FROM THE EDITOR
Looking for the Spark to Light Up Your Business Dreams?
These High School Students Have the Right Idea
by Vickie L. Milazzo, RN, MSN, JD
I just spent 2 hours with 75 high school juniors. These young people had gathered for a 2 1/2 day program sponsored by Rotary International at Camp Allen near Houston. The topic: entrepreneurship and business.
I got to talk to the students about my business — how I got started, the obstacles I faced, the things I love about owning my own business, etc.
I was so impressed with the confidence of these 17-year-olds and the quality of the questions they asked. They had given the issue of going into business for themselves serious thought. Some of them already knew what kind of business they want to own.
I asked them why they wanted to start a business. Here are some of their answers:
To be in charge of my own future
To be my own boss
So I won't be bored
To earn a profit
To choose my own direction
To take responsibility for my future
To have control over my life
To do something unique
To be a real expert
To own a Porsche
To build a reputation
To have prestige
So my parents will be proud of me
To make a difference
To be able to bike through Morocco (like Vickie)
It's the easiest way to make a living
Do any of these goals sound familiar? These are the dreams of youth, and they run the gamut from practical to fanciful. But to the young men and women who shared these goals, they are REAL personal dreams, the kind of heartfelt desires that can inspire genuine success.
How long has it been since you thought about your dreams for your business? Have you given your goals voice, made them specific and concrete and real for yourself?
Do yourself a favor right now: Sit down and write out all the reasons you want to own a LNC practice. Don't judge the reasons you come up with. Whether you want to become a LNC to make a difference or own a Porsche or both, that's okay. Just get in touch with the reasons that inspire you. Send your reasons to me at: feedback@legalnurse.com
If you're already practicing, take the time to remind yourself of all the reasons you started your business. This exercise is guaranteed to renew your spark. While you're at it, write down why you would never go back to work for anyone else again.
The next step in this exercise is equally important: Read your list every day for the next 30 days. Once you've made your list, don't simply file it away. Keep your goals in front of you on a daily basis. Let them remind you of the youthful enthusiasm and zest that inspired you to take on the challenge of becoming a LNC to begin with. If you review your list every day for a month, I predict you will do something dramatic that will catapult you to the next level.
My deepest thanks to these wonderful teenagers who so refreshingly remind us of what it takes to dream. They are living examples of the truth that success has no age limits. Whether you're 17 or 47, it's never too late – or too early – to live your dreams and start your own business.
BEST PRACTICES FOR BUSINESS MANAGEMENT
Expect the Unexpected
by Rose Clifford, RN, CLNC
Legal nurse consulting work is often challenging, and the unexpected can happen when you least expect it. When you get surprised, you may have to make an uncomfortable decision as I did in a recent case. In 14 years of practice behind the scenes as a LNC, my company's policy has always been not to testify. But then a fairly new attorney-client for whom we had done some merit reviews named me as a testifying expert — on an out-of-state case I had never even seen.
Wait a minute, I thought. How could that possibly happen? The law firm had not formally contacted me or retained me. I had not seen the medical records. I had not consented to serve as a testifying expert. This could not be happening.
But I listened to the junior associate explain. "We thought we could have the doctor in this malpractice case testify to the standard of nursing practice, but the judge said 'no.' So we named you as the testifying nurse expert. Can you help us out?"
His plea rang in my ears. "Can you help us out?" My gut reaction was "no," but I did not know quite how to tell him. Instead I said, "Let me think about this," and hung up.
What was there to think about? The answer was a resounding "No. No, I cannot testify. I haven't been in clinical practice in ten years."
But how should I handle this situation from a business perspective? What were my choices personally and professionally? Depending on the state, I might not even qualify to testify, and my decision would be made for me. Much to my disappointment, I did qualify. According to the statute in that particular state, I did not have to be clinically active in nursing to qualify. I still did not feel comfortable testifying.
Seek Expert Advice When You Need It
I consulted with an experienced plaintiff medical malpractice attorney whose opinion I highly respect. His response was not all that surprising. He understood clearly how the situation arose. "He got caught before the judge without a nursing expert," my plaintiff friend said. "His deadline to name his experts had run, and he used your name in a pinch. Don't be mad at him. It happens to all of us at one time or another."
He outlined my choices: Either decline the case up front or testify. "If you choose to testify, there are a few hurdles to overcome from the beginning. Charge him a fairly high retainer and a higher hourly fee. Make them come to you, and give your testimony professionally, based on your review of the medical records."
