Recently I had the privilege of traveling to Morocco. I love visiting remote places that are totally different from my day-to-day culture and environment.
When packing for the trip, I noticed that even though I had invested a lot of time and money in the adventure of exploring an exotic new destination, I was trying to bring my American comforts with me.
I thought, "If I'm going to bring the U.S. with me, I might as well stay home." If I succeeded in replicating the comforts of home, I would actually miss what I was going in search of – an exciting, unexpected experience that would spark my senses, stimulate my creative juices and move me out of my comfort zone so I could return home ready to deal comfortably with all the challenges of life and my business.
I quickly decided I didn't need items like my blow dryer to go on a camel ride in the desert. And by leaving those items behind, I was able to pack lighter and immerse myself in the Moroccan culture with a more complete sense of adventure.
The same thing that almost happened to me as I prepared for my trip to Morocco could happen to you as you embark on your legal nurse consulting adventure. Are you packing all your old "career comforts" as you pursue your new LNC career?
To experience all that legal nurse consulting has to offer, you must be willing to shed your old ways and habits, step out of your comfort zone and let go of old beliefs that no longer serve you. As a RN, you may have that steady paycheck, but as a LNC, you'll have more fun and the potential for greater financial prosperity as soon as you open up to the possibilities within you.
Pack your bags today. And be sure the wardrobe and accessories you take match what is needed for your new adventure as a legal nurse consultant, not what was needed in your old life as a RN.
If you pack even a single familiar "career comfort," you might learn painfully that you could have stayed "home" and saved yourself a lot of time and money.
Happy travels!
Vickie L. Milazzo, RN, MSN, JD
President, Medical-Legal Consulting Institute, Inc.
P.S.
Camels do smell bad and they do spit a lot! But the camel ride is an experience I wouldn't have missed, and I sure didn't need my blow dryer for the adventure.
Providing Quality Service – Easy to Say, But Are You Delivering?
by Rose Clifford, RN, CLNC
Anyone can say they provide quality legal nurse consulting service. The true test of that claim is whether your attorney-clients actually feel they're receiving quality service.
Do certain attorneys or law firms immediately think of your firm when they have a medical issue? Do they not only think of you, but also call you? If not, that hesitation to call may be due to the attorney-client's perception of your service. Your goal is to make sure he feels satisfied with your service and to make sure that feeling persists.
Where does quality service start? Quality service begins with the small stuff. It begins the day you decide to become a legal nurse consultant, and it starts with:
Your belief about what constitutes quality service.
All the preliminary groundwork you do to set up your business.
Every action you take to maintain and market your firm.
Quality service is one component that makes your firm memorable.
Step One - Are You a Consulting Expert or Testifying Expert?
The first way to provide quality service is to be clear up front whether you are providing behind the scenes consulting services or functioning solely as a testifying expert. This is your decision alone, not the attorney's.
Once you have made your decision, it is your responsibility to stick to it. Yes, you may provide both services. But not on the same case, especially if you start out providing behind the scenes consulting and then down the road agree to serve as an expert witness.
Step Two - Asking Questions Is the Route to Knowledge and Quality Service
The second way to exhibit quality service is by responding professionally to an attorney's inquiry. Whether by phone, fax, email or in person, your initial response lays the groundwork for creating the perception of quality service.
Your response should include listening carefully to what the attorney is calling about and asking preliminary questions. Remember, asking questions will not make you look like you don't know what you're doing. Quite the contrary, asking questions actually puts you in a position of knowledge and
control.
How would you feel if you got sick and went to your doctor, and he asked no questions, made no attempt to find out what your problem was? Before you could volunteer any information, he said, "Wait — don't tell me. Have I got a prescription for you!" You'd feel uncomfortable, wouldn't you? You'd
probably doubt the quality of his service. Wouldn't you expect him to ask questions?
Bring that attitude into your services in the legal arena. You need to ask your attorney-prospect questions such as:
"What is this case about?"
"Who are the opposing parties?"
