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Certified Legal Nurse Consultant Spots Medical Negligence Where it's Least Expected

When an attorney takes on a medical-related lawsuit, the attorney is confronted with enormous volumes of medical records crammed with esoteric terminology, inexplicable shorthand and indecipherable handwriting. Yet his client's future depends on the attorney understanding those records and using them to support the case effectively. That's why a Certified Legal Nurse Consultant's service is the healthiest thing that will ever happen to an attorney's practice.

While the services of a legal nurse consultant can make a big difference in a catastrophic case, many attorneys don't wait for such cases to come along before engaging the services of a Certified Legal Nurse Consultant. Kenneth Phillips, a Los Angeles-based attorney known nationally as the "dog bite king," uses the services of Dale Barnes, RN, CLNC on all his cases.

After Phillips' office orders the medical records, Barnes receives and tracks them, and keeps him apprised of the status. "Because Dale has so much nursing experience," says Phillips, "she's invaluable at simply gathering the necessary records and documenting the injuries. I never worked in a hospital, so I could miss something, but she doesn't."

Dale's alertness and training as a Certified Legal Nurse Consultant was crucial to a complex case that Phillips describes as "everyone's worst nightmare." A woman was walking her three chow dogs, when one animal broke free and grabbed 18-month-old Ted Ferrell* by the face as his mother was getting him out of the car. Mrs. Ferrell picked up her son and ran to the garage with the dog chasing her. She fell with Ted in her arms and shielded him with her own body against the continued attacks. Her husband heard the screaming, came out and chased the dog away.

"Ted's injuries were quite extensive," says Barnes. "He sustained multiple puncture wounds to his face and around his eyes. Two of his upper teeth were knocked out, and his lip and mouth were injured. Most dog bite cases don't involve negligent medical care, but this one raised some red flags. In addition to explaining the injuries in detail, I was able to point out that some of the medical care was below the standard of care."
"This is a good reason for involving a Certified Legal Nurse Consultant like Dale," says Phillips. "I need someone with medical training to review my client's care. I cannot assume it's correct. And using Dale's services is less expensive than hiring a physician to review every case."

After Ted was discharged from the hospital, he was readmitted with wound infection around his right eye. A new antibiotic was prescribed, but Mr. Ferrell wasn't happy with his son's lack of improvement, so the boy was transferred to another hospital for IV antibiotic therapy. The staff at the second hospital noted that the wound was abscessed and performed surgery immediately to drain the abscess. Cultures taken during surgery showed bacteria and explained why Ted had not responded to the previous antibiotics. "The first hospital never took any bacterial cultures," says Phillips, "so the physicians were only guessing at which antibiotics might be successful."

Dale’s experience as a legal nurse consultant also helped her to notice a number of other discrepancies in the records:

1. There were no home health notes in the records. This would have been helpful in assessing when the infection started.
2. Even though Ted's white blood cell count was still slightly elevated, there was no record of lab work on the day he was discharged from the first hospital.
3. No nursing notes were included from either hospital, and no speech or occupational therapy (OT) notes from one facility. Such assessments are necessary in cases involving injuries to the mouth.

Certified Legal Nurse Consultant Uncovers the Significant Extent of the Injuries Phillips continues, "Dale's expertise as a Certified Legal Nurse Consultant enabled her to help me sort out all the nursing, physician and home health issues and present a clear case. I could understand the injuries, procedures and prognosis, and see where the physicians were negligent. Dale also assisted in identifying additional records I needed to obtain for a more complete review of the case."

"Ted had significant nerve damage," Barnes reports. "You could tell that by watching him try to smile. A nerve conduction study should have been ordered to confirm this observation."

"The doctor assumed the condition would resolve itself," Phillips adds, "but he should have ordered the study to guide the boy's treatment. Dale's knowledge of medical testing is so extensive that she suggested we order the study to document the existence and extent of nerve damage and to help demonstrate Ted's suffering. We could do that with subjective evidence, but the objective evidence provided by the nerve conduction study was more persuasive, and we wouldn't have had that without Dale."

Barnes' legal nurse consultant services are essential in Phillips' type of practice. "Most of my clients are children who have been bitten in the face and disfigured," he explains. "The parents may downplay their child's suffering to encourage the child through this horrible event and to allay their own guilt. In addition, because 75% of attacking dogs belong to a family member or friend, parents don't want to hurt the defendant in the case. The doctor may also optimistically downplay the severity of the injuries because he believes he can handle the problem. Under these circumstances, I may never learn the devastating effect on a child without an experienced, word-by-word examination of the medical record for clues such as bed-wetting, hives, stuttering, muteness, violent behavior or other signs of post-traumatic stress. Dale picks up on these clues, sometimes by talking to the plaintiff, but usually just from examining the record."

Likewise, some injuries can appear more significant than they really are. Phillips states, "A medical term may suggest something awful to me, but Dale knows enough to tell me the finding is not significant."
In Ted's case, "Dale realized the injury was more extensive than we originally thought. She saw that the doctors were focusing on one issue, but they were neglecting other serious problems. We had the opportunity to correct the situation and get the child the help he needed. The patient received better medical treatment because of what Dale observed."

Phillips notes several additional benefits of using Dale's legal nurse consultant services on all his cases:

1. "My case is stronger and cleaner, and my presentation is more efficient and effective because of Dale's great summary of the medical information."
2. "From the outset the full nature and extent of the injury is on the table, enabling us to put our best foot forward with the insurance company."
3. "My demand letter appears more objective because it's backed by a medical person, and frankly, Dale is more objective because she has so much experience."

The total settlement in Ted's case came to more than ,000,000, including costs of past and future medical care. As in other cases, the cost of Dale's legal nurse consultant services was rightly passed through to the client. "It's not like she's a secretary or paralegal," Phillips notes. "She's an outside professional who provides additional expertise and an invaluable medical perspective on the case."
He concludes, "Attorneys have neither the time nor the experience nor the medical knowledge to thoroughly review the records. We can't rely on the treating physician. If he doesn't know us, he may not be open with us. I think every attorney needs a Certified Legal Nurse Consultant like Dale, someone medically trained, on his team."

* Name has been changed.


About the Author: Inc. Top 10 Entrepreneur Vickie L. Milazzo, RN, MSN, JD is the founder and president of Vickie Milazzo Institute. She is credited by The New York Times with creating the legal nurse consulting profession in 1982. She is the recipient of the Nursing Excellence Award for Advancing the Profession and the Stevie Award (business's Oscar) as Mentor of the Year. Vickie has revolutionized the careers of thousands of RNs. She is the author of Inside Every Woman: Using the 10 Strengths You Didn't Know You Had to Get the Career and Life You Want Now, from John Wiley & Sons, Inc. Order this top 5 Amazon.com bestseller now. Reprinting and republishing of this article is granted only with the above credit included. Permission to reprint or republish does not waive any copyright or other rights.
Copyright © 2006 Vickie Milazzo Institute, a division of Medical-Legal Consulting Institute, Inc., Houston, Texas.
All Rights Reserved.




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