My Most Memorable CLNC® Case: This Cardiac Arrest Case Reminded Me of the Importance of Reverting to Basic Nursing and Medical Principles

Over ten years ago, I was hired by a law firm as an independent Certified Legal Nurse Consultant to organize medical records and review their cases for merit. It was a family-operated practice, where the father and his three sons were the attorneys. My primary interactions were with the son who was the managing attorney.

One day, the father called me into his office to discuss a case. This most Memorable CLNC Case involved a woman in her 50s who had a history of gallbladder problems. She arrived at the emergency department complaining of nausea. While en route to undergo a CT scan, she experienced a cardiac arrest and sustained brain injury. The attorney requested that I review the medical records and mentioned that his medical experts were unable to determine what went wrong. The attorney was specifically interested in the cause of the cardiac arrest.

First, I organized all of the medical records in chronological order. Next, I developed a detailed timeline of the events in the emergency department prior to the cardiac arrest. My review revealed that the patient had received at least four or five different antiemetic medications. She was also treated for pain. Subsequently, an abdominal CT scan was ordered.

While drafting the timeline, I integrated my CLNC brain with my nursing brain, reverting to basic nursing and medical principles. As an RN, I know that when several medications are administered concurrently, drug interactions may pose a significant risk. I consulted a reputable drug-interaction website and entered all of the medications into the database. I found that the first two medications posed potential risks for prolongation of the QT interval. With the addition of each subsequent antiemetic medication, the potential for prolongation of the QT interval increased significantly. Since QT prolongation can lead to sudden cardiac arrest, I concluded that cardiac arrest was due to drug interactions and that the case was meritorious.

I presented my opinions and report to the attorney. Initially, he had been skeptical about using a Certified Legal Nurse Consultant on his cases, but that day, he was convinced of my value. He clearly respected my qualifications as a CLNC consultant.

This Memorable CLNC Case reminded me of the importance of reverting to basic nursing and medical principles. Simplified explanations are invariably more accessible to attorneys and juries alike. Complicating cases only impedes understanding. This case bolstered my confidence in screening cases for merit. The rigorous training I received through the CLNC Certification Program aptly prepared me to succeed.

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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 magnet hospital.

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