NEWS FLASH Houston Chronicle Features Vickie and the LNC Profession
After interviewing Vickie L. Milazzo, RN, MSN, JD, the Houston Chronicle (Houston's major daily newspaper) published an article on Vickie and the profession of legal nurse consulting in the Sunday, January 27, 2002 edition.
In the article, "Nurse Consultants Tackle Medical-Legal Issues," Chronicle correspondent Alice Adams reported that, "Legal nurse consultants who have earned an RN will charge anywhere from $75 to $150, depending on the consultant and their experience. Compared to what physicians usually charge — often $400 an hour — nurse consultants have become a cost-effective solution to getting cases analyzed prior to trial."
The article also pointed out that "of the approximately 900,000 attorneys in practice today, 25 percent deal with medical malpractice and personal injury cases. Sheer numbers indicate the growing need for specialized legal nurse consultants."
Vickie is quoted as saying, "Attorneys are seeking nursing experience. Attorneys know the law and they understand the legal implications of a case. What they need is an interpreter to help them understand the medical aspects of the trial."
The piece featured a photo of two of Vickie's students, Copia Westbrook, RN, and Jennifer Fougerousee, RN, CLNC, consulting on a complicated medical case. In addition to outlining the typical steps in an LNC's involvement in a medical malpractice case, the article gave an overview of MLCI's training programs.
CLNC® SUCCESS STORY
My Success Is Written in the Stars
Pam McDonald, RN, CLNC, Michigan
I attended Vickie's CLNC® 6-Day Certification Seminar with the clear intention of leaving hospital nursing and becoming a legal nurse consultant. My consulting practice already had a name, Aurora Consulting Services, for the aurora borealis. I can view the Northern Lights in my small, rural town as if I'm in a planetarium. I've always loved the night sky.
The moment Vickie stepped onto the stage at the 6-day seminar, she was a complete dynamo, and I immediately knew I would be successful. Vickie gave us the power to believe in ourselves, our nursing skills and experience, and our ability to become as successful as we want to be. She and the Institute have motivated me to do just that – get out of the hospital and own my own business. No more holidays and night-shifts for me.
My dream is already taking form. Although the small, tight-knit group of attorneys in my town don't litigate many medical cases, I started marketing to them. One attorney gave me a list of all the trial lawyers in Michigan. In addition to sending the usual resume and cover letter, I added that I specialize in OB. I also announced that I could present an in-service on fetal monitoring strips and would call in 2-3 weeks to ask how many would attend the presentation.
One law firm consistently advertises in the small, local newspapers in my area. At first, I was reluctant to market my services to a firm that advertises so proactively, but I did anyway. As it turns out, this attorney spends his summer vacation in my small town and has three other offices nearby. He grew up here, and we know many of the same people.
More importantly, he had a case for me to review. I went to see him, told him my fee and asked him to sign a contract. I walked out with a signed contract, $1000 retainer and the medical records. I was thrilled, excited and terrified because I didn't have a clue where to begin. I called the Institute, and my CLNC® mentor guided me through my first case successfully.
Since then this attorney has given me 2 more cases. He told me he was pleased with my work and that I picked up things the MD missed, which really heightened my confidence. He also mentioned that he didn't understand all the medical terminology. All my experience as a nurse was now paying off at $125/hour. I've worked on three cases for 19 hours and made $2,375.
My marketing efforts continue, and I have subscribed to our weekly lawyers' news publication which announces all the local and state meetings and conventions. This small publication has opened up a whole new world of marketing opportunities for me.
It is thrilling and exciting to work with attorneys who seek and truly value my professional opinions as an RN. I'll meet my goal of leaving the hospital, and I will look out at the Northern Lights and realize that I made my dream come true with my hard work and the help of Vickie Milazzo and the Medical-Legal Consulting Institute, Inc.
Pam McDonald, RNC, CLNC is the owner of Aurora Consulting Services, Inc. in rural northern Michigan and specializes in medical-malpractice
cases.
MY MOST MEMORABLE CASE
Long-Term Care Case Sparks Publicity and Action
by Nancy Dion, RN, MSM, CLNC, CPHQ, CHCRM, LNHA
About 2½ years ago, an out-of-state attorney asked me to provide expert testimony in a malpractice case involving a long-term care facility. I sent him my usual packet of information, and when he called back, I was both pleased and concerned because I wouldn't be working with my state's familiar rules. Although I did not know the licensing rules, regulations and standards used in his state, I accepted the case. I reviewed clinical records, agency licensing review information, staffing information, JCAHO reports and relevant depositions.
Problem Nursing Home Resident + Lax Rule Enforcement = Disaster
The case focused around a middle-aged male with a history of CVA, severe cerebral vascular insufficiency, some vascular dementia, alcohol abuse and chronic addiction to cigarettes. At the time of his admission, his behavior showed some psychotic-like features, but the facility agreed to admit him, feeling that his behaviors could be controlled and that they could provide the rehabilitation needed to prepare him for discharge back to his home.
