Memorable CLNC® Case

My Most Memorable CLNC® Case: This Digoxin Toxicity Case Validated How Valuable My Certified Legal Nurse Consultant Skills Are

My most memorable case was the one that taught me valuable lessons that have become the foundation of my legal nurse consulting role. I was requested to review overseas claim forms and medical records with the goal of identifying inappropriate medical billing practices and investigating whether services rendered were appropriate and medically necessary.

The case highlighted the most difficult aspect of performing CLNC® work for a Special Investigations Unit (SIU); identifying negligent care within a timeline that prevented me from saving a life when its discovery occurred too late to make a positive patient impact.

My experience and training as a Nationally Registered Paramedic, RN, and CLNC consultant qualified me to review a 25-day hospital admission of a male with a history of cardiac arrhythmias reportedly controlled by taking digoxin. His symptoms which included presence of vision changes and a yellow haze were consistent with digoxin toxicity, all of which were documented by the physicians and nurses. He saw specialists including emergency department (ED) doctors, cardiologists, endocrinologists, urologists and internal medicine physicians along with three different nurses each day. There were no orders or suggestions for obtaining a blood digoxin level. None of the doctors documented consideration that his condition was worsening from a toxic drug level. Finally on inpatient day 22, an endocrinologist suggested checking his digoxin level. As I expected, the record showed an unbelievably elevated result which could not be lowered without administration of Digibind.

Digibind was never ordered by any physician for this patient. Orders were given to hold the full morning digoxin dose for a day. The following day, he was ordered to have half his normal dose. The next day he was given his full dose again. Four days post identification of the critically high drug level, he was discharged home with the same symptoms he had when he was seen in the ED 25 days prior. Six months later, his hospital claim for more than $100,000.00 landed on my desk.

I vividly remember my dramatic and unexpected reaction to reading the information in his medical record. It was one of those moments when you blurt something out before your brain acknowledges the meaning of the words you used. “Oh my god. I think they just killed this man.” I asked a colleague to check his health insurance enrollment information, specifically to determine if he was still alive. In my heart, I already knew the answer. My suspicions were spot on. He had died ten days later having never received the appropriate and available drug to bind with the excessive digoxin in his body.

I recall saying to my SIU Manager, Rod (also a Certified Legal Nurse Consultant), “If those records got to me in real time, I could have saved this man’s life.” Thankfully, Rod understood how I was feeling from an RN, CLNC standpoint. He supported me through a period when I wasn’t sure I could handle any other experiences of reviewing medical records illustrating gross negligence. Instead of trying to give me a pep talk about ‘just doing my job and going home at the end of the day,’ which nurses like me have a very hard time doing, Rod encouraged me to process and face the emotions head-on. He compared the experience to the unfinished business of EMS which I had learned to handle years before becoming an RN. I worked under Rod’s leadership, and he played an active role in my professional development, telling me once that I was a “diamond in the rough.” He offered to mentor me to become a “polished diamond.” I believe I earned my first facet that day.

Performing that claim and medical record review had a great impact on my CLNC career. It gave me the confidence to elevate my SIU nursing practice by trusting and respecting my nursing experience and intuition. If I had the chance to do the claim all over again, I don’t think I’d do anything differently. I learned valuable lessons and finally recognized how impactful and valuable my CLNC skills were, a realization that helped me develop and escalate my passion for medical record documentation and analysis.

Guest Blogger Profile

Caryn “CJ” Jaffe, RN, CLNC owns New Heights Legal Nurse Consulting, LLC in Columbia, Maryland. She specializes in medical malpractice, personal injury, products liability, workers’ compensation and disability discrimination cases for both plaintiff and defense attorneys.

P.S. Comment here to congratulate Caryn Jaffe, RN, CLNC and to share your most memorable CLNC case.

5 thoughts on “My Most Memorable CLNC® Case: This Digoxin Toxicity Case Validated How Valuable My Certified Legal Nurse Consultant Skills Are

  1. Thank God for nurses like you. I appreciate your story. It made me mad and angry as I was reading, yelling “WHY DIDN’T SOMEBODY ORDER THE FREAKING DIGIBIND”. Your story reminds me to continue to be a critical thinker, responsible and accountable RN in my practice of care. God bless you.

    1. Kudos to you for your expert eye and medical knowledge to pick up on what happened to this poor patient, that otherwise would have been swept under the rug. There are too many cases like this out there in which deaths could have been prevented. Thank you for sharing and congratulations on your great work identifying the wrongdoings in this case.

  2. Bravo to you for explaining moment in our analysis as Certified Legal Nurse Consultants and experienced expert hands on nurses when we experience a fact analysis we are on to something. Such moments come after many cups of coffee, hours of scanning a chart, piecing together a story, copious documents, select consultations, to find lack of critical collaboration (though all consults point to the issue at hand) to arrive at the correct treatment plan until it is too late…

  3. It was heartwarming to hear your story. Just last week, I had to close a Workers’ Comp case where I couldn’t convince anyone (client and doctors alike) to advocate for back surgery when it was obviously the next course. As Certified Legal Nurse Consultants we are pivotal in moving care along to the next level. While we can’t always affect the immediate health outcomes, we can do our best to expose the best practice to those responsible. Thanks for sharing.

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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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