will know whether you need to call on another CLNC^® subcontractor and also the credentials they require for specific cases. I invite you to post a call for CLNC^® subcontractors on my Facebook page. And of course you can search for subcontractors in the NACLNC^® Directory by specialty and location. I do recommend subcontracting outside of your geographical area to avoid future competition issues. Be sure to keep me posted and I look forward to reading your CLNC^® Success Story soon. 

Success Is Inside!

Everything you put into a comprehensive report as a Certified Legal Nurse Consultant should be there for one purpose and one purpose only – to inform your attorney-client of the information necessary to win the case. Every opinion, every paragraph, every table, every exhibit, every reference should serve that purpose. Your job as a Certified Legal Nurse Consultant is to make sure the purpose of each part of your report is clear to the attorney reading it. After all, if the attorney has to figure out what you mean by something or why you included something, he might as well do the work himself.

Your attorney-client will be a lot more likely to call on you again and again for comprehensive reports if you make his job easy by following these strategies for creating first-class comprehensive reports.

1. Identify the attorney’s preferences
   The attorney-client may not always know what he needs but often before you provide what you know he needs you may have to first give him what he thinks he needs. Inquire about the intended purpose of the report, potential users of the report and any preferences for format or design. This will accomplish two things in advance:
   • You can more easily judge the format (chronology, narrative, etc.) and amount of detail required for specific portions of the report.
   • You and your attorney-client both know what is being requested, which decreases the risk of providing an unwanted, unnecessary or surprise work product to an attorney.

   This approach will never fail to earn you positive feedback.

2. Keep it real
   Try to learn how much medical knowledge and experience the attorney has with similar cases. For example, if an attorney handles a large number of failure-to-diagnose myocardial infarction (MI) cases, you may not have to include an extensive discussion about anatomy or physiology because the attorney may already be familiar with this information. Instead, tailor this portion of the report to the specific case issues regarding this specific MI. Conversely, if an attorney does not have extensive medical malpractice experience with MI cases, you may devote a section of the report to a review of anatomy and physiology, disease process and current treatment protocols. Don’t assume the attorney knows how this information applies to the case. Always explain how it applies both to the case and the client the attorney is representing. Assessing the attorney’s medical knowledge also guides you in knowing how much you need to translate the medical record and medical terminology.
3. Do Your Research Before You Start Writing
   Review applicable standards of care and scientific literature and identify the sources you will use before drafting the report. This time-saving procedure helps you organize your thoughts and determine where to include the relevant resource material.
4. Recycle your research from other reports for greater efficiency
   Depending on the type of case, you may be able to re-use sections from previous legal nurse consulting reports or summaries prepared for similar cases. For example, in two cases involving delay in diagnosis of myocardial infarction or chest pain evaluation, the standards you applied to the first case may be relevant to the second case. Review your other reports on similar cases to determine if any of the material applies to your current case before starting the report. Of course, there is no “one size fits all” approach to report writing. Each case must be analyzed individually, but occasionally, you may be able to avoid duplicating your effort and research.
5. Create an outline to ensure you cover all important issues

   Outline your opinions as well as your plan for presenting them.

   A comprehensive report includes some or all of the following:

   • Letter to the attorney.
   • Cover sheet.
   • Table of contents.
   • List of records, documents and tangible items reviewed and examined to date.
   • List of significant players.
   • Summary of the case or summary of relevant information.
   • General and specific deviations from, and adherences to, the standards of care (malpractice cases only).
   • Summary of scientific theory, research and standards.
   • Additional discovery.
   • Definitions of all medical terminology and abbreviations in simple terms.
   • Potential opposition arguments.
   • Conclusions.
   • Follow-up questions.
   • Recommendations.
   • Reference list.
   • Summary of testifying experts’ opinions.
   • Abstracts of pertinent articles
   • Copies of relevant scientific literature.
6. Apply a systematic approach to keep chronologies reliable
   Even a small error in date or time can influence the rest of your report. To minimize these costly typos, enter data from one complete section of the chart before moving on to another section. For example, start entering data with nursing and vital sign graphic entries because these data are usually dated and timed and occur more frequently than entries by other healthcare providers. Then, enter all lab report data in the appropriate order before moving on to radiology reports. It may then be possible to place undated or, more often, untimed physician’s progress notes and orders based on the chronology you have already created. In putting the pieces of the puzzle together in this fashion, you may identify other important issues to address in your evaluation and report.
7. Customize the report format to meet the attorney-client’s needs
   Avoid using the same format and length for each and every case. You may wind up including information that is not cost effective or relevant. Instead, write a report that meets your attorney-client’s needs and presents the information in the most logical manner. If you have difficulty organizing your thoughts or facing a blank computer screen, use a computer software program that can help with formatting case reports and chronologies. The key, however, to producing an effective work product is not only format and visual appeal, but the content, analysis, and conclusions you draw. This is the value you bring to case analysis that other members of the legal team are not qualified to do.
8. Break up the topics
   Break up long paragraphs. Stick to one topic per paragraph, just like your English teacher taught you.
9. Use lists to communicate a sequence of items
   To make groups of related points clearer, use bulleted lists. If the sequence of items is important, number the list instead of using bullets, e.g., number a sequence of steps that came or should come in order.
10. Format consistently throughout the report
    Refer to dates and times consistently. You may be used to “military” time, but if your attorney-client isn’t, help the attorney out by also indicating the standard. If using a.m. and p.m., choose a standard format for this and stick to it. Likewise for dates, pick one way of formatting dates and use it throughout the report. Vickie Milazzo Institute standard is the mm/dd/yy format – i.e., March 5, 2010 is formatted 03/05/10. You may choose to spell out dates in the body of your report and use a numerical format for tables.
11. Respect your attorney-client’s intelligence
    When writing your legal nurse consulting report, explain a medically complex situation with the preface, “This is the way I would explain it to a jury.” This allows you to get down to the attorney’s level without insulting his intelligence.
12. Use a cover letter
    If the report is comprehensive, be sure to include a cover letter introducing the report, restating your assignment briefly, summarizing your bottom-line opinion, and conclude by thanking the attorney-client and offering to  provide additional CLNC® services on this or future cases. Also include a table of contents listing the major subheadings within the report.
13. Clarify medical terms and abbreviations
    Either define medical terms and abbreviations on the spot (if few terms are used) or provide a glossary at the end of the report (if numerous terms are used). Whenever you use an abbreviation for the first time, unless you’re absolutely sure your attorney-client is familiar with it (e.g., MD, RN), spell out the term then put the abbreviation in parentheses – for example, advanced cardiac life support (ACLS). Then on subsequent uses of the term, you can simply use the abbreviation. Most acronyms can be formatted without periods. Remember, you’re so familiar with many medical acronyms, you don’t even notice them – but if your attorney-client has to stop and look up a term or puzzle it out, he won’t appreciate your wasting his time.
14. Correctly shorten units of measure
    Use consistent notation for units of measurement throughout the report. In general, abbreviations for units of measurement do not require periods (unless they’re used at the end of a sentence), nor do they require adding an “s” for the plural. For example, 1.5 cc, 0.5 mg, 127 lb (not 127 lbs), etc.
15. Make your report shine by setting it aside
    If time allows, put the report aside for one or two days before doing any final proofreading or editing. Check the report for overall continuity and format, then review each paragraph for content, relevancy and grammar. Finally, analyze each sentence for grammar, proper placement and always check spelling.

