Memorable CLNC® Cases

I Expanded My Role as a Certified Legal Nurse Consultant

by Dale Barnes, RN, MSN, PHN, CLNC

This is one of my most memorable cases because it expanded my role as a Certified Legal Nurse Consultant. The child in this case was 4 years old when he attended a church day care while his parents attended services. He was an active, healthy child, but did have a milk allergy. The boy was aware of his own allergy and always told his teachers he could not drink milk.

The CLNC® services I provided impacted the family in a positive way, as is evidenced by the financial support they received to care for this child for the rest of his life.

On the day of incident, he told the day care teacher that he was no longer allergic to milk. The teacher (taking the word of a 4-year-old) gave the boy a glass of milk. When his parents picked him up, the boy stated he did not feel well. On the drive home the boy became lethargic and his breathing became shallow. The parents took him directly to the closest emergency department (ED). By the time they arrived, the child was in full arrest. The healthcare providers resuscitated him, but he required continued ventilatory support. The parents called the church and discovered that he was given milk during day care that day. The child was diagnosed with anaphylactic reaction due to milk allergy.

He was unable to be weaned from the ventilator. The parents brought him home and he required nursing care around the clock. Over the next few years, the child was unable to respond in any meaningful way. He opened his eyes, but could not follow commands. His caregivers provided range of motion exercises several times per day, turned him regularly and provided feeding via G-tube. He developed pressure ulcers and eventually required a Foley catheter. He was incontinent of bowel. He developed several infections after the Foley was inserted, and they intermittently left it out while he was getting antibiotics. Eventually, the nurses’ hours were decreased to 20 hours/day, and the mother filled in on the remaining four hours.

The defense attorney contacted me three years after the incident. He knew the church was liable and was aware that they would be making a settlement. However, before he entered those negotiations, he wanted to know if the care provided for the child was appropriate and within the standards of care. He asked me to assess the child and the nursing records to make the determination. He also wanted to know the cost for future care, as he knew this was going to be an issue for as long as this child lived. I located a life care planner to assess future costs.

Essentially, the attorney wanted us to actually provide a form of defense medical exam (DME) from a nursing care standpoint. This was new to me, but also exciting. The life care planner and I made a joint visit to the family’s home. The boy’s hospital bed was in the main living area of the family’s home, and everything revolved around this area. There was a younger brother who came home while we were there, walked in, kissed his brother and went about his business. He most likely did not remember his brother when he was a healthy, active child.

I recorded videos of the home environment, all the equipment and the child (after the parents signed consents). I recorded the entire session as we interviewed the parents and the nurse who was present. I noted all the medications and treatments, and carefully reviewed the chart of nursing notes. The life care planner looked at all the medications and treatments, and also at possible further surgical intervention.

I submitted my written report, video and audio recordings to the defense attorney. I determined that the care was appropriate. I did note, however, that in the years to come, this might become too overwhelming for the family, and they may need to consider a facility that could manage his care. The life care planner noted the same. The life care planner felt even more strongly than I did that placement of this child was inevitable. The amount she determined would be required was more than the attorney was hoping for, but he accepted what we both determined and went on to make an appropriate settlement offer to the family.

The attorney would not have been able to make his determinations without me and the life care planner. He was pleased with my CLNC® services and has since had me provide DMEs from a nursing standpoint for other cases. His comment was, “I could not have done this confidently without you, and your locating the life care planner was invaluable.”

This has given me another stream of income that I plan to further market to attorney-prospects. This is a great opportunity for CLNC consultants, and I recommend marketing this service in the future. The CLNC services I provided impacted the family in a positive way, as is evidenced by the financial support they received to care for this child for the rest of his life.

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