Certified Legal Nurse Consultants Save Cases for Attorneys – Here’s How!

I asked the CLNC® pros to share situations where they’ve saved their attorney-client’s case. From civil to criminal and plaintiff to defense, it’s obvious why some of these attorneys have been clients of these Certified Legal Nurse Consultants for more than a decade.

“I was involved in preparing a PowerPoint presentation for mediation as a defense CLNC consultant for the skilled nursing facility who was the sole defendant in the case. I presented the case facts and physiology of the plaintiff’s multiple medical conditions. I emphasized the medical management of the treating physician. The nursing staff had consistently notified him of the patient’s condition, ensured specialists’ appointments were kept and provided psychological support by supplying psychology services and overall care to promote the highest practicable level of well-being.

Despite escalating repeat requests, including involvement of the medical director, the treating physician failed to provide the necessary medical interventions. Together with the legal arguments presented by defense counsel, we were able to demonstrate that the plaintiff had sued the wrong defendant. The plaintiff attorney was both humbled and impressed with my presentation. He had not used a Certified Legal Nurse Consultant!

It was well worth the defense dollars to use a Certified Legal Nurse Consultant. The defense attorney and his law firm have remained my client for 16 years.”

– Suzanne Arragg, RN, BSN, CDONA/LTC, CLNC

“I was the defense CLNC consultant for a case involving a 24-year-old male with a known psychiatric history. He was in and out of jail and generally had trouble adjusting since he was a small boy arriving to the U.S. from Russia.

The plaintiff’s complaint alleged damages against the county during his most recent arrest. He alleged that the arresting officer and staff at the county jail withheld the plaintiff’s medication. The plaintiff was not on a suicide watch, as he was not assessed to be at risk. He jumped from a three-story building and sustained a traumatic brain injury. He was immediately transferred to a hospital where he underwent three craniotomies to relieve pressure and evacuate hematomas. He was transferred to a rehab facility and eventually made a complete recovery.

The county defense attorney was ready to negotiate a large settlement and wanted to know what the staff could have done differently to prevent this trauma. There were about 3,500 pages of medical records covering a six year period that included psychiatric facility notes, drug and alcohol rehab, hospital and physician records. I found documentation from the jail staff that the prescribed medication was given to the plaintiff when he was first incarcerated. He also had a history of prior suicide attempts while taking his medication on a regular basis. In my opinion causation was not satisfied in this case.

The county defense attorney office did not settle and the plaintiff dropped all charges. They were overjoyed that I had saved them so much money. I now have an attorney-client for life!”

– Dale Barnes, RN, MSN, CLNC

“I was the Certified Legal Nurse Consultant for a case involving a dispute between two residents in a short-term women’s shelter for victims of domestic violence and sexual assault. According to information distributed by the shelter, residents would be ‘safe and free from violence, would become renewed in body, mind and spirit, and would find inner strength and peace.’ The shelter did not require any background information (physical, emotional or psychiatric) prior to admitting residents.

I reviewed police reports, shelter documents, depositions and hospital and medical records of Ms. A., the plaintiff. Ms. A. was an African-American woman in her early thirties with a high school education who had been physically and sexually abused by her father when she was a child (including being given heroin). She was divorced (domestic violence) and was residing in the shelter because of physical and sexual abuse by her boyfriend. She had a history of varied employment and was on disability for numerous physical problems and post-traumatic stress disorder.

Ms. B. was a Hispanic woman in her early thirties with a high school education and divorced after a long history of domestic violence. She denied any physical or psychiatric illnesses and was also a resident because of domestic violence from her current boyfriend.

Ms. B., after learning that some of her clothes were missing, went into the bedroom screaming and accused Ms. A. (one of her roommates) of taking them. A verbal confrontation ensued with Ms. A. denying she had taken the clothes and Ms. B. becoming increasingly angry and threatening. No staff member witnessed the bedroom confrontation. Throughout that day and the next, Ms. B. complained to staff that Ms. A. had threatened her. She demanded that Ms. A. be removed from the shelter and called the police twice to come and investigate. Ms. A. likewise spoke to staff members about specific threats made by Ms. B. that she would kill her.

On the following morning Ms. B. complained to staff and called the police again to no satisfaction. Ms. B. obtained a large knife from the kitchen and stabbed the sleeping Ms. A. 11 times, barely missing the femoral artery. Her stated motive was that she had to stab Ms. A. before Ms. A. killed her. Ms. A. was taken to the hospital and recovered with nerve and muscle damage. Ms. B. was arrested.

A careful review of the 35 records revealed many inconsistencies in the stories told by staff members and their lack of appropriate responses. A timeline of the 49 hours and a comparison of statements made in depositions highlighted these inconsistencies and helped refute statements that they had treated both women fairly, that they had responded appropriately to the situation, and that the stabbing incident was one they could not have predicted or prevented. As a result of my analysis, the case settled before the trial began.”

