MY MOST MEMORABLE CASE My First Case Generated Courage, Passion, Self-Confidence... and Two More Cases
by Lawrence H. Frace, RN, CLNC
Like many CLNC®s, my most memorable case was my very first case. This case came more than a year after I took Vickie's CLNC® 6-Day Certification Seminar – that's right, 1½ years after I completed my CLNC® training. As you might imagine, I was one of those procrastinators.
One day I finally got up enough nerve to send out the marketing packages that were collecting dust on my desk. Within days of sending out the first seven packages, one of the law firms called and said they had a case for me.
Vickie's Advice Worked like Magic – I Walked Out with a Chart and a Check
At our first meeting, my fear turned into sheer panic as the attorney slid a jumbled, 2½-foot stack of records across the desk to me. The records covered a seven-year period at multiple hospitals and home health services. Even though my heart was racing and my mouth was dry as a desert, I managed to ask for my fee up front. Mr. Smooth I was not, but I left the attorney's office that day with my very first case and with chart and check in hand. I had put Vickie's advice into action and bingo! It worked.
The attorney explained that the patient had signed several legal documents and some family members were now questioning his mental capacity at the time. The focus of my assignment was to go through the medical records and assess the patient's mental clarity and independent judgment capability during two specific time frames. "Simple," I thought to myself. No medical malpractice issues. No deviations from standards of care.
However, assessing mental clarity and judgment through a medical record can be challenging and tedious. I'd have to scrutinize each and every page and examine every note and entry. Insights into the patient's mental clarity could spring from any note or lab value or literally any page in that 2½-foot stack of records.
This case would be different from a med mal case involving a botched surgery or fatal medication error. In such cases the CLNC® may not need to review whole categories of documentation, such as dietary entries, notes from pastoral care and social services, and routine PT, OT and home health service notes. But in my new case, I had to look at everything, and I mean literally everything.
Remember also, mental clarity and independent judgment may have nothing to do with the patient's physical condition or appearance. This patient had been in and out of several hospitals, had suffered a stroke, had many other medical conditions and had been on multiple medications. He was wheelchair bound and fed via a feeding tube. Reviewing the documentation of home care by various agencies was especially important since the attorney had told me to keep an eye out for any evidence that the patient was under undue influence when he signed the legal documents.
CLNC® Strategies Made the Difference in Satisfying My Attorney-Client
Delving into the chart at home, I created a chronology, got a feel for the case, took notes and put into practice what Vickie taught. Here are a few professional strategies I quickly implemented:
Use a Simple Letter of Agreement to Spell Out the Assignment.
Be sure what the attorney wants you to do is clear and spell it out in the letter of agreement. I kept a copy of the agreement in front of me to avoid going off on rabbit trails and doing things the attorney didn't ask me to do.
Read Each and Every Page of the Medical Record.
Every page of a medical record, no matter how benign the subject, could hold an important clue or fact. Read each page. Attorneys love detail-oriented consultants.
Give the Attorney the Total Picture.
Attorneys DON'T like surprises. They want to know the strengths as well as the weaknesses of any case, no matter which side they're sitting on.
Be Able to Cite and Locate Important Entries at a Moment's Notice.
With the attorney's permission I flagged with sticky notes the pages of the record I considered important and wrote concise notes on my flags. I then copied those flagged pages and placed them in a separate folder with an index for fast review.
Create a Visual Timeline of Important Events.
Converting a written chronology into a visual timeline is a snap (well, almost a snap). Attorneys like visual presentations. In this case so did I, since my timeline made me realize that a record was missing.
Notify the Attorney Immediately of Important or Unexpected Findings.
Upon discovering that a record was missing, I immediately called the attorney and he requested the missing record. For some reason the hospital didn't include this particular record, which was part of his original request. I was in his office when he received the missing record, and I could tell he was pleased and impressed with my attention to detail in discovering the omission.
Make Your Written Report and Supplemental Materials Attorney Friendly.
My written report included laymen's terms for the medical jargon and separate folders for medication information and general medical information. The general medical information folder contained diagrams and pictures to show the attorney what I meant when I mentioned disease entities and anatomy or physiology concepts. Remember, CLNC®s should be committed to being lifetime educators to their attorney-clients.
Take a Position on Your Findings.
My attorney-client (and his client) knew that I had scrutinized the 2½-foot stack of medical records page by page and entry by entry, and my professional opinion put their concerns and questions to rest. Attorneys want you to take a stand about what you believe your case findings actually reveal. Remember, you are a CLNC®, and you owe it to your attorney-client to voice your professional opinion based on your findings and research.
5 Lessons from My First Case Set the Stage for Future CLNC® Successes
Looking back at my first case, I was surprised at just how many lessons I learned.
I had always imagined that writing a report would be one of my most difficult tasks, but it turned out to be one of the most enjoyable. Never in my wildest dreams would I have thought report writing could be fun, but it truly is.
I learned how easy achieving attorney satisfaction is when you simply take the time up front to understand exactly what the attorney wants you to do.
As I worked on my first case, fear and panic subsided. Fear had made me procrastinate for 1½ years before starting my business, and completing my first case put fear in its rightful place and out of my vocabulary.
Before my first case I knew legal nurse consulting was for me, but I couldn't truly realize my passion for it until I completed my first case. That's when I knew just how valuable my CLNC® services are and how many people they benefit. This case was worth its weight in gold because it ignited my excitement for being a CLNC®.
My first case made me realize that I can do this and do it well. Now I had the proof. Vickie puts it best: "I Believe as a Nurse I Really Can Do Anything."
Looking back, if someone asked me what I would have done differently on this case, my answer would be simple: I wouldn't have done anything differently. However, I would not have left my marketing packages sitting on my desk till they collected dust.
My first case gave me the confidence and the opportunity I needed to put into practice what Vickie taught me nearly 1½ years earlier. This case set the stage for others that followed in terms of how I put together a report and how I use my report to educate the attorney about my case findings. That first case banished my fears, ignited my passion for being a CLNC® and made me realize that as a nurse I really can do anything! After I finished my assignment, my first attorney-client handed me case #2 and case #3. Courage, passion, self-confidence and two new cases, all from my first case. No wonder my first case was my most memorable.
Lawrence H. Frace, RN, CLNC is an independent CLNC® with 30 years of nursing experience. He is the founder of Spectrum Medical-Legal Consulting located in central New Jersey and specializes in medical malpractice cases.
EDITOR'S NOTE: Thanks to Suzanne Arragg, RN, BSN, CDONA/LTC, CLNC for sharing her thoughts about the Best Practices for Business Development article, "Integrity and Stepping Out Without Guarantees Are Vickie's 2 Secrets for CLNC® Success," published in Legal Nurse Consulting Ezine, Vol. 17, No. 12, dated June 9, 2006.
I thoroughly enjoyed reading the latest issue of the Legal Nurse Consulting Ezine. As usual, Vickie is on point. In fact, I was discussing the importance of maintaining professionalism and integrity with a colleague just yesterday. We agreed that when faced with struggles, Vickie's voice continues to remind us of the importance of doing the right thing. Vickie, you have no idea how many times I've implemented this solid advice while developing my business. Thank you for continuing to inspire and remind us of the integrity and strength within ourselves to stand firm in our beliefs.
By the way, I'm proud to report I now have 10 full-time employees and we are on track to exceed our projected revenues of more than $1,000,000.00 for 2006.
Your faithful student,
Suzanne E. Arragg, RN, BSN, CDONA/LTC, CLNC, California
Like many CLNC®s, my most memorable case was my very first case. This case came more than a year after I took Vickie's 
