Memorable CLNC® Cases

Complex Legal Nurse Consulting Cases Often Hinge on Simple Issues

by Lisa Ellison, RNC, CLNC

I was asked to provide an initial opinion on an OB case involving a vaginal delivery after cesarean section that resulted in a ruptured uterus and a very badly injured infant. Every case I work on as a Certified Legal Nurse Consultant is a learning experience, and this case was a lesson in the importance of the KISS principle (keep it simple, stupid).

The attorney-client asked me to create a detailed chronology and case summary, conduct literature research, prepare deposition questions and requests for production, review deposition responses, and locate an expert nursing witness.

The attorney-client was generous with his praise for my work. He appreciated my research and my assistance. But what he appreciated more was my dedication.

I did a lot of research on the causes of uterine rupture, on safety issues affecting vaginal delivery after cesarean section, and on cerebral palsy, neonatal resuscitation and Apgar scores. I scoured ACOG, AWHONN and neonatal resuscitation standards.

However, the real issues of the case were much simpler. The gross deviations from the standards of care related directly to the Nurse Practice Act. Among other basics, this particular case involved failure to assess, failure to notify the physician, failure to notify the house supervisor and failure to change a malfunctioning piece of equipment — basics every nurse knows or ought to know. My point is that complex cases sometimes come down to the rules we learn in Nursing 101. Pointing out the deviations from those rules can win a case for a plaintiff attorney.

The attorney-client in this case was generous with his praise for my work. He appreciated my research and my assistance in interpreting the Nurse Practice Act as well as the fetal monitor strips. But what he appreciated more was my dedication to the KISS principle.

While detailed clinical research on complex medical and nursing issues is essential, we must look for the basic issues as well. We must always remember that the most fundamental nursing errors can cause devastating outcomes for patients. I feel certain the verdict will be for the plaintiff who was so badly damaged.


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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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