– Carolyn J. Bilodeau, RN, BSN, MS, CLNC

“Following my attendance at a local bar association meeting an attorney contacted me requesting my CLNC services in defending a mentally impaired client in a child abuse case. I have to admit, upon hearing child abuse, I was immediately concerned about a successful resolution of this case. But, I desperately wanted to branch out into criminal law, so I enthusiastically agreed to review the case.

The case involved a nine-month-old girl who was seen in the Emergency Department (ED) for a fall evaluation. Her mother stated that her boyfriend (the defendant) was lying in bed with her daughter, the patient, on his chest. At some point her daughter rolled over and fell, landing on the hardwood floor. In the ED the patient was noted to have some left-sided bruising, but X-rays, CT and a bone scan were negative. A referral was made to a children and youth agency. The next day, after further review of the X-rays, a buckle fracture and possible rib fractures were diagnosed. Although protesting that he did not hurt the little girl, the defendant was under investigation for child abuse and ordered to have no contact with the child.

On the surface this case seemed straight forward, but it proved to be one of those cases that the deeper you dug, the more the medical records revealed inconsistencies helpful to the defense. Inspired by my attorney-client’s passionate belief in the defendant, I scrutinized the medical records, researched key issues in the case, prepared a detailed chronology and located a pediatric radiologist expert.

One key aspect of the case was that the initial ED X-ray reports were negative then read as a buckle and rib fracture the next day. Additional X-rays were taken ten days after the injury. These X-rays revealed a new, not old fracture. Therefore, the attorney-client was able to assert that the defendant, unable to have contact with the child, could not have inflicted those injuries.

In addition to this objective finding, the medical records revealed subjective nursing documentation not supported by objective documentation: inconsistent timed entries indicating tampering and an entry by an RN documenting a conversation between the mother and boyfriend, which was overheard by a medical secretary. Because the RN was not present to hear the exchange and implicated the mother and boyfriend through an opinion she documented in the nurses notes, The Code of Ethics for Nurses, section 3.2 Confidentiality was violated. The attorney-client was able to use this fact to impeach the RN during cross-examination.

Following the conclusion of this case, my attorney-client sent me a letter stating: ‘I was able to prepare cross-examination of the doctors in advance using your chronology and interpretation of the medical records, which made things very clear for this attorney with no medical training. I kept the chronology with me during the actual testimony and was able to build on my prepared questions in response to the doctor’s testimony. I believe that your review and report enabled me to perform a better cross-examination which is critical in these cases.’”

– Debra Good-Zeiner, RN, MSN, CLNC

“My example didn’t save the attorney-client’s case, but it did save the attorney’s face. This is a prime example of why attorneys need a Certified Legal Nurse Consultant to review all medical records instead of relying upon their office staff’s assessment.

I had been trying to convince a personal injury (P.I.) attorney that he could benefit from my CLNC services. He insisted that he and his staff had everything under control and couldn’t justify my fee. After much persistence, he hired me to consult on an auto accident case.

The plaintiff claimed he had suffered a knee injury and multiple fractured ribs. The attorney’s assistant had already prepared a summary. Her summary stated the plaintiff had rib fractures and a knee injury which required a splint and referral to an orthopedic surgeon for a torn meniscus. The attorney told me he was getting ready to prepare a settlement packet and asked me to see if I was able to do any better.

The case made a u-turn after my review of the medical records. There were just a few pages from the Emergency Department (ED) visit, but enough to derail the original case. Evidently when the assistant did her summary, she wasn’t looking at the right areas. She saw in the triage notes: patient states ‘I have broken ribs.’ When the client had X-rays, the ‘reason for the exam’ said R/O rib fractures. The secretary thought that meant he had fractures. She didn’t know to read the ‘impression’ on the radiology report. It turned out he didn’t have any rib fractures. The knee injury was actually a soft tissue injury with bruising and swelling. The ED applied a splint and referred the plaintiff to the orthopedic surgeon he had been seeing for a pre-existing torn meniscus. The plaintiff was sure his ribs were fractured because of the continued pain and he didn’t think anyone would check and find out that he had a bad knee before the accident.

The attorney was in disbelief when I told him that the plaintiff didn’t have any broken ribs or a new knee injury. It turned out that the assistant who did the summary was relatively new to the firm and claimed she had P.I. experience with medical records. He was surprisingly humble and thanked me for saving him from a case of egg on his face.

Now this P.I. attorney understands the value of a CLNC consultant and always hires me for his larger and more complicated injury cases.”

– Jane Hurst, RN, CLNC

“I consulted on a urology case. The attorneys were taking depos before the case went to the medical review board. Neither side had considered that the deceased may have contributed to his own death. As the defense CLNC consultant, I went deep into the computer scheduling and found over eight appointments that the patient had failed to keep. Needless to say, there was no case and once the plaintiff attorney learned these facts, the case was dropped!”