    Be sure you deliver what you promised. Before you submit your final report, go back over your notes and the original letter from your attorney-client. What did the attorney ask for? Did you include this information? In your cover letter for your report, do you state that you’re including requests for production, a list of references or a glossary? Make sure it’s all there in the final draft.

Your CLNC^® report will linger in the case file long after your meeting with your attorney-client. It may travel to other law firms or co-counsel, and will be used by many members of the legal team before the case concludes. What type of first (and sometimes, only) impression are you leaving with your attorney-clients and potential future clients? Make every report the best ever by paying stellar attention to detail.

Success Is Inside!

The first attorney I consulted with as a legal nurse consultant was serendipity. Everything I did was perfectly in sync with him. We hit it off like best friends – it was as though we had known each other in another lifetime. With my goal to turn my legal nurse consulting business from my part-time venture into a full-time business, I concluded, “I’ve got it all figured out. I know exactly what attorneys want and this is going to be easy.” Boy, I could not have been more wrong.

When Andy went to his partner Jim (who literally wrote the book in Texas on medical malpractice) and said “Jim, you have to start using Vickie,” use me Jim did. He rode me like my twin brother, Vince rides a thoroughbred horse – hard and fast. Jim was the smartest attorney I’ve ever met and he turned out to be my most challenging attorney-client. In contrast, Andy was fun, respectful and treated me like a lady, while Jim was 100% good-ole-boy and thought women had their place and should stay exactly where that place was (and it wasn’t a good place).

When I moved to Texas from New Orleans for nursing school, I steered clear of the good-ole-boys. The one and only time I went country-western dancing with my friends, some urban cowboy clamped his hand around the back of my neck to lead me like a horse onto the dance floor. I was like, “That’s it! I’m out of here.” I never went country-western dancing again and to this day I don’t like pickup trucks and men in cowboy hats. Country-western music still gives me a pain in my neck. Apologies to all country-western fans – please don’t let my opinion stop you from reading the rest of this blog.

Working with Jim was like being right back in that cowboy dance hall again. After a particularly difficult Jim encounter, I figured if I could survive growing up with my twin brother Vince (who bucked me up at an early age), I could survive this attorney. Understand, Jim is one of the best attorneys I’ve ever met and at the time, I knew I could learn a lot from him, that is if I could keep from killing him or bashing him on the head with one of his big cigars. I haven’t mentioned the cigars and the way he’d smoke them everywhere he went. He figured that when your name is the first one on the door, you do what you want – and he did.

Andy was a gentle giant. In deposition he was vicious but in a way that was downright gentlemanly. Outside the legal arena, he was a teddy bear. This “Odd Couple” (like Brooks and Dunn) were amazingly effective together. Jim was the courtroom showboat and Andy was the street fighter, slugging it out in depositions and motions. Together they created an enviable record and legend.

The experience with Andy and Jim taught me that attorneys come in all shapes and sizes and if I was going to build something big, which was my intention for my legal nurse consulting business, I would have to respond accordingly and get in sync instead of going insane. Jim set the bar very high and expected everyone to leap over it, and we all did – his partners, associates and legal assistants – all rose to his challenge.

So, I bucked up and Jim and I did our dance, through clouds of cigar smoke, glasses of whisky, dirty boots up on his desk during brainstorms and along the way he taught me more about medical malpractice than 95% of other attorneys will ever know. The learning wasn’t just one way though. In my buck-up style, I taught him women professionals didn’t need to be led around by the neck. We reached a truce and our own level of understanding. He made me a better legal nurse consultant. I like to think he’d admit that my work product made him a better attorney, but I don’t think he ever would.

It wasn’t serendipity with Jim, not at first and not ever. But, here’s the real surprise. Like Andy, Jim will always be one of my favorite attorney-clients. But hey, maybe that’s not so surprising, after all, I always LOVE a challenge…as a Certified Legal Nurse Consultant, don’t you?

Success Is Inside!

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!