"What do you need me to do for you?"
"When do you need this done?"
Be sure to restate the attorney's responses to clarify your understanding of his needs.
Step Three - Quality Service Takes Time - Be Sure Your Client Knows How Much
Another step in providing quality service is to clarify early on the number of hours it will take to provide the service the attorney wants. Determining how much time you need to complete your assignment is hard for most legal nurse consultants. But it's even more difficult for the attorney because he is buying the promise of future performance of a service he may not have ever received before.
Each case takes on a life of its own, but in general you can make a preliminary estimate of the time you'll need based on the type of case, the attorney's needs, the service you are providing, and the deadline. Here are some guidelines that serve me well:
A merit review of a medical malpractice case with only a verbal report to the attorney should take 1-5 hours. If a written report is required, this will double your time.
Initial literature research for medical malpractice, personal injury and product liability cases should take 1-2 hours, or up to 3-4 hours in complicated cases.
Developing a time-line or medical chronology should take 10-20 hours, depending on the complexity of the case.
Reviewing physician office records should take 1-1.5 hours, depending on their legibility and the number of office visits involved. Physical therapy records take about an hour to review. Chiropractic records can take longer due to the inconsistent formats and unique acronyms used by individual practitioners, but such records generally take 1-2 hours to review.
Focused reviews to detect fraud may take 45 minutes to 1.5 hours, depending on the reason for the review, provider being reviewed, deadline and number of financial claims being correlated.
The total time for all reviews can be as little as 15 minutes or as long as 6-8 hours.
Additional written reports and conferences with the attorney will further increase your time, depending on the extent of the reports and the number and length of the conferences.
The key is to stay within your projected number of hours. If you are close to this limit but haven't completed the task, call the attorney and let him know how far along you are, how many hours you've used, and how many hours you think you still need to complete his assignment.
The point is to avoid surprising your attorney-client. For instance, you should never spend 30 hours on an initial review if the attorney is unaware that you're planning to bill for 30-40 hours of research.
Regardless of how committed you are to doing an excellent job, let the attorney be your guide in determining when a project has met his needs. But don't be afraid to ask about providing additional services that are appropriate for the case.
For example, after you complete a merit review for a medical malpractice case, if the attorney decides to file suit, offer to do a detailed chronology of significant events. Be sure to let him know how much time this would take and get his approval before starting the additional service.
It's vital to keep your attorney-client in the loop. Let him know what his case needs next, but give him the opportunity to approve or disapprove any additional time you might spend. If he agrees, ask him to set the deadline for completing the next service. Be sure to follow up with a letter of
agreement confirming the additional time, cost and deadline.
Step Four - Set Your Fees to Reflect Your Quality
Take a close look at the fees you charge, and be aware of what your fees say about the quality of your service. Your attorney-clients expect to pay more for top quality service. A higher price changes their perception of the quality of the service being provided. Charging more may actually improve
their experience and perception of your work.
Conversely, although some attorneys encourage legal nurse consultants to lower their fees, if you do this, they may not truly appreciate the quality of your service. Think twice before offering your services at fees that undervalue your quality. Always charge what you're worth.
Remember, attorneys want different levels of service. One may need a simple review completed within 30 days. Another will ask for a turn-around time of three days or for service available seven days a week. To meet these varying needs, consider offering a tiered pricing schedule with higher prices for those who want immediate service.
Step Five - Keep Your Word - Every Time
A major part of delivering quality service is doing what you promised you would do at the time agreed upon. Timeliness is critical to the attorney's perception of quality.
For example, an attorney recently asked us to report on the merit of a medical malpractice case. He needed the report by Monday. Our office was behind and did not finish the report on the preceding Friday afternoon. We worked through the weekend to complete the report accurately, then faxed it to
the attorney's office Sunday evening so he'd have it first thing Monday morning. The attorney called us early Monday to discuss the report. To our surprise, his opening comment was, "I see you were in your office Sunday evening, just as I was when I received your fax. I'm glad to know you're working as diligently as I am on this case."
