CLNC® SUCCESS STORY
I Turned a Humdrum Nursing Job into An Exciting New Career
by Pam Long, RN, CLNC, LLC
About a year ago I complained to my neighbor, a successful trial attorney, about my humdrum nursing job and mediocre pay. He said, "You should go into legal consulting. I think you'd enjoy that." I had no idea nurses consulted with attorneys, but it made good sense. He explained how his firm worked with an independent nurse consultant and gave me her name.
The next day I called this nurse, and we talked for an hour about legal nurse consulting. She had purchased Vickie's CLNC®Home-Study Certification Program on video and she encouraged me to check out the Medical-Legal Consulting Institute's website.
I was soon registered for the 6-day seminar. The course was great, and nursing once again became an exciting and challenging career for me.
I came home after the seminar and began preparing for my CLNC® business. I was determined to be successful so I worked at my business plan consistently and was animated by Vickie's marketing ideas. Before long I was networking with my attorney neighbor and I told him how Vickie's course had prepared me to meet attorneys' needs.
He was impressed that I had taken the CLNC® course and gave me a case. When I turned in my report, he was extremely pleased and gave me a much more important case, the defense of a negligence suit against a huge public utilities corporation. I just turned in my 40-page comprehensive report. If my attorney-client wins the case, he could save the corporation $10,000,000. It's obvious he's getting more than his money's worth tapping into my skills as a successful CLNC®.
Thanks, Vickie, for giving me the keys to success. I'm so excited about my new career path! I even convinced one of my nurse friends to take the course, and he has already registered.
Pam Long, RN, CLNC, LLC is a legal nurse consultant and the owner of her own consulting firm in Utah. She specializes in managed care and personal injury cases.
MY MOST MEMORABLE CASE
A Tall Tale Just Kept Growing Taller
by Donna Adkins, RN, BSN, CRRN, CCM, CLCP
My attorney-client was excited about an MVA case involving a 27-year-old male driver whose vehicle was rear-ended at a stop light. The attorney was sure the case would be a winner with a lot of zeros at the end of the settlement amount. But his excitement faded after I took a close look at the "facts."
Minor Accident — Major Injuries?
After the accident, Mark, the plaintiff was taken to the local emergency room where he was treated and discharged. He complained of neck and head pain, pain in the left knee and being "sore all over." He told the ER physician he believed he was unconscious for a short time following the accident.
The ER report told a different story: X-rays were negative for bony damage. Lab studies were normal. The physical exam was within normal limits. There were no visible injuries. The discharge diagnoses included possible closed head injury/concussion (this is what caught the attorney's eye), multiple contusions and pain in the left knee. Mark was given a prescription for pain medication (Tylenol #3) and was instructed to follow up with his family physician if he had further symptoms.
Three days later, instead of seeing his doctor, Mark made an appointment with my attorney-client. He claimed he was having severe headaches, problems with cognitive functioning and memory, severe pain in his neck and low back (new symptom), pain in his RIGHT knee (he'd already forgotten which one was hurting the day of the accident).
Through the Legal System — or Through the Looking Glass?
One year later, Mark's case was winding its way through the legal system. The lawsuit had been filed, and a trial date set. Mark had an impressive volume of medical records and bills, including an enormous pharmaceutical bill. He had been evaluated by numerous physicians, most of whom were self-referred by Mark and his attorney (this is called "building the case"). In addition to back and neck pain and pain in the right knee, Mark claimed a head injury with serious symptoms including inability to work due to impaired cognition. He had not worked since the accident.
By now the case was considered significant. The insurance company requested an independent medical exam (IME) and began gathering information to mount their defense.
Enter the Legal Nurse Consultant
The attorney's instructions to me: Find out what this case is worth and help me explain Mark's injuries since he has no bruises and looks okay. Simple instructions, but not so simple to follow. I would become a true medical detective before this case was resolved.
Of course, I requested all of the records. Here's what I learned from the police report and the EMS report:
Mark was wearing his seatbelt.
The car that struck him was going 15 miles per hour or less.
Damage to his car was negligible, and there was no damage to the other car.
No other injuries were reported, and no charges were filed as a result of the MVA.
When the police and ambulance crew arrived, Mark was walking around and talking.
His Glasgow Coma Scale was 15 (completely normal). The exam did not reveal any deficiencies or outward signs of trauma and vital signs were normal.
The ambulance crew followed standard protocols for immobilization, vital signs, transport, etc. No advanced life support was instituted.
Mark's subsequent medical records were equally revealing:
His subjective complaints increased, yet no objective exams supported these claims. He began seeing his family physician every week. The notes from these visits were sketchy — the usual documentation was "same as before" — and no physical exams were documented.
Mark was prescribed various medications including narcotics, benzodiazepines, hypnotics, muscle relaxants, anti-inflammatory meds, etc. — up to 30 pills per day.
He self-referred to a chiropractor who began manipulations of his neck and back three times a week.
He also self-referred to a pain management physician and psychologist.
Interestingly, neither a neurosurgeon nor a neurologist evaluated his headaches, neck and back pain, and no orthopedic surgeon evaluated his knee pain.
The Tall Tale Grows Taller
It became increasingly clear that Mark was embellishing his injuries. He even documented his complaints and medical appointments in a daily diary he started the day of his accident. His subjective complaints did not match up with the initial physical exam and did not improve with time and multiple treatment modalities and medications. He applied for Social Security Disability benefits (subsequently denied, not unusual for a first-time applicant).
I requested Mark's past medical records, pharmaceutical records and work records. I also asked the attorney for socio-economic information, another revealing piece of the puzzle:
Mark was the father of three children by three different women. He had been hauled into court for non-payment of child support many times.
