July 6th, 2010
Several years ago, a plaintiff attorney asked if I could find an anesthesiology expert to review a medical malpractice case which was well underway. When I know an attorney, I don’t mind just giving him a name and CV, if able. But I’m still hesitant to recommend a potential testifying expert without first reviewing the case myself.
Proper vetting of a testifying expert is very time-consuming and many attorneys prefer to do that task themselves. But, for me to even preliminarily contact a potential expert, I need to know the facts of the case so I can intelligently go over the specifics with the expert, prior to making a referral.
Although I had a great anesthesiologist in mind the more questions I asked of the attorney, the more puzzled I became. The attorney finally got tired of my endless questions and sent me the medical records.
Basic facts of the case: A gentleman coded while in the special procedures room and had to be taken directly to surgery. He never regained consciousness and tubes were pulled a few days later.
Several very well-qualified physician experts in various specialties had already reviewed the file. I read several of the expert depositions.The defense repeatedly stated there were no code blue records, due to the code happening in the special treatment room. (RED FLAG) Read the rest of this entry »
Tags: attorney, depositions, legal nurse consultant, LNC, medical record review, testifying expert
Posted in Legal Nurse Consultants | 7 Comments »
June 27th, 2010
THE JERK LNC FLASH OF THE WEEK
This week, I’m discussing some of the legal and ethical issues a Legal Nurse Consultant (LNC) has to deal with on a regular basis. Please read on to enjoy a sampling of what we learn by being involved in a close-knit group of legal nurse consultants. The J.E.R.K. LNC members learn & share something new & exciting every week!
There are many different situations an LNC could find herself in that might
endanger her career. When specifically dealing with liability, the LNC
should be aware of the theories that can be used against her, and how to
avoid them completely.
To begin with, the major theories are malpractice cause of action,
unauthorized practice of law, breach of contract cause of action, fraud,
misrepresentation, breach of warranty, disciplinary action by a state board
of nursing, and others. Each of these theories of liability can be advanced
against the LNC, so it’s important to be cautious of when the LNC is
accountable for her actions.
For instance, in the case of malpractice cause of action, the LNC is
accountable for her actions AT ALL TIMES. This is important to remember
because the plaintiff must prove four elements against the defendant LNC :
Duty, Breach of Duty, Damages, and Causation.
Beginning with duty, the plaintiff must first prove that the LNC has a duty
that goes by a specific standard of conduct. The courts typically ask
themselves., “Was there a relationship between the plaintiff and defendant
LNC at the time of the incident, and did it make the basis of the lawsuit?”
If yes, then the defendant LNC has a responsibility to the plaintiff to
conduct herself prudently. Read the rest of this entry »
Tags: CLNC, contract, ethical, expert, JERK LNC, legal, legal nurse, legal nurse consultant, liability, LNC
Posted in Legal Nurse Consultants | 1 Comment »
April 30th, 2010
What is pain and how can a nerve block help your patients?
Let’s do a brief general overview of pain management and Interventional Nerve Blocks shall we?
Pain is the body’s natural response to harm and possible harm. It serves as a warning that an injury is impending or has occurred and that we need to take action. As nurses, we are taught to be objective….so pain is anything the patient says it is.
There are 2 types of pain:
- Nociceptive - When a harmful stimulus is applied to our skin, joints or muscles, specialized nerve endings, called nociceptors are activated. When they are activated, we feel pain and react to eliminate the cause to prevent further harm. Pains from the activation of these receptors are called nociceptive or Somatic pain. It can be described as either sharp or dull; examples would be tissue damage as a result of cancer, or pain from an injured muscle or bone. Frequently it responds well to anti-inflammatory agents and pain relievers.
- Neuropathic - Pain can also arise spontaneously, without a stimulus, to the nociceptors, often as a result of dysfunction or damage to the nervous system through injury, disease, or localized trauma (e.g. an infection or surgery.) This is called neuropathic or chronic pain. Some patients describe this pain as continuous, burning or intense, stabbing pain that continues all day and night with out relief. For others, it is intermittent but severe. Chronic pain does not respond well to drugs and other standard therapies. The chronic pain can become the focal point of one’s life and the negative effects can be extensive.
Pain incorporates two components:
- the sensation of pain
- the reaction to pain
An individual’s reaction to pain can be divided into three phases:
- Immediate pain occurs directly after an injury such as a burn or a cut, and it might last for seconds or minutes. The response to immediate pain is a reflex withdrawal and active protection of the injured part.
- Acute pain occurs hours or days following an injury such as a twisted ankle. It is the throbbing sensation that occurs after the immediate pain vanishes. Acute pain acts as a protective mechanism; it warns the individual to avoid using the injured area during the healing process to prevent further injury. The response to acute pain is typically a combination of anxiety, avoidance, and guarding of the injured area.
- Chronic pain can be defined as pain that exists for 1 month longer than expected, persists longer than six months after an injury, reoccurs periodically over six months, or continues for an indefinite length of time. Chronic intractable pain is chronic pain that has not been completely removed by ordinary medical, surgical, or nursing measures.
Chronic pain treatments can be divided into three tiers. Nerve blocks are considered second-tier.
Therapeutic nerve blocks are local anesthetic and/or steroid injected directly onto the nerve serving the painful area. With epidural blocks, local anesthetics and/or steroids may provide pain relief for up to six months, depending on the patient’s specific etiology. Some patients get no relief or have exacerbation of their pain. Read the rest of this entry »
Tags: back pain, chronic pain, Epidural nerve blocks, Facet blocks, legal nurse consultant, LNC, medical record review, nerve blocks, pain, pain management, personal injury
Posted in Legal Nurse Consultants | 5 Comments »
February 27th, 2010
When discussing the “appropriate path” for preparation of nurses and
nursing specialties, the discussion often spins around to what HAS been
utilized and what paths individuals have taken to arrive at successful,
challenging, lucrative, (insert your favorite adjective) careers. This is
unfortunate — discussions about education preparation are, or should be,
about the FUTURE. What do we need to do to assure that the fresh faces in
our profession are well prepared to take on the role? What do we need to
do to assure that they meet with willing preceptors and institutions who
are welcoming, supportive, and nurturing? What kind of knowledge do they
need to gain in the classroom environment that will translate adequately
and RAPIDLY at the bedside? What kind of educational preparation do they
need to continue building the recognition and acknowledgment that we ARE a
profession? How will they be best prepared to gain the respect and the
seat at EVERY important discussion that we so desire and that will be of
significant benefit to health care in the world? This dialogue is NOT
about how we have arrived at where we are but a discussion of how we can
assure that those who come AFTER us are better equipped EARLIER to do the
work that needs to be done.
I have traveled the long path: LPN, ADN, BSN, MSN, CNM, and am working on
my dissertation. I LOVE formal classroom education. THAT is where I obtain
the knowledge that I apply at the bedside, in the office, in the
courtroom, and wherever else I practice nursing. I understand that others
will find different opportunities to learn and grow. I honor those
different paths and seek to learn from THEM what their life lessons have
provided. All knowledge is valuable and should be honored as such. Read the rest of this entry »
Tags: BSN, college degree, higher degree, legal nurse consultant, nursing education, nursing student, registered nurse, RN
Posted in Legal Nurse Consultants | 3 Comments »
January 6th, 2010
We have finally reached a time in health care where the term “Living Will” is used fairly comