The Role of the Certified Legal Nurse Consultant in Compassionate Release Cases

I have been a Certified Legal Nurse Consultant for 14 years now. The support I have received from the CLNC® Mentors at the Institute has always been encouraging. In August, I was asked to review some medical records for a compassionate release request for a new attorney. I called the Institute and received much encouragement.

The client is a public defender and represents defendants who are unable to afford legal assistance in criminal matters. The First Step Act of 2018 grants all individuals incarcerated in federal prisons and penitentiaries eligibility for compassionate release, so long as they are able to demonstrate “extraordinary and compelling reasons” for a reduction in sentence and do not pose a threat to society.

I had been on a couple of mentoring sessions with the Institute about COVID-19 cases. I was interested in COVID-19 cases and accepted the request. I reviewed and summarized the records, just as I do in a civil matter. I was also asked to write an affidavit based on the medical records and current literature and research related to COVID-19.

Following this matter, she asked me to review another similar type of case. The attorney who recommended me to the first attorney also called to have me review a case for him. Since then, I have had three more attorneys who have asked me to review compassionate release cases. Now, I am doing compassionate release cases for a total of five attorneys. My goal is to do more cases similar to this for more attorneys. Also, these new attorneys now know my report writing skills. I will ask them to consider me to review medical records in their other criminal matters.

The CLNC experience I’ve had in civil matters prepared me for this assignment. I defined medical terms and described disease conditions that an attorney or judge may not understand. I researched reputable internet sites such as the Centers for Disease Control to substantiate the risk of COVID-19 on disease conditions.

Being a Certified Legal Nurse Consultant has given me personal satisfaction and professional confidence. As Vickie says, “We Are Nurses and We Can Do Anything!” The report writing skills and networking strategies learned in the CLNC Certification Program prepared me for this assignment. I look forward to what 2021 hold for all of us as CLNC consultants.