He was currently married to the mother of his third child, and he and his wife were both unemployed at the time of the accident. The couple lived in a rented mobile home in an impoverished rural region with few job opportunities. The family was receiving Medicaid benefits and other social services from state agencies.
Mark had a police record that included charges of domestic violence and DUI.
His vehicle was not insured.
Although his ten-year-old vehicle had received little damage, Mark had purchased a new sports utility vehicle.
The nurse investigator in me wanted to know more. I discovered that Mark had received a scholarship covering tuition and books at the local junior college, along with a monthly stipend. Amazingly, since his accident, Mark had not missed a class. I requested his transcript. BINGO!
An accounting major, Mark was taking an array of math courses, including statistical analysis, quantitative algebra and advanced calculus. Since I'd persevered through basic chemistry and statistics myself, I knew he needed a high level of brain function to survive this academic ordeal. Mark not only completed these courses (after the accident); he earned a grade point average (GPA) of 4.0!
Outsmarting the Smart Guy
Mark was indeed a smart guy, but maybe a nurse who hated math could outwit him. I scheduled a meeting with my attorney-client to share my suspicions of malingering and embellished injury claims, as well as possible fraud and criminal activity. The facts as I uncovered them were quite different from Mark's story:
Red Flag #1:
The potent drugs being prescribed for Mark affect mental acuity. Chronic pain may also cause depression and slow down mental processes. Yet Mark was functioning well enough to maintain a 4.0 GPA (even with all those math classes!). In my opinion Mark could not possibly have been taking all those medications without risking an overdose or at least experiencing a decrease in cognitive functioning.
Red Flag #2:
Mark was obtaining multiple medications from THREE different pharmacies. No medical records in Mark's name could be found for two of the physicians prescribing narcotics. In addition, some of the medications could not be taken in combination; the contraindications were clear. Obviously, the physicians writing these prescriptions were not aware of each other. There did not appear to be any oversight by the pharmacies involved.
Red Flag #3:
Though unemployed, Mark had recently bought a new car.
He was apparently "doctor hopping" and manipulating the physicians into writing prescriptions in order to obtain large amounts of medications. I concluded he was likely selling the drugs.
I supported my conclusion with the facts:
My time-line and charts illustrated the tactics of an individual skillfully manipulating the medical system to win a personal injury lawsuit.
I created a simple chart that showed my attorney-client Mark's "consumption" of 30 pills per day, along with information on the effects of the multiple medications.
I provided information on closed head injury which indicated that narcotics are contraindicated in such cases. This shocked the attorney.
I also supplied detailed evaluation of the numerous itemized pharmaceutical bills.
The attorney was stunned at my revelations. He had no inkling that his client had feigned his injuries. He quickly agreed with my conclusion that financial gain was the primary motive in this case.
I suggested that the attorney meet with Mark to discuss the case. I also suggested hiring a private investigator to keep the plaintiff under surveillance, since I suspected the insurance company would do just that. If the investigation uncovered deceit, fraud or criminal activity, the case would definitely head in a different direction and not toward any financial recovery.
The attorney arranged a meeting with Mark and asked him to bring his wife. At the first mention of the attorney's concern about the use of many physicians and numerous prescription drugs, Mark's wife became distressed. After a long session, during which all the facts were discussed, Mark and his wife asked that the lawsuit be dropped. The attorney suggested attempting an out of court settlement.
Amazingly, the insurance company offered $60,000 (with no future medical care included) to settle the case. This amounted to a windfall to Mark of around $30,000 after paying attorney and other fees related to the suit. Mark immediately accepted this offer (remember, he's a sharp guy), and the deal was signed two days later.
Tying Up the Loose Ends and Cementing a Win-Win Relationship
Was the case over? Not yet. I still had some loose ends to tie up.
With approval of the attorney, I notified Mark's primary MD and the pharmacies of his "doctor hopping" and obtaining medications from several sources. (You must be careful here. Make sure the client has signed a Release of Medical Information allowing you to obtain the records). I did not insinuate any illegal activity. I simply alerted them that Mark was receiving care from several sources. This would perhaps prevent them from becoming unwitting accomplices to drug trafficking, if that was indeed going on.
The attorney and I made sure Mark understood that we were onto his deceit. He agreed to discontinue "use" of the medications and stop pressing his injury claim with his healthcare providers. He and his wife indicated they would be moving as soon as he obtained his degree.
Suffice it to say, the attorney was grateful that I ferreted out the weaknesses in and defenses against his case. Mark's lack of truthfulness could have resulted in disaster if the opposition had uncovered the facts first. We were fortunate that the insurance company had a backlog of claims and was slow in investigating this one. They would certainly have prevailed in court and might have instituted criminal proceedings.
This turned out to be a win-win case. The attorney received a nice check and avoided potentially serious legal hassles. The insurance company adjustor complimented him on his conciliatory manner. Both sides avoided a long dispute. In addition, society hopefully benefitted because Mark was dissuaded from misusing medications, and the pharmacies and physicians involved were reminded to "clean up their act."
Before this case my attorney-client had never hired a legal nurse consultant. I was able to demonstrate the value of educating him on the medical facts of a case and of correlating the client's complaints to those facts. Has he hired me again? You bet. The first thing he usually asks is, "Do you want the school records?"
Donna Adkins, RN, BSN, CRRN, CCM, CLCP, owns Medical Claims Analysis & Management Services. Inc., in Kentucky. The company focuses on developing life care plans, as well as plaintiff and defense workers' compensation, medical negligence and malpractice, personal injury and criminal cases.