Delivering on your promises will go far in establishing lasting business relationships and in conveying the feeling of quality to your clients.
Successful people commit themselves to providing quality service no matter what. They do it with a positive attitude and a smile. And they do it because they believe in the importance of their own work, the importance of keeping their word and the value they provide when they give quality service.
For 14 years Rose Clifford, RN, CLNC has been an expert independent LNC specializing in investigating Medicare billing fraud and PIP auto fraud. She owns Medical Analysis Resources, Inc. in Kentucky.
Rules of Discoverability Challenge the Testifying Expert
by Vickie L. Milazzo, RN, MSN, JD
Q.
I am serving as an expert witness in a case, and I have been subpoenaed to bring everything I've reviewed in preparing for my testimony to my scheduled deposition. Is everything I've reviewed discoverable?
A.
The testifying expert's opinions, the basis of those opinions, and everything the expert has done to prepare and derive those opinions is generally discoverable. This includes written notes, reports, conversations with peers, etc. All relevant non-privileged materials that an expert witness uses in preparing opinions are also generally discoverable. Additionally, any document normally protected under attorney-client privilege and used by the testifying expert to refresh her memory is generally held to have waived any privilege because it was voluntarily disclosed (i.e., the act of allowing the expert to review the confidential communication waives the privilege).
Q.
Should I comply with the opposition's subpoena?
A.
Be sure your attorney-client reviews anything you intend to bring to your deposition or to trial before you actually appear. Letting the opposing side depose or cross-examine you on something your attorney-client hasn't reviewed could have grave consequences for your case. Remember that everything you bring to a deposition or trial is potentially discoverable. I've seen depositions stopped until the expert has retrieved every note she took and every document she reviewed.
Q.
What if I've reviewed an article from a nursing journal or some other source that is unfavorable to my case? What should I do or say about this article?
A.
First of all, you have a duty to your attorney-client to notify him of any conflicting opinions in the medical or nursing literature regarding the issues of your case. Your client needs to know about these discrepancies because they could affect the outcome of the case.
Concerning what to say about the conflicting article in court, this is a difficult question that carries both legal and moral obligations. Let's look at three possible approaches you could take:
Do what your attorney-client advises you to do. If you're uncomfortable with that advice, seek counsel from another attorney who has no interest in the case. Remember, your honor, integrity and reputation are at risk if you get caught in a lie, not the attorney's.
Don't bring the conflicting materials with you. Most attorneys, however, are smart enough to ask if you've reviewed anything else that you don't have in your possession at the deposition. Now you face a dilemma because you certainly don't want to hurt your client's case, and you don't want to do the opposition's homework for them by giving them the ammunition to assert their position. While some experts think nothing of perjuring themselves, most are not willing to lie just to help an attorney win a case. The appropriate thing to do in this situation is to respond honestly, and discuss why you do not recognize this article as authoritative. Remember, if the opposing attorney only asks what you're basing your opinion on, you have no obligation whatsoever to mention treatises that disagree with your position.
Bring everything with you, including conflicting literature. Do this only with your attorney-client's permission. Explain why that particular treatise is not authoritative, valid, reliable, relevant to the issues or applicable to the case at hand. This approach may actually give a strong impression that you are an objective educator, rather than a prejudiced advocate. It demonstrates that you're not trying to hide anything from the jury. Additionally, it precludes the opposition from attacking you for reviewing and bringing forward only favorable articles and ignoring unfavorable articles. If you fail to consider unfavorable literature, the opposing attorney may attack your objectivity and therefore your credibility, and he may also suggest that your opinion is not reliable because you haven't identified a representative sample of the available literature.
Finally, be careful about what you agree to testify to. Before agreeing to testify, be confident that the literature, standards, guidelines and practice parameters support your opinions.
Vickie L. Milazzo, RN, MSN, JD, founder and president of the Medical-Legal Consulting Institute, Inc., pioneered the field of legal nurse consulting and created the first national certification program for LNCs.