His daughter arranged the admission and wanted to be continually involved in his care and discharge planning. As admission was being arranged, however, no one informed the resident or his family of the facility's smoking policy even though the staff knew he was practically a chain smoker. The facility policy required that residents smoke outside with supervision and leave their smoking materials at the nurses' station.
Throughout the record, the resident's non-compliance with the smoking policy was noted along with resulting behavior management issues. His plan of care addressed his physical rehabilitation needs and processes, and also acknowledged his smoking and behavior management issues. However, the care plan indicated that the resident was expected to comply with the facility policy. During his 3-4 month stay at the facility, the plan was reviewed but few changes were made until active discharge planning was started. Except for smoking, he was given more independence in all areas but frequently could not complete the tasks assigned.
In the two weeks prior to the incident around which this case focused, there were obvious changes in the resident's behavior. He became more psychotic, talking to staff about other residents pointing at him, picking on him and talking about him behind his back. His medications were changed, and the staff documented that he was drowsier at night although he continued to get up 2-3 times per night to smoke.
On the night of the incident, a staff member took the resident to the inside courtyard. The resident was left unsupervised with his cigarettes and lighter. Staff, upon questioning later, indicated that the resident had his own smoking supplies which he brought to the patio with him. About 10-15 minutes after the resident was left alone, he was seen pounding on the door to get in, his clothing in flames. The door to the courtyard locked automatically after people passed through it. Although there was a doorbell, no one saw the resident when the bell rang before he pounded on the door. Emergency procedures were initiated, 911 was called, and the resident was taken to the hospital where he expired from complications of his burns.
The LNC's Role — Testifying Expert and Attorney Educator
My role in this case was to serve as an expert witness for the plaintiff, identifying deviations from standards, rules and regulations, which included:
Staff deviated from standards of care in the resident's care planning, monitoring and documentation of his lack of compliance with policies and procedures, as well as his inability to complete personal care tasks.
Staff minimally monitored his reaction to the psychotropic medication ordered shortly before this final incident even though such monitoring is required in Federal guidelines.
Staff did not comply with their own smoking policy by allowing the resident to keep his smoking supplies at his bedside and by allowing him to smoke without supervision.
In the report to JCAHO on the incident, the DON reported that the courtyard door was never locked; however, all other staff who were deposed or questioned during the state licensing office investigation of the incident reported that the courtyard door locked automatically upon closure and this was not changed for almost four weeks after the incident.
In addition to my testimony, I educated the attorney about what could be requested by interrogatory and what was discoverable within public records about the facility, its licensing reviews and status. Through the discovery process, I was able to access licensing agency reports on prior issues at the facility, along with the summary of the JCAHO Sentinel Event Report, which I used in preparing for and during the trial. I also worked with the attorney in preparing questions to ask staff and administration at deposition, and with the legal support staff in preparing visual aids to be used during the trial.
Outcome Generates Local Coverage, Valuable Lessons
The jury found for the plaintiff and awarded compensation to the family. Based on newspaper reports and conversations with members of the jury at the end of the case, the attorney told me my confidence and ability to communicate in non-clinical terms how the events unfolded for both the staff and the resident helped the jury reach its conclusion more easily. Jurors who were interviewed made it clear that the visual aids used by the plaintiff's attorney were a great asset in understanding the environment, staff placement at the time of the incident and visual constraints related to the courtyard, all of which also impacted their decision.
Aside from the trial result, the issue of JCAHO Sentinel Event reporting was communicated to JCAHO. Even though a resurvey had already been conducted, a team from JCAHO made a special survey trip to the facility. As a result the nursing home's status was changed to conditional accreditation.
I learned a valuable lesson: not to rely solely on my experience and knowledge of the rules and regulations. I also learned to use the support staff at the attorney's office for help in creating the clear visual aids that were so pertinent in attaining a positive outcome. If simple and well done, such aids can make a case. I was grateful to the attorney and his staff for giving me this opportunity. For LNCs who provide expert testimony, if the case lends itself to the use of visual aids, grab the opportunity to help develop and use them at trial. Working with legal office support staff in this development also provides different insights into trial preparation that you may not be able to gain elsewhere. Since the conclusion of this case I find myself looking to use visual aids whenever I can to strengthen my testimony.
The attorney was well pleased with my involvement in the case, since I was able to provide concise, assured insights and testimony. The attorney also told me that the family, whom I eventually got to meet, were aware of how well the case went based on my involvement. They indicated that the monetary settlement was only part of what they hoped their suit would achieve. They thought the public needed to know what could happen even at JCAHO-accredited facilities. We accomplished this goal, since reports of both the trial and the JCAHO revisit findings made the front page of their local newspaper.
Nancy Dion, RN, MSM, CLNC, CPHQ, CHCRM, LNHA, is a healthcare professional based in Florida. She has more than 35 successful years in the healthcare and business arenas. Her expertise includes clinical services, organizational redesign, quality improvement, risk management, facility and agency executive team building and management, along with her legal nurse consulting skills.
