CLNC® SUCCESS STORY
I Am Now Financially Independent
by Barbara Rose, RN, CLNC
After finishing Vickie's CLNC® Live Certification Program, I set a goal of having a case in three months. I followed Vickie's marketing instructions to the letter and had that first case in four months. I was able to open my own consulting practice in a little over a year. I am now financially independent, and no longer depend on the hospital.
Since I knew I would specialize in long-term care, I sought out attorneys who dealt with long-term care and Medicare issues. I sent out 200 marketing packets with only one response, but that response became my first case. That attorney gave my name to two other attorneys, and from those referrals, I received another case.
Networking with a coworker led me to my first regular attorney-client. He in turn recommended me to three more attorneys, and two of them have since become regular clients. I now work with attorneys all over Texas.
When asked to do my first deposition, I went right back to the Core Curriculum for Legal Nurse Consulting®, and I felt completely prepared. The attorney and I overwhelmed the opposition, and they settled. The opposing counsel told me, "I never want to be on the opposing side when you're being deposed." That literally put me over the top. I am now comfortable with attorneys because I speak their language. I could only have developed that confidence from Vickie's program.
Becoming a CLNC® has been a life-changing experience. As a nurse, I never realized this opportunity was out there. Vickie's course gave me the tools I needed to become an LNC, from putting reports together, to being deposed, to learning about interrogatories.
Best of all – I get to work from my home. I now have more money, more respect, and more free time than I have ever had in my entire life.
Barbara Rose, RN, CLNC, is the owner of Rose Consulting Services in Texas. She specializes in long-term care.
BEST PRACTICES FOR MEDICAL RESEARCH
12 Ways to Make Your Medical Research Excellent, Cost-Effective
and Hassle-Free
Our CLNC® pros – Gloria A. Blackmon, RNC, BSN, LNHA, Lisa Ellison, RNC, CLNC, Pam Hollsten, RN, BSN, DABFN, CLNC and Carla R. Kitten, RN, BSN, CLNC – deliver their top techniques to boost the efficiency and thoroughness of your medical research.
Based on the case theme or what the case is about, do a brief overview of the disease and its current treatment. This gives you an idea of general treatment issues, including any treatment controversies that may complicate causation or expert testimony. Often this information leads to further review of textbooks you may own or to a simple search via http://www.google.com or http://www.dogpile.com to find what's on the Internet about a specific medical condition.
Keep your beginning search simple, then do a more complex search. Sometimes the simple things are the most pertinent to the case. Don't make it harder than it has to be. Ask yourself what you really need to find, verify or compare. If you can't find what you're after with relative ease, review the Medical-Legal Consulting Institute's material on library research or ask a librarian how to narrow your search.
When searching for a primary subject, such as diabetes, remember at the same time to search for related issues relevant to the case, such as decubitus. This helps you avoid duplicating your efforts later.
Always review the standards of any pertinent professional organization. You can identify the relevant associations through the ECRI Healthcare Standards Official Directory. This ensures that you include these standards in your research and don't miss professional standards that aren't reported in the literature. For example, for an emergency room case, contact the American Board of Emergency Room Physicians (http://www.abem.org). For an obstetrical case contact the National Association of Neonatal Nurses (http://www.nann.org) and American College of Obstetricians and Gynecologists (http://www.acog.org). These sites offer a wealth of information. Request information the associations publish for consumers as well. The references cited in the bibliography of any standards are also useful.
Always check the bibliography of any journal article for additional research sources. While searching for general information in texts and Internet sources, make a list of the authors most widely published or referenced. This list could provide additional literature sources or potential experts the attorney-client might consider for consulting or testifying.
Abstract the articles you find for your client and point out areas pertinent to the case. This way the client can read your abstract to decide if he needs to read the whole article.
Make note of the medications and medical products used. Then search for any interactions or medical device incidents that could have contributed to the case in any way. Systematically reviewing this information keeps you from overlooking any potential product liability issues resulting from significant drug reactions or adverse events caused by medical devices.
