NEWS FLASH
Sigma Theta Tau Features Vickie as a Nursing Leader
Sigma Theta Tau featured Vickie L. Milazzo, RN, MSN, JD, as a nursing leader in its first issue of the 2002 Reflections on Nursing Leadership journal. The article entitled "Nothing but the Truth" not only profiled Vickie but also described legal nurse consulting in-depth.
"Nobody knows better than an RN what should be inside a medical record," said Vickie. "In the next 20 years we'll see even more impact of RNs interfacing with the legal world. There is a big distinction between reading the lines in a medical chart and reading between the lines. You can figure out what's not there that should be there. You are able to interpret those meanings that aren't so obvious to a nonhealth-care professional." The award-winning news magazine of the nursing honor society Sigma Theta Tau International also told readers, "An LNC may work independently or as an in-house member of a legal team."
FROM THE EDITOR
Entrepreneurial DNA – From Asia to America, the Spirit Is
Everywhere
by Vickie L. Milazzo, RN, MSN, JD
On a recent trip to Vietnam, I encountered the entrepreneurial spirit at its rawest and liveliest.
Everywhere I looked someone had opened a shop repairing shoes, bicycles or "motos."
Every bit of open sidewalk was crammed with vendors hawking new clothing, used clothing, books, knock-off books, watches, luggage, lemonade in plastic bags, gasoline in 1-liter whiskey bottles (the better to fill up your motorcycle), and everything else you can imagine, including cobras inside bottles of liquor.
Women weighing 30 pounds less than I do (and I'm not a large woman) carried yokes with complete soup kitchens balanced upon them, bowls, utensils and food on one side and a charcoal grill on the other side holding pots of broth and tea. The grill was hot, and the pots were simmering even as they walked. In Vietnam, fast food comes to you.
There are no grocery stores, so some people purchased fruit and vegetables at the markets on the edge of town. Then, using their bicycles or their backs, they carried the produce to customers in the downtown streets.
Entrepreneurship Is Our Birthright
Everyone in Vietnam seems to have a side-job, side-shop or sideline and wants to be their own boss. Why so many budding entrepreneurs in a third world country like Vietnam which doesn't even encourage entrepreneurship?
I believe it's because entrepreneurship is in the human DNA. The Vietnamese people have been victims of war and turmoil for more than 1,000 years. Today they live under a communist regime with limited infrastructure, few government handouts, little welfare. They know that what their government can give, it can also take away. Yet in spite of — or perhaps because of — these challenges, thousands of tiny independent enterprises have sprung up and flourished. Even the communist government is unable, or unwilling, to stem the tide of free enterprise.
No one wants to work for the government or for an institution they distrust. In fact, the current generation of Vietnamese is not interested in socialism or communism, and they're not willing to live on the average $50-a-month salary. They're interested in materialism and creating better lives for themselves, just like Americans.
The Vietnamese are remarkably self-reliant, and nothing drives entrepreneurship more than the need, or desire, to be self-reliant. They are not afraid to work hard to improve their lives, and everywhere I looked, I saw hundreds of people working extremely hard.
No One Has a Corner on Free Enterprise
Is this entrepreneurial DNA unique to the Asian population? Most Americans know the common story of Asians coming to this country with nothing, opening a restaurant (in which the family lives) and within 3 years not only owning a chain of successful restaurants but also having two children graduating summa cum laude from Harvard and another child who is high school valedictorian. I've witnessed the Vietnamese work ethic first hand, and I know Asians who own a chain of restaurants in Houston. It's easy to believe that Asians have some gift for hard work and entrepreneurial success.
But entrepreneurial DNA is not unique to people of Asian ancestry. Every one of us inherited our own entrepreneurial DNA from our immigrant ancestors who created the American melting pot. When my grandfather was 13 years old he came to the U.S. from Italy with virtually nothing. In his pursuit of a better life he owned numerous small businesses over the years, some successful, some not. He had the work ethic to match, working until he was 80 years old (I hope I didn't inherit that part of his DNA!).
On the streets of New York, Chicago, Houston or any major city you can see the results produced by generations of entrepreneurial immigrants. You may not find curb-side restaurants thanks to our boards of health, but you will see people working their hardest to provide for their families. In my own neighborhood in Houston I see plenty of evidence of this spirit, from a 10-year-old selling lemonade, to a self-employed plumber working his brand new business while holding down a full-time job. My husband would work all night if I didn't turn the lights off, and I'm up early and at my desk hours before most people awaken.
All of us are doing whatever it takes to make our enterprises, large or small, prosper because we want to create better lives for ourselves. This desire is inbred in most of us. Even those who don't want to be their own boss still want a piece of the pie — a life of their own choosing, not one chosen by someone else.
Success Is in Your DNA
Those of us who connect with our entrepreneurial DNA often find ourselves driven to work harder and longer in order to achieve our goals. While other people are watching television, we're dreaming up new business plans, inventing new technology or charting a way to penetrate a new market. It's hard work; it requires long hours and consistent commitment to your vision. But success is in your DNA, if you can only tap into that spirit, that drive, that desire.
This doesn't mean you won't face obstacles and be tempted to give up. But the next time you find yourself thinking about flopping in front of the TV and pondering who'll get voted off the island, consider this: Is it possible that you're turning off your entrepreneurial DNA and voting
yourself off your own island of success?
