NEWS FLASH
Vickie L. Milazzo Wins Nursing Excellence Award
Vickie L. Milazzo, RN, MSN, JD was honored to win the 2004 Nursing Excellence Award for Advancing the Profession. Selected from among the thousands of nurses in the South Central region, Vickie's achievements were heralded in October at NurseWeek's gala ceremony attended by more than 200 nurses and their supporters.
"It was the first time I've ever nominated anyone for this award," says Carol Hartwig, RN, MS, CNAA, CLNC. "I don't know another nurse who has done so much for nursing on her own. She has helped and guided thousands of RNs as they discover a new direction for their nursing skills and experience. In my 34 years of nursing, I've never met anyone else who so truly deserves this recognition."
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BEST PRACTICES FOR BUSINESS DEVELOPMENT
CLNC®s Improve the Health of Attorney-Clients' Cases
by Vickie L. Milazzo, RN, MSN, JD
When an attorney takes on a medical-related lawsuit, the attorney is confronted with enormous volumes of medical records crammed with esoteric terminology, inexplicable shorthand and indecipherable handwriting. Yet his client's (plaintiff or defense) future depends on the attorney understanding those records and using them to support the case effectively. That's why being a Certified Legal Nurse ConsultantCM (CLNC®) is the healthiest thing that will ever happen to your attorney-client's practice.
CLNC®'s Pain and Suffering Analysis Spurs Record Settlement
On a sunny Virginia morning, meter maid Beverly Adams* was severely burned over 50% of her body when her three-wheeled motorcycle turned over and caught fire. "She was making a slight turn on dry pavement," says her attorney, Rob Walker of Robert Walker and Associates, Richmond. "The vehicle was defectively designed with the driver sitting right on top of the gas tank." That arrangement almost proved lethal for Adams.
"Under Virginia law," continues Walker, "you can't sue an employer for an on-the-job injury that takes place in the course of employment. Instead, we took on the engineering firm and the foreign corporation that designed and distributed the vehicle."
According to Walker, his 42-year-old nonsmoking client sang in her church choir and was a 15-year veteran of the police force. Adams had a reputation for going by the book and writing more tickets than most of her peers. "She was the perfect plaintiff," he says.
The accident changed Adams' life completely and permanently. "In addition to her severe burns," says Walker, "she lost four fingers on one hand, lost her eyelids, ears, nose and most of her hair. She spent three months in the hospital, almost a year in rehab, and needed 32 reconstructive surgeries and other surgical procedures. For the rest of her life she'll have to use prosthetic devices and special creams for her damaged skin."
How does the attorney make sense of a year's worth of complicated medical records describing such devastating injuries? How does he even begin to grasp the pain and suffering Adams endured, much less make it real for a jury? Walker's answer is simple: He doesn't. He calls in an expert. His expert of choice was Sharon Scott, RN, CLNC.
The CLNC® Is the Key to Understanding the Medical Issues – For the Adams case, Scott tapped both her 19 years of nursing experience and her extensive training as a CLNC®. "I developed a detailed chronology of the case and explained all the medical procedures in lay terms," she says. "My services included indexing the records and explaining the difference between second and third degree burns. I also pulled out every recorded instance of Adam's pain and suffering and prepared a chart listing all the pain medications, sedatives, etc., she took."
Walker explains the value of Scott's CLNC® services. "I had no idea what was being done to the plaintiff because much of it was in medical shorthand. Sharon indexed the records so we could find what we were looking for. Then on a daily basis she summarized Adams' condition, treatments, surgeries, medications and outcome." This detailed summary made it easier for Walker to answer defense interrogatories and to decide which witnesses to call.
"We were most concerned about Adams' pain and suffering," he continues. "We needed a handle on that. Sharon put all the procedures and surgeries into words we could understand. For example, debridement is just a medical term to me. Sharon explained that meant scrubbing off the dead skin. When you see how often they did that, you understand how much my client suffered."