Subscribe to MD Consult (www.MDConsult.com) and conduct a minimal search for general and specific information. The site contains many authoritative and up-to-date text and journal references. As you review individual journal publications, you can search for more articles on specific topics, instead of starting a new search. This time-saver allows you to cross-reference pertinent literature and identify key search words during your original search. You can even identify literature that is critical of the researchers or their methods, sometimes with notes citing conflicting results from other studies.
The gold standard for simplifying your medical research is the National Library of Medicine (http://www.nlm.nih.gov). From this site you can enter Medline, a comprehensive database of article summaries from international medical literature. From Medline you can search GratefulMed, PubMed and Medline Plus.
Join a medical school library. The membership fee is usually small, but the benefits are great. You can do your own research, then fax journal or textbook reference information to the library. For a small additional charge, the librarians pull the hard copies you request. This charge can be billed back to your client.
Keep your mind open to new opportunities, rather than always following the same path. We all get into ruts, but when researching, it is very important to explore new avenues. Researching On Line for Dummies, by Reva Basch and Mary Ellen Bates, is excellent at reminding you to do this.
Remember to take frequent breaks when doing online medical research. It can be frustrating, and you might be tempted to throw your computer out the window. Hang in there and take a walk to prevent computer mayhem. Online research can be very rewarding when you come across that perfect nugget of information that will be the key to winning a case for your attorney-client.
Gloria A. Blackmon, RNC, BSN, LNHA is the CEO of Blackmon & Associates Medical-Legal Consulting in Kansas specializing in long-term care issues.
Lisa Ellison, RNC, CLNC owns Premier Nursing Consultants in Texas. She assists attorneys in preparing medical malpractice and personal injury cases and provides in-depth research, chronologies and reports.
Pamela A. Hollsten, RN, BSN, DABFN, CLNC, an independent LNC in Georgia, owns Hollsten & Associates, specializing in medical malpractice.
Carla R. Kitten, RN, BSN, CLNC has been a practicing independent legal nurse consultant since 1993, specializing in medical malpractice and criminal defense. She is a full-time in-house LNC for the Gray Hart Law Firm in Texas.
First of all, bookmark at least the following top 5 websites. These sites offer the best access when searching for general medical information. These sites are a great way to start, but they may not be the best for your practice. For example, if you specialize in nursing home cases, you will need to access more specific websites.
Our CLNC® pros also suggest these medical research websites (in alphabetical order):
Agency for Healthcare Research and Quality http://www.ahcpr.gov
Links to clinical information, current clinical research and other links for the Agency for Healthcare Research and Quality.
American Medical Directors Association http://www.amda.com
Links to AMDA's publications and products, news releases and resource library. Specific sections address the interests of medical directors and physicians who practice in long-term care.
Department of Health and Human Services Office of the Inspector General http://exclusions.oig.hhs.gov/
Allows you to check on the exclusion status of a healthcare provider or facility. Contains the list of sanctions and definitions of exclusions for Medicare fraud and other sanctions.
eMedicine.com, Inc. World Medical Library http://www.emedicine.com
Contains peer-reviewed online medical textbooks. Physicians continually update and revise this site. The standard format for each disease or condition includes diagnosis and treatment, differential diagnoses, and a list of additional references.
Federation of State Medical Boards http://www.fsmb.org
Contains a databank of board actions and physician disciplinary actions. Includes links to state medical boards.
Health Medicine refdesk.com http://www.refdesk.com/health.html
Contains an alphabetical list of health and disease-related links useful as a starting point for finding medical literature and other sites.
The Health Pages http://thehealthpages.com
Allows you to search for a physician by name and state or by specialty practice. This site has more current contact information than other physician directory sites, particularly telephone numbers. Links to state medical boards offering physician discipline information, as well as reports on physicians and facilities, are planned for this site.