SAMPLE AFFIDAVIT

1. I am a Registered Nurse licensed to practice in the State of Maryland. My curriculum vitae is attached hereto as Exhibit “A” for purposes of more fully detailing my education, training, and experience.
2. In forming my opinions, I have reviewed the following medical records regarding JOHN DOE, Date of Birth 1/1/1975:
   • Bureau of Prisons Health Services psychological and medical records, dated 2019; and
   • Bureau of Prisons Health Services psychological and medical records, dated 2020.
3. Based on my review of the above medical records and information known to date, JOHN DOE is a black American male who is incarcerated.
4. In review of the literature, according to the Center for Disease Control (CDC), a person who is a black American is 4.7 times more likely to be hospitalized if diagnosed with COVID-19 than a white American. According to the American Council on Science and Health, as of 6/23/20, black Americans constitute about 13% of the U.S. population but suffered 23% of all COVID-19 deaths.
5. Based on my review of the above medical records and information known to date, JOHN DOE is of male gender.
6. In review of the literature, a new study published in Nature Communications on 12/9/20, there is no difference in the proportion of males and females with confirmed COVID-19. But once positive for the virus, male patients are almost three times more likely to require intensive care unit admission. Also, the study said that the death rate was estimated to be 1.4 times more likely for men.
7. Based on my review of the above medical records and information known to date, JOHN DOE has a history of severe obesity. His body mass index was greater than 42% on 11/8/20. According to the CDC, severe obesity is defined as a body mass index (BMI) greater than 40%.
8. In review of the literature, according to an article in Circulation published by The American Heart Association on 11/17/20, patients with severe obesity, defined by a BMI of 40 or greater, had slightly more than double the risk of being put on a ventilator and a 26% higher risk of death compared to normal weight patients. The mortality association was strongest in younger adults, age 50 and younger. Those with severe obesity had a 36% higher risk of death compared to their normal weight peers.
9. Based on my review of the above medical records and information known to date, JOHN DOE has a history of type 2 diabetes mellitus. His hemoglobin A1C consistently was above normal with a range of 6.3-7.0%. Normal hemoglobin A1C is less than 5.7%. Hemoglobin A1C is the three-month average of plasma glucose, used to diagnose prediabetes and diabetes mellitus. Therefore, based on his laboratory results, his diabetes, type 2 was poorly controlled. Mr. Doe takes two medications daily for his type 2 diabetes mellitus.
10. In review of the literature, according to the Center for Disease Control on 2/3/21, a person who has diabetes, type 2, is at an increased risk of severe illness if diagnosed with COVID-19. The increased risk is especially true if the diabetes is not well controlled. Diabetes also keeps the body in a low-level state of inflammation, which makes its healing response to any infection slower. High blood sugar levels combined with a persistent state of inflammation make it much more difficult for people with diabetes to recover from illnesses such as COVID-19.
11. Based on my review of the above medical records and information known to date, JOHN DOE has a history of asthma. He required two inhalers for regular use for this medical condition in 2020. Asthma is a chronic lung condition that affect the airways and causes inflammation. The inflammation causes spasms and narrowing if the airways, which leads to wheezing, shortness of breath, and coughing. The airways narrow, swell, and produce extra mucus, making breathing difficult.
12. In review of the literature, respiratory viral infections, such as COVID-19, can trigger and worsen asthma symptoms. Asthma does not go away, and a person could have a flare up when the right trigger is present. Two researchers at The Hunter Medical Research Institute, Professor Peter Wark and Associate Professor Nathan Bartlett, explain that those people with pre-existing respiratory conditions such as asthma, extra caution is required. If the person has disease issues with the target organ, in this case the lungs, then that gives the virus a better chance of getting into the lung tissue and causing a more serious condition.
13. The Journal of Allergy and Clinical Immunology published a study that cited data from the Center for Disease Control (CDC). The CDC data indicated that asthma is present in about 17% of all admitted COVID-19 patients in the United States, and in as high as 27% of patients in the age group of 20 to 49 years, which marks asthma as the second most common comorbidity in this age group, following obesity. Among the patients who developed severe respiratory symptoms requiring intubation, asthma was associated with a significantly longer intubation time.
14. Based on my review of the above medical records and information known to date, JOHN DOE has a history of hypertension, also known as high blood pressure, diagnosed in 2010. Mr. Doe takes three medications daily for his hypertension.
15. In review of the literature, even though the CDC states that people with hypertension might be at risk of severe illness from COVID-19, there are other articles that consider it a serious risk. An article in Anaesthesia, published on 4/27/20, noted that hypertension should be considered as a significant risk factor for poor outcomes amongst those presenting to the hospital with COVID-19.
16. Another article in European Heart Journal, published on 6/4/20, noted that patients with hypertension had a two-fold increase in the relative risk of mortality as compared to patients without hypertension. The World Health Organization (WHO) says that people with hypertension are at increased risk of sever disease and death from COVID-19.
17. Based on my review of the above medical records and information known to date, JOHN DOE has hyperlipemia also known as high cholesterol, Mr. Doe takes medication daily to lower his cholesterol.
18. In review of the literature, according to a study published on 5/10/20, higher cholesterol levels cause an increase in the number and size of entry points for the COVID-19 virus, accounting for the much higher likelihood of infection.
19. Based on my review of the above medical records and information known to date, JOHN DOE has seven comorbidities: his ethnicity, his male gender, his morbid obesity, his type 2 diabetes mellitus, his asthma, his hypertension, and his hyperlipidemia.
20. In review of the literature, according to the CDC, having more than one comorbidity causes him to be six times as likely to be hospitalized and 12 times as likely to die, compared with those who have no comorbidities. The CDC found that 94 percent of the patients who died from COVID-19 had more than one comorbidity.
21. Based on my review of the above medical records and information know to date, JOHN DOE also has medical diagnoses of astigmatism, sciatica, and dental caries.
22. In review of the literature, I did not find that the diagnoses in statement number 20 put a person at an increased risk of getting COVID-19 or having a serious response or needing to be hospitalized if diagnosed with COVID-19.
23. My opinions expressed above are limited to the medical records reviewed in the data outlined above as well as current research. I reserve the right to amend my opinions if I am supplied with additional information from other sources.

Guest Blogger Profile

Marcia L. Bell, RN, BSN, CAPA, CLNC owns Bell Legal Nurse Consulting in Maryland. Marcia works as a consulting expert on medical malpractice, personal injury and criminal cases. She also works as a testifying expert in PACU cases. Marcia is clinically active part time at a day surgery center.

P.S. Comment and share unique types of cases you’ve consulted on.