Scott's next step was to make the actual amount of painkiller Adams received real for people. Walker explains, "Sharon tallied all the dosages for the first six weeks of treatment, then concluded by saying my client had received enough medicine to relieve the pain of 850 heart attacks or 1,700-3,400 hours of labor. That vivid picture of what Adams went through gave us an advantage over the defense attorney when we started talking about damages."
Although the case was pending in federal court, local rules required Walker and the defense to attempt a good-faith settlement. "Both sides chose mediation," he says, "and we settled in about a day. Sharon's summary made the damages so evident, we never had to discuss them. This made for a cleaner conference focused on the liability issues."
The result was a $14,000,000 settlement, at that time (2000) one of the largest out-of-court settlements ever reached for a personal injury case in Virginia. "One reason we got this settlement," Walker acknowledges, "was the understanding of the medical records Sharon gave us." An indirect result of this case was that the vehicle in which Adams nearly died has been redesigned to move the gas tank and its opening to the back.
CLNC®s Save Attorneys Time and Money – "I have a small office," Walker says. "I can't read 4,000 pages of medical records. Having the services of someone like Sharon allows me to take on complex cases that I could not handle otherwise."
Scott's status as an independent CLNC® in private practice is an advantage for Walker. "I trust her judgment and her opinions more than I would a nurse working in my own office. An independent consultant doesn't have an axe to grind with you. If you get a case of questionable merit, Sharon will tell you not to pursue it."
Another benefit of working with a CLNC® is cost savings. "You can lose a lot of money on cases with complex medical issues if you're not on firm ground," says Walker. "My out-of-pocket expenses on the Adams case were around $240,000. Sharon can quickly and economically identify whether you have a case, and she can cut down on your staff time going through medical records. If you're in a small or medium-sized firm and you need help indexing records or understanding complex medical issues, a CLNC® is indispensable."
CLNC® Serves as Plaintiff Attorney's Watchdog to Keep Defense Honest
One of the largest personal injury firms in the Pacific Northwest, Stritmatter Kessler Whelan Withey Coluccio (SKWWC), also uses CLNC®s. "CLNC®s are very professional and thorough," says SKWWC partner Michael E. Withey. "They're keenly appreciative of our clients' needs. I recommend them highly."
This Seattle-based firm has a nationwide practice limited to cases involving catastrophic injury and wrongful death. Their noteworthy victories include the Exxon Valdez oil-spill litigation and the record-breaking $15,000,000 wrongful death verdict against then-Philippine ruler Ferdinand Marcos and his wife Imelda.
In 1998, a notable personal injury case came Withey's way. Jeremy Lohr was injured in a chemical plant explosion in Moses Lake, Washington. The accident, in which two other workers died, was the subject of an "I Survived" article in Reader's Digest1.
According to the Washington State Department of Labor and Industries L&I News, "a six-inch high-pressure pipe burst and workers were exposed to a toxic mix of silicon tetrachloride and trichlorosilane. An estimated 35,000 pounds of material was released."2 Jani Gilbert, Washington State Department of Ecology, reports that both silicon tetrachloride and trichlorosilane can form hydrochloric acid when they come in contact with water vapor in the air. The release created about 14 tons of highly corrosive hydrochloric acid, which can burn human skin and lung tissues.3
Lohr collapsed while pulling another fallen worker to safety, according to the Reader's Digest account. The man Lohr was trying to rescue died of his injuries.
The CLNC® Frees the Attorney to Focus on the Legal Issues – "Lohr sustained significant lung injuries," Withey says. "He requires constant antibiotic treatment and inhalants to aid his breathing. He will eventually need a lung transplant. He also sustained scarring of his corneas and suffered a loss of vision necessitating corneal transplants."
These kinds of injuries leave both physical and emotional scars requiring long-term rehabilitation. The defense hired medical experts in various disciplines to examine Lohr and evaluate the extent of his injuries and need for rehabilitation. Withey, in turn, hired Sue Burnham, RNC, CLNC to be present with Lohr during the defense medical examinations (DMEs).