– Rochelle Johnson, RN, MSN, FNP-BC, CUNP, CLNC

“A plaintiff attorney contacted me to accompany him to arbitration for a motor vehicle accident case. He disclosed to the arbitrator and the defense council that he would be bringing a Certified Legal Nurse Consultant to the meeting to help explain and support the medical records in the case.

The plaintiff was struck by a car that had changed lanes and hit her straight on. The attorney was trying to make heads or tails of her injuries and separate out her pre-existing conditions. She had chronic lower back pain, PTSD and a history of depression. The insurance company was not willing to settle without a clear picture of her injuries and the potential surgical costs.

He asked me to review all of the medical records and provide him with a complete understanding of each of her complaints and the evidence in the medical records that supported them. The attorney also wanted me to show how each of the injuries was supported by the documentation in the records. We separated out the pre-existing conditions from those residual ones after the car accident.

In doing this, I had a great opportunity to teach the attorney about different disease processes and the anatomy of the injuries. Together we worked on developing demonstrative evidence which showed her broken nose, fractured left orbital bone, fractured left clavicle, fractured ribs 1-4 on the left and 3-5 on the right. The plaintiff was going to need shoulder/clavicle surgery in the future with a long rehabilitation course. We wanted to be sure to capture all relevant medical expenses and lost wages despite not knowing when she would have the surgery.

We sent the final copy of our exhibits to defense council two days before the meeting. Upon receipt, the defense council was making calls each hour to the insurance company to increase their offer. The plaintiff attorney did not budge.

We were prepared for the arbitration with every piece of supporting documentation and we were not settling for anything less than the maximum policy amount.

The morning of the arbitration the case settled. The defense attorney was not willing to take the chance that I might have found enough supporting documentation that could raise the settlement any higher. The plaintiff attorney was thrilled and the client got the maximum policy amount.

The plaintiff attorney just hired me for another case!”

– Millie Mannion, RN, BSN, CNOR, CLNC

Thank you to all the CLNC Pros for sharing their stories about saving their attorney-client’s case.

I’m Just Sayin’

P.S. Comment and share how you saved an attorney-client’s case.

3 thoughts on “Certified Legal Nurse Consultants Save Cases for Attorneys – Here’s How!

    1. Much of this is rather brilliant, love it ! I will continue staying appraised!

  1. I recently did a case for an attorney-client who was convinced his plaintiff-client had a meritorious personal injury case. He told me everyone in the office told him to drop the case, “but I felt like a bulldog with a bone and don’t want to let go until I am sure, so please see what you can find, it is a $500.00 budget.” He had already spent thousands on an investigator who told him there was no evidence to support the case. There were only 19 pages of medical records. 4 hours later, I sent him a 2-page report of the findings. My findings helped him make the decision to drop the (bone) case. I commended him on trying all he knew to do for his client and to get me on his next medical related cases.
    The case:
    Plaintiff told the attorney she runs a cleaning business for building contractors. She was in a building and received an electrical shock while on a ladder cleaning a ceiling beam, “The electricity traveled to my left back and ruptured a muscle and I had two surgeries to the back muscle and I am unable to return to work.”
    She was suing the building contractor business for her injury claim. The attorney also spent time for travel to a burn center to ask questions to nurses and MDs about electric shock and if it can cause a ruptured muscle. I educated him that electrical injuries could occur, although rare if there are no visible burns. The contractor let the investigator know that there were some electrical wires exposed but the electrician said they were safe and secure before the claimed event occurred. The investigator noted that witnesses who were there at the time of the event said this gal never indicated she received a shock (witness holding the ladder plaintiff was on).
    The medical records revealed the truth:
    She went to a clinic and was seen by an MD who found a non-tender lump in her back (never diagnosed as ruptured muscle) diagnosis Grynfeltt Hernia, herniation of the descending colon caused by over stretching the muscle. Surgery was scheduled in one week. She left the clinic with a high dose of Vicodin for her “9” level pain and Ativan. From this time on she had more narcotics and benzodiazepine prescribed. She had surgery and more narcotics. She never told any MD of her electrical shock until she talked to a second surgeon 7 months later. He took her word that “she had a ruptured muscle from high voltage electrical shock some months ago.” The second surgeon did surgery and her muscle was torn and in a real mess this time and in severe back pain.
    The medical records did not support her injury claim, but it did support she had filed a false claim.

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*The opinions and statements made by Vickie Milazzo, the founder of Medical-Legal Consulting Institute, Inc. are based on her experiences and expertise, should not be applied beyond the specific context provided, and do not guaranty or project actual results. Vickie Milazzo is no longer involved in the operations or management of the business, but is involved as an independent education consultant.

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