Healthcare Financing Administration http://www.hcfa.gov/search
Links to Medicare, Medicaid, SCHIP and other federal search resources.
Hippocrates Magazine http://www.hippocrates.com
Contains clinical updates in primary care and practice management with access to archives and search features.
Johns Hopkins Division of Infectious Diseases Antibiotic Guide http://www.hopkins-abxguide.org
Provides information about infectious diseases and antibiotics. The site requires registration (free).
Manufacturer and User Facility Device Experience Database (MAUDE) http://www.fda.gov/cdrh/maude.html
Links to reports of product and device failure and other information.
MD Consult http://www.MDConsult.com
Allows you to search many leading texts and reference books, a wide variety of peer-reviewed journals, plus clinical guidelines, patient teaching guidelines and drug information. This subscription site offers a free trial period to new users.
MDLinx.com http://www.MDLinx.com
Contains links to 40 medical specialty websites for the latest developments and access to top journals. Also offers an email subscription service to alert you to news in specialities you select.
Medical Matrix http://www.medmatrix.org
Provides online resources for a variety of journals, texts, diseases and medical conditions.
Merck Manuals Online http://www.merck.com/pubs/
Contains links to search the Merck Manual of Medical Information, Merck Manual of Geriatrics, and Merck Manual of Diagnosis and Therapy.
National Guideline Clearinghouse http://www.guideline.gov/
Database of published guidelines searchable by medical topic or professional organization.
National Library of Medicine http://www.nlm.nih.gov
Promotes awareness of the latest, most effective medical and scientific toxicology, environmental health and basic biomedical research. Allows you to access numerous websites, such as Pubmed, GratefulMed, Medline, Toxline and many more.
NetDepot.org http://www.netdepot.org/reference/conversions.htm
Helps you convert or quickly validate drug doses and doses for IV drips, as well as convert body temperature from Celsius to Fahrenheit, etc.
Surgical-Medical-New Terms Glossary http://www.mtdesk.com/s.shtml
Offers the most complete list of medical products, devices and pharmaceuticals, with links to manufacturers' websites and Food and Drug Administration information on the product. This informational site is updated weekly.
My best practice tip for medical research is to subcontract with an LNC who loves to do it. I never particularly enjoyed medical research, although I appreciate the great value it adds to cases. Through networking I have found several excellent LNCs who love to do medical research and focus on just that.
I guide the LNC subcontractor regarding the amount of research needed. The extent and cost of the research is dictated by the permanent damages in the case and the potential damage award. In the early stages of a case, medical research may be as simple as defining a medical term or providing a basic anatomical drawing to illustrate a point. As the case progresses, so does the depth of the research. Once the medical literature research is done, I review the abstracts and request copies of articles that apply in any way to the issues in the case. I then verbally present the findings to the attorney.
How to Select LNC Subcontractors
Once I locate LNCs interested in subcontracting, I ask about their research experience and interests. I follow up by requesting copies of their CVs, fee schedules and samples of work product. I measure their interest by how quickly they respond to my requests. Based on their professionalism (e.g., courteous, timely and accurate response), their ability to perform the required search and their diligence in follow-up, I choose my primary LNC subcontractor, as well as one or two back-up subcontractors.
Qualifications I look for include experience in medical research and their association with a medical library or librarian. Other important qualities are tenacity and perseverance in completing the research. LNC subcontractors must also exhibit a sincere interest in helping me help my attorney-client.
I pay the LNC subcontractor a third or more of my hourly rate, depending on the individual LNC's experience, availability and quality of work product. The LNC bills me for her time, and I bill the attorney-client at my rate. Ideally, I pay subcontractors when I'm paid by the attorney-client, usually within 30 days of completing the assignment.
Subcontracting helps me do what I enjoy most, reviewing actual cases. It's also a great way to leverage my time and bring in more revenue for my company.
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.
