MY MOST MEMORABLE CASE
I Saved the Defendant Millions with My In-Depth Review
by Gina I. Rogers, RN, BSN, CLNC
Late one Friday afternoon I received a call from an insurance defense attorney asking me to review a plaintiff's medical records. Because the plaintiff's deposition was scheduled for the following Tuesday, my attorney-client sent the records overnight via FedEx.
Here are the facts of the case. The defendant had agreed to be the designated driver when she and a group of friends went out partying. On the way home from the second bar the driver, who had not been drinking, hit a tree. The plaintiff was sitting in the back seat and was not wearing a seatbelt. Everyone else in the car had their seat belts on and essentially walked away from the accident. But the plaintiff suffered a fractured vertebra that was repaired surgically. He claimed he was totally disabled due solely to the injuries sustained in the accident. He complained that these injuries caused his weakness, fatigue and inability to work.
On Monday morning, with the deposition 24 hours away, I received four volumes of medical records documenting ten years of the plaintiff's medical history. My review of the records revealed a very different picture from his allegations:
This plaintiff had a long history of HIV and had complained of fatigue on several occasions.
Prior to the accident the plaintiff was on the medications AZT, Combivir and Bacofen, which can have side effects including weakness, fatigue, headaches, dizziness and muscle breakdown.
He had chronic hepatitis, which also contributed to his weakness, fatigue and malaise. His treating doctor had documented that he was not to drink due to his hepatitis. The plaintiff's blood alcohol level was significantly elevated when he arrived at the emergency room following the accident.
I faxed my attorney-client the highlights of my findings in the medical record, along with the side effects of the plaintiff's medications. On Monday evening the attorney and I discussed the case and my findings which revealed that the plaintiff had complained of pain, weakness and fatigue before the accident.
Per my attorney-client's request, I also wrote deposition questions for him to ask the plaintiff. Sample questions included:
Please describe the onset, location, duration and severity of your pain.
When did these symptoms start?
Did you have any of these problems before the accident?
During deposition the plaintiff stated that prior to the accident he was fine and had no complaints. The medical records had revealed to me a totally different picture. Armed with my in-depth review of pre-existing conditions, the insurance defense attorney was prepared to dispute this testimony.
Mediation was set for the next day. The plaintiff attorney stated that his client was severely injured during this accident and the defendant was responsible. He was demanding $5,000,000 from the defendant above the $500,000 policy limits.
When it was the defense attorney's turn, he clearly related the plaintiff's ongoing complaints to his long history of HIV and hepatitis, the side effects of his medications and his noncompliance with his physician's orders. These facts were documented in the medical record long before the accident, and the complaints were therefore not solely related to the accident.
At this point the plaintiff attorney started looking very uncomfortable and blurted out, "This case has been in my office for two years, and this is the first time I have ever heard of this information." The plaintiff attorney had obviously not reviewed his client's medical records nor prepared like the defense attorney had. And he definitely never hired a CLNC®.
The case settled for $10,000. It was extremely satisfying knowing I helped the defendant save millions with my in-depth review.
Gina I. Rogers, RN, BSN, CLNC is the founder of Medical Review Consulting, LLC in Kentucky. Her company consults with plaintiff and defense attorneys as well as insurance companies. She serves as a CLNC® Mentor and faculty member for the Institute.
CLNC®s from all over the U.S. offer their tips and strategies for first-class marketing and effective business practices.
Building Client Relationships
Use giveaways to build relationships with clients and be sure your gift is useful. For example, attorneys like tools, so I give away multi-tip screwdrivers with this note attached: "MLR* Medical Legal Review has the tools to help you tweak the medical aspects of all your cases." I like knowing the attorneys are thinking of me every time they use my gift.
– Barb Rogers, RN, CLNC MLR* Medical Legal Review Kentucky
Marketing Strategies
I send my information newsletters in colored envelopes. This way my newsletter stands out and gets more attention.
I made a hit with this low-cost marketing idea: I fill coffee mugs with candy and wrap each in cellophane with my business card attached to the ribbon. Each mug is accompanied by a booklet that includes my resume, description of my case reports, sample table of contents, sample report, list of my CLNC® services and sample contracts. On my drive to Orlando for the 2003 NACLNC® Conference, I dropped off mugs and booklets at law firms in several cities along the way. I got great responses from the office managers and receptionists – all of them shared my information with the attorneys in their firms.
One of my best marketing strategies is what I call "street walking." I go out and visit law firms just to keep my face out there. Attorneys love my term for this practice and even enjoy seeing me. It reminds them that I'm always ready to go to work for them.
