Memorable CLNC® Cases

My First Case as a Certified Legal Nurse Consultant Was the Hottest Case in Town

by Jane Grametbaur, RN, CCHP, CLNC

With the wide variety of cases available to cut my teeth on as a new Certified Legal Nurse Consultant, I never imagined I would end up in the middle of a high-profile criminal case. The ink had barely dried on my CLNC® Certification certificate when I found myself involved in a murder case that quickly became one of the hottest topics in town.

During the CLNC Certification Seminar, Vickie stressed the importance of assertively seeking business opportunities.

With the wide variety of cases available to cut my teeth on as a new Certified Legal Nurse Consultant, I never imagined I would end up in the middle of a high-profile criminal case.

With the goal of getting my business up and running as quickly as possible and after getting help from my CLNC Mentor, I put together a marketing packet with brochures and business cards, sample reports and a comprehensive CV. I emerged from my home office with a professional-looking marketing packet. I was ready for action.

It Pays to Pay Attention to the News

A few days later I caught the end of a news conference on TV. A defense attorney insisted that the murder charge against his client be dropped, because the victim had actually died of an overdose of heparin while being treated for a stab wound inflicted by his client. The attorney concluded, “The nurse killed him. If it hadn’t been for the nurse, Mr. C. would be alive and well today.”

As a correctional nurse for more than 20 years I saw this case as a golden opportunity to apply a unique aspect of my nursing expertise. I phoned the DA’s office and offered my CLNC services. I had nothing to lose and, if the DA accepted my offer, everything to gain. After a few calls I tracked down the assistant DA assigned to the case and left a message.

She returned my call the next day and told me she didn’t know if she could successfully prosecute the five defendants charged with murder because she didn’t have a clue about what had actually happened to Mr. C., the victim. She had no real knowledge of medicine and didn’t understand why a patient who was bleeding would receive heparin.

The facts of the case were as follows: Mr. C. had been stabbed coming out of a bar. Taken to the county hospital, he exsanguinated after a nurse gave him too much heparin during an autologous transfusion. The medication error came to light three weeks after the incident, when a doctor who heard a rumor of the error contacted the coroner. The coroner amended the cause of death to include heparin overdose.

When I first spoke with the DA, she had not received the hospital chart. Her information came from the coroner’s report. I asked her to obtain copies of the hospital chart and all of Mr. C.’s medical records from the previous ten years. I then made an appointment to meet with her to discuss the case.

She eagerly accepted my assistance. The fact that I had offered to work pro bono helped. I didn’t tell her my CLNC Certification was fresh off the press. Instead, I projected all the confidence in the world even though inside I was a mass of quivering insecurity.

The main issue in this case involved the heparin overdose. The defense attorney’s allegation that the heparin had killed the victim was valid. Obviously, this fact would be a major obstacle in proving our case.

After some discussion about the legal requirements for obtaining a murder conviction, I felt that the DA could successfully prosecute the case. She would have to prove that Mr. C.’s stab wound had been life-threatening.

We met to review the patient’s chart. After the stabbing, Mr. C. and a friend drove home, a trip that took at least an hour. Upon his arrival home Mr. C. discovered his chest pain was not just his broken rib but it was due to a stab wound. His friend immediately took him to the emergency room. By the time Mr. C. arrived at the ED, he was so weak he had to be carried in.

His vital signs were fairly stable and his blood work unremarkable. A CT scan of the chest showed a hemopneumothorax and a fractured eighth rib.

A chest tube was inserted with a return of 1400cc of blood. At this point Mr. C. had received several units of blood. The resident decided to use the chest tube drainage in an autologous transfusion. The ED nurse, unsure of the correct dose of heparin needed for the transfusion, arbitrarily decided that 100,000 units would be appropriate. She added the heparin to the transfusion. Mr. C. then went to surgery where he underwent a lobectomy. Postop he was transferred to ICU where he continued to bleed. Several hours later he was taken back to surgery and died on the table.

Because I could not take the medical record out of the DA’s office, I took extensive notes. Any malpractice attorney presented with this case would have been ecstatic. Mr. C.’s treatment had been a tragedy of errors that had ultimately resulted in his death. However, the issue in this case was not who was guilty of malpractice but who caused Mr. C.’s death, the criminal defendant or the nurse?

Two Key Facts from My Research Helped Bring in a Murder Charge

After a thorough review, I advised the DA to keep in mind that because the heparin had killed Mr. C., we would need to focus on the complications of massive trauma and hemorrhage. Mr. C. had a history of HIV infection, which may have left him more vulnerable to complications.

Because the DA had no medical background, I provided her with a report explaining in simple terms the mechanism of injury, the anatomy and physiology involved, the accepted treatment for hemopneumothorax, as well as the deviations from the standard of care I had found in the medical chart. My report also discussed the possible complications of hemopnuemothorax and massive hemorrhage, such as DIC, total organ failure, infection, ARDS, heparin overdose, HIV and trauma. I researched traumatic injury on MEDLINE and included a number of articles about complications of traumatic injury.

My research revealed a key fact about heparin: There is no known fatal dose.

My most important finding related to the nature of the knife wound Mr. C. had sustained. The knife had severed his intercostal artery, and I found a reference that told me a lacerated intercostal artery could pump out 50cc of blood per minute. I used this reference to estimate Mr. C.’s blood loss before he reached the emergency room. I also gave the DA some ideas for demonstrative evidence.

At the DA’s request, I met her in the courtroom the day of the preliminary hearing. I had never been to court before and was terrified I would make a mistake that would reveal my lack of experience. I gained some confidence when a group of lawyers smiled and nodded at me on the elevator. At least I knew I had achieved the “look” in my new suit.

When I reached the courtroom, the DA was relieved to see me. My timeline was a real hit and she couldn’t stop thanking me for taking time out of my busy schedule to help her. I answered her last-minute questions and wished her luck.

The defendants never went to trial. After the preliminary hearing, all five defendants were charged with murder and chose to accept a prison term rather than go to trial.

Although I was disappointed not to have the opportunity to work through the trial phase of this case, I feel that without my help, these five men would have walked free. In the end, justice was served and the defendants will pay for their crime.

This case taught me many valuable lessons. I discovered that I have the ability to be an effective Certified Legal Nurse Consultant. My many years as a nurse have made me self-reliant. While beginning a new career can be a frightening experience, I found the courage to take the first step toward a bright and promising future as a CLNC consultant.

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