"I accompanied Jeremy to four defense medical examinations," Burnham reports, "including psychiatric interviews by a doctor known to be very pro-defense, and appointments with a vocational rehabilitation specialist, a retinal specialist and an exercise physiologist. My role was to keep these doctors hired by the defense honest."
"Sue provided us with tapes and a status report regarding each exam," Withey adds. "Her presence let the defense know someone was there who knew how these exams should be handled and who could take care of the client in case anything inappropriate took place. This was very helpful, because it allowed me to focus on trial preparation instead of personally attending the examinations with Lohr." The case settled out of court in Lohr's favor for an undisclosed amount.
CLNC® Spots Medical Negligence Where it's Least Expected
While the services of a CLNC® can make a big difference in a catastrophic case, many attorneys don't wait for such cases to come along before engaging the services of a CLNC®. Kenneth Phillips, a Los Angeles-based attorney known nationally as the "dog bite king," uses the services of Dale Barnes, RN, CLNC on all his cases.
After Phillips' office orders the medical records, Barnes receives and tracks them, and keeps him apprised of the status. "Because Dale has so much nursing experience," says Phillips, "she's invaluable at simply gathering the necessary records and documenting the injuries. I never worked in a hospital, so I could miss something, but she doesn't."
Dale's alertness was crucial to a complex case that Phillips describes as "everyone's worst nightmare." A woman was walking her three chow dogs, when one animal broke free and grabbed 18-month-old Ted Ferrell* by the face as his mother was getting him out of the car. Mrs. Ferrell picked up her son and ran to the garage with the dog chasing her. She fell with Ted in her arms and shielded him with her own body against the continued attacks. Her husband heard the screaming, came out and and chased the dog away.
"Ted's injuries were quite extensive," says Barnes. "He sustained multiple puncture wounds to his face and around his eyes. Two of his upper teeth were knocked out, and his lip and mouth were injured. Most dog bite cases don't involve negligent medical care, but this one raised some red flags. In addition to explaining the injuries in detail, I was able to point out that some of the medical care was below the standard of care."
"This is a good reason for involving somebody like Dale," says Phillips. "I need someone with medical training to review my client's care. I cannot assume it's correct. And using Dale's services is less expensive than hiring a physician to review every case."
After Ted was discharged from the hospital, he was readmitted with wound infection around his right eye. A new antibiotic was prescribed, but Mr. Ferrell wasn't happy with his son's lack of improvement, so the boy was transferred to another hospital for IV antibiotic therapy. The staff at the second hospital noted that the wound was abscessed and performed surgery immediately to drain the abscess. Cultures taken during surgery showed bacteria and explained why Ted had not responded to the previous antibiotics. "The first hospital never took any bacterial cultures," says Phillips, "so the physicians were only guessing at which antibiotics might be successful."
Dale also noticed a number of other discrepancies in the records:
There were no home health notes in the records. This would have been helpful in assessing when the infection started.
Even though Ted's white blood cell count was still slightly elevated, there was no record of lab work on the day he was discharged from the first hospital.
No nursing notes were included from either hospital, and no speech or occupational therapy (OT) notes from one facility. Such assessments are necessary in cases involving injuries to the mouth.
Vickie L. Milazzo, RN, MSN, JD is the founder and president of the Vickie Milazzo Institute. She is credited by The New York Times with creating the legal nurse consulting profession in 1982. Vickie has revolutionized the careers of thousands of RNs.
1
Michael Tennesen. "Into the Toxic Cloud." Reader's Digest, July 2000, p. 134-142.
2
Washington State Department of Labor and Industries. "Violations alleged in fatal Moses Lake silicon plant explosion." L&I News, April 14, 1999. http://www.lni.wa.gov/news/1999/pr990414a.htm
3
Jani Gilbert. "Moses Lake company fined $10,000 for releasing toxic chemicals." Washington State Department of Ecology news release, Feb. 22, 1999. http://www.ecy.wa.gov/news/1999news/99-036.html