My other alternative was to call the client back and politely say no. "Thank him for thinking so highly of your services," my friend advised. "Obviously, he has confidence in your work and values your professional opinion, or he would not have named you. However, explain your firm's policy of performing behind the scenes work only. Follow up your telephone conversation with a letter to the attorney reiterating your request that he remove you as his named expert. Then move on and don't worry about it."
This was good advice, but I felt that I needed a second opinion. This time I called an insurance attorney with whom I had done a number of cases over the years. Although he was a defense attorney rather than a plaintiff attorney, he basically agreed. But he suggested that if I had a long-standing professional relationship with the attorney, I might want to consider testifying, especially if he personally asked me to help him out of this potentially damaging situation.
Then he warned me of the problems I would face if I did testify. Given the timing of when I was named the testifying expert, I would face difficult deposition and trial questions, such as:
When were you first notified of this case, by whom and what did he say?
When did you review the medical records, before or after you agreed to testify in this case?
In how many other cases have you agreed to testify for the plaintiff without reviewing the medical records first?
How much is your fee for testifying? Is your fee higher than usual?
"Your answers to all these problematic questions will quickly chip away at your credibility," he concluded.
Make a Decision You Can Live with Personally and Professionally
My decision was not an easy one. It took time, research and a great deal of consideration for all parties involved. The issue ultimately came down to professionalism. I was uncomfortable with the attorney's ethics in naming me as a testifying expert without seeking my permission first. In addition, he had done so without giving me the opportunity to review the medical records for merit.
The decision was also a business decision. This attorney had not done much business with our company, and his track record with us was poor. He had signed a contract on one case, but was very slow to pay for the services rendered. On another case he had requested an immediate review, but failed to sign the contract, forward a retainer or answer our calls. If my decision cost me his business, it would not be a great loss.
Once I made my decision, I notified the attorney by phone, then sent the following letter confirming the decision (names in the letter have been changed):
John Smith, Esq.
P.O. Box 19 Clarksville, CA 93552
Re: Mary Johns vs. Clarksville Memorial Hospital
Dear Mr. Smith:
It has come to my attention through a telephone conversation with your partner, Jack Clemens, yesterday afternoon, that you have named me as your testifying expert in the above captioned case without: 1) retaining my services, 2) allowing me the opportunity to review the medical records for merit, and 3) asking my permission prior to doing so. Although I am very flattered that you thought highly enough of my work to name me, I am extremely disappointed in hearing that this occurred knowing the improper nature of it.
Though I understand the circumstances under which this came about, I am nonetheless compelled to continue to uphold our company's belief and practice of doing what is in the best interest of the attorneys we work with and their clients. Please be advised that it is not in the best interest of your client that I testify. Again, I greatly appreciate your vote of confidence, but respectfully request that you immediately withdraw my name as your named expert in this case.
If you have any questions regarding my decision, please feel free to call me. Again, thank you for calling our firm.
Very truly yours,
Rose Clifford, RN, CLNC
What I learned from this incident is this: Be prepared to expect the unexpected. Be ready to make uncomfortable decisions when circumstances require them. Also, prepare yourself for an attorney to try to change your mind. Remember your convictions and stand firm on your decision. Remain positive. You will be a better legal nurse consultant for it.
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.
Q. What is an authoritative textbook and how do I find them?
A. An authoritative textbook is a book considered to be the authority in a specific field of nursing or medicine. These are the texts that are generally used in university hospitals and medical and nursing schools. Examples of authoritative texts include:
To identify the authoritative texts in a particular specialty:
Ask practicing nurses and doctors which textbooks they rely on.
Ask expert witnesses and other LNCs which texts they rely on in their practice.
Ask a medical librarian or go to the CORE or reserve section of the medical library.
Go to Amazon.com and identify the bestselling texts in a specialty. (You can order all books from Amazon through our Website at www.LegalNurse.com. All commissions we receive go to the Susan G. Komen Breast Cancer Foundation.)
If you have a medical bookstore in your area, ask which texts are the bestsellers in a particular specialty.
For a complete list of textbooks in all specialties, visit the CLNC® Membership section of the Medical-Legal Consulting Institute's Website at www.LegalNurse.com
Q. Is the PDR authoritative?
A. Most testifying experts do not recognize the PDR as authoritative because the information comes directly from the manufacturers. The PDR publishes the information required by FDA labeling guidelines. It is not the definitive source for the Standard of Care in prescribing or monitoring drug therapy.
Most LNCs start with the PDR, then supplement this useful reference with more authoritative pharmacological textbooks.
