Nursing consultants become integral to their legal teams

Carolyn Palash is a legal nurse consultant with 30-plus years of nursing experience. She has worked with attorneys in the city of Chicago and its western suburbs for the past 15 years. Contact her at (630) 682-9971 or carolyn@psi.biz.

A patient is admitted to the emergency room with complaints of headache, dizziness and vomiting.  With a past history of cardiac disease, the ER physician initiates a cardiac workup.  Over the next few hours, the patient becomes more lethargic and difficult to understand. The ER physician admits the patient.  His admission orders include a stat CT scan of the head.  As the evening progresses, the patient becomes increasingly difficult to arouse with a decrease in vital signs.  Finally, late in the evening, the stat CT scan is obtained.  A few hours later, the patient suffers a respiratory and cardiac arrest. Early the next morning, the results of the earlier CT scan indicate an ischemic stroke.  The patient eventually expires after removal of life support.

Review by an internal medicine doctor found the attending physician negligent for failure to diagnose the stroke.  The case is filed.  The records are then sent to a nurse consultant who identifies clear warning signs of a stroke while the patient was in the ER.  By not including stroke in the differential diagnosis, the ER physician was also negligent.  Unfortunately, he had not been named in the suit though clearly liable.

When medical negligence is suspected, nursing consultants should be an integral part of your legal team.  From the initial intake through the conclusion of the trial, the nurse can facilitate maneuvering through the medical maze.  

There are multiple advantages to using nurse consultants rather than a physician at this stage of the medical review:

  1. Nurse consultants review the entire record.  Oftentimes when physicians review the record, they focus on their specialty, thereby potentially missing negligence in another area.
  2. A well qualified nurse consultant has expertise in not only medicine, but also the health-care system.  The nurse consultant is able to navigate hospital records, knowing where to look for corroborating evidence that may not necessarily be in the medical record. 
  3. Nurse consultants perform the medical record review in a more timely fashion.
  4. Nurse consultants charge a lower hourly fee.  Considering the low percentage of cases that are actually filed, the attorney saves a considerable amount in fees by utilizing nurse consultants for the initial medical record review.
  5. A nurse consultant fee is money well-spent.  If the review indicates medical negligence, the nurse consultant can assist the attorney in working up the case, deciding what type of expert is appropriate, determining which additional records may be needed, developing a timeline, obtaining experts, completing interrogatories, defining damages, to name a few.
  6. A nurse consultant may assist the attorney in locating appropriate experts. Quite often a physician will not return a call from an attorney but will speak to a nurse consultant.
  7. Once the expert is obtained, the nurse consultant can serve as the liaison with the plaintiff experts, providing assistance with formulating opinions, expert affidavits and deposition preparation.
  8. As part of the legal team, the nurse consultant is able to assist the attorney in preparing for the defense expert deposition, research the background of the expert, understand the medical testimony and formulate appropriate questions for the deposition.

Nursing consultants can be utilized in additional roles such as evaluation of injuries and potential damages in personal-injury cases. The nurse consultant is frequently more efficient than a paralegal in issues involving medicine.

Finding a qualified nurse consultant can be a challenge.  Experience matters.  The nurse consultant should be an independent thinker, analytical, possess strong critical thinking skills and communicate effectively. After working with a nurse consultant, the attorney will realize the multiple advantage of having a nurse consultant on the legal team.

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