If your answer is "yes," think of the Vietnamese woman carrying a soup kitchen on her shoulders, think of the 10-year-old lemonade merchant in your neighborhood, think of the generations of immigrants who have turned poverty, language barriers, ignorance and prejudice into shining examples of success. Without that bold entrepreneurial spirit, there would be no America, and the entire world would be a far poorer place.
As for me, I'm busy pondering and working on my own dreams, not watching someone else live theirs. Excuse me. I have to go! My entrepreneurial DNA is in high gear and I have work to do.
BEST PRACTICES FOR EVALUATING LONG-TERM CARE CASES
5 Strategies for Keeping Complex Long-Term Care Cases
Under Control
by Nancy Dion, RN, MSM, CLNC, CPHQ, CHCRM, LNHA
Much of my practice focuses on long-term care facility cases. These cases can be extremely complex, involving multiple issues, unique policies and procedures, and esoteric legislation. Here are five strategies that help me get a handle on these cases and provide the best service to my clients:
Know the Facility's Documentation Practices — I always ask for a copy of the facility's documentation policies and procedures. This helps me understand the documentation process up front, so I don't waste time looking for information that is not normally recorded or may be recorded in a different segment of the clinical record. I can also indicate whether facility practices are in compliance with community standards and forewarn my attorney-client about additional compliance issues of which she may not be aware.
Rely on Your Own Case Review — Many of my case files include a chronology or summary prepared by a member of the attorney's staff. I always complete my own review, making notes as I go, then compare my review with the chronology in the file to be sure I have not overlooked anything in the records. When I'm serving as an expert witness, I know I must rely on my own knowledge and interpretation of the case facts. If I used someone else's chronology or summary to shortcut my own review, I might miss important facts and give the attorney a questionable substantiation of the case.
Develop Systems for Tracking Multiple Case Issues — I use colored tabs to mark pages containing information significant to my case. I generally mark the date and time of the notation or finding, the issue it relates to, and color code by either clinical entity or medical issue. Since long-term care cases often involve multiple issues that can become difficult to keep track of, color coding by medical issue usually makes the most sense. This process also facilitates making more intense notes, creating affidavits and constructing expert opinions in each case. As I go through the records, I may also use a mini-tape recorder to expand on and improve my notes. Once transcribed, the tapes can be recycled for the next case.
Know the Statutes Affecting Your Case — Many long-term care facility cases involve violations of residents' rights as well as medical care issues. The legal nurse consultant (LNC) must become well versed in residents' rights statutes and interpretations in the state where the case is filed. For example, in Florida, most violations of rights cases can be pursued only if the resident is alive when the case goes to trial, unless the suit is brought by the resident's spouse. Children or estates cannot sue for rights violations. Being aware of such a limitation can save your attorney-client from wasting time and money formulating issues that would only be thrown out in the end.
Stay in Touch with Your Attorney-Client — The LNC must communicate regularly with the attorney-client to assure that they are both aware of the direction the case is taking. This communication can save you hours of frustration. For example, you might identify staffing numbers as an issue in a given case, when the attorney has already determined he is not interested in pursuing that issue. To avoid wasting time pursuing the wrong issues, frequently and consistently validate your findings with the attorney.
If you will apply these strategies, you will save time and win repeat business.
Nancy Dion, RN, MSM, CLNC, CPHQ, CHCRM, LNHA 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.
CLNC® Q&A
What to Do When Your Attorney-Client Requests an Affidavit
Q.
My attorney-client has asked me to prepare and sign an affidavit. What is an affidavit?
A.
An affidavit is a voluntary written declaration of fact given under oath and sworn as true, usually before a notary public or officer of the court. An affidavit may also be called a letter of merit, affidavit of merit, declaration of merit, certificate of review or verified written medical expert opinion. Affidavits are not lengthy reports — they are brief.
Q.
Why would the attorney ask for an affidavit?
A.
Before suit is filed, several states require an affidavit stating that a reasonable probability exists that the Standard of Care was breached. Many states require the affidavit to be prepared and sworn by someone licensed in the same profession or specialty as the person who allegedly committed the breach. Some states also require an affidavit that addresses causation, and causation issues usually must be addressed by an MD.
Q.
How do I prepare an affidavit?
A.
Clarify with the attorney the purpose of the affidavit. For example, are you being asked to address the deviations from the Standard of Care or to state that in all reasonable medical probability the deviations caused the claimed injury?
Clarify with the attorney whether you will also be expected to testify. Some attorneys will want you to be named as an expert witness. Other attorneys may not want to reveal who their experts are at the time a case is filed, and will use other professionals to prepare and file the affidavit.
Determine whether a standard format is required. Frequently, an affidavit contains standard "boilerplate" language which your attorney-client will provide. Usually, the person preparing the affidavit includes statements identifying themselves and their qualifications, the information they have reviewed to formulate their opinion and the opinion. The opinion may include general or specific deviations from the Standard of Care, as well as a statement that the opinion may change if additional information becomes available.
After you have drafted your affidavit, the attorney may revise it based on the legal purpose of the affidavit. Do not sign an affidavit until you have reviewed the attorney's changes. Be sure to read the final version carefully before you sign it to ensure it accurately reflects your qualifications and declaration of the facts.
Q.
Where can I find sample affidavits to review?
A.
Several sample affidavits appear in the textbook accompanying the Basic CLNC® Certification Program. However, because the purpose and required content of affidavits vary from state to state, you should discuss this in more detail with any attorney requesting this service.