My strategy for marketing to attorneys works like a charm. Just follow these steps:
Look up the ABA or your state bar association on the Internet. Click on any link to continuing legal education and see what topics interest you.
Register and attend the seminar. Dress for success and arrive early.
Cheerfully greet and introduce yourself to attendees as they arrive.
Exchange business cards and hand out your brochure.
Schmooze with the presenters – they are attorneys. When they ask what you do, repeat your rehearsed introduction. When the program is about to start, sit near the front. Look alive, attentive and professional.
Breathe, sit back, listen and learn.
– Denise C. Lemakos, RN, CLNC Lemakos and Associates New York
I attend attorneys' monthly meetings and luncheons. At every Texas Trial Lawyers Association meeting, 2-4 attorneys approach me to discuss case work they need done. This gives me an opportunity to market my CLNC® services.
– Donna T. Sulier, RN, CLNC Sulier & Associates New Mexico
I use the Internet Yellow Pages to locate attorney-prospects in other towns. I look these attorneys up on their websites, or on Martindale-Hubbell or Lawyers.com to learn about their areas of practice. When I follow up with a customized letter of introduction, you can bet it gets read, because in it I demonstrate my knowledge of the attorney's firm.
– Tonya Johns, RN, BSN, CLNC Medical Legal Consulting of Green Country Oklahoma
Learn where attorneys go for lunch and coffee in your community. In my area, it's Starbucks, so I often go for coffee early in the morning. (My CPA questioned all those lattes as marketing expenses.) While having my coffee, I casually talk with attorneys and begin cultivating long-term relationships. Any attorney I meet over coffee receives a Starbucks gift card when I close the sale.
When I'm evaluating a case, I ask myself lots of questions. I write my questions down to ask the attorney, then I really listen to the answers. There's no shortcut for thoroughness.
– Teresa L. Hamrick, RN, CLNC TLH Medical-Legal Consulting, Inc. Florida
The first time I go through the record, especially a large chart, I use different colored Post-It® flags to mark key pages. I use one color for each issue; for example, red flags for medication issues, blue for physician issues, green for standard of care issues. When I go back for specifics, I can easily find what I'm looking for and make detailed, organized notes. This technique also makes it easier to refer to pages during meetings.
– Melanie M. Morris, RN, MBA, BSN, TNCC, CLNC Professional Medical Legal Services, LLC Ohio
Favorite Resources
I have all of the Vickie Milazzo Institute's tapes organized in a Tupperware® shoe box in my car so I can choose a tape relevant to the type of case I'm working on or pick a motivational tape on a slow day. Books I read (when I'm not driving) include: Illuminata: A Return to Prayer by Marianne Williamson; Don't Count Yourself Out by Zig Ziglar; and Guerrilla Marketing: Secrets for Making Big Profits from Your Small Business by Jay Levinson.
Avoid filing big stacks of fax copies by using eFax® from eFax.com. This service lets you fax via email. Your fax is always available even when you're away at the NACLNC® Conference. You can also search your email by keywords to retrieve faxes later.
If you are familiar with charting software such as medical practice management software, market this knowledge as part of your CLNC® services. I am currently working on a case where the court has ordered a forensic inspection of all hard drives in the physician's office computers. My nursing expertise and computer skills will complement the know-how and resources of the information technology expert we've subcontracted to assist us.
– Barb Rogers, RN, CLNC MLR* Medical Legal Review Kentucky
Business Management
I use a white dry-erase board to keep track of my cases. This strategy keeps me aware of the due date and type of report requested. When the case is complete and invoiced, I erase it from the board. I use another board for tracking the status of expert witness searches.
I have a separate phone number for my business on the same phone line as my home number. This only costs a few dollars a month. The business line has a different ring so family members know not to answer it. I also have two voice mail boxes – one for family, one for business.
– Tonya Johns, RN, BSN, CLNC Medical Legal Consulting of Green Country Oklahoma
Testifying Strategies
My testifying strategy is practice, practice, practice. Practice in front of a mirror – practice in front of close friends or family members. Remember that you're teaching when presenting to the jury, so remember to use your teaching tools. Testifying can be an intimidating experience, but with plenty of preparation your confidence will soar.
I have my attorney-client discuss the opposing counsel's strategies and style with me if I don't already know that attorney. If I have worked with the opposing counsel in the past, I make sure to let the jury know this.
Network all over the U.S., not just in your local area. My best sources for nursing experts and CLNC® subcontractors are other CLNC®s. Attend the NACLNC® Conference every year, and you will meet every type of nursing expert you'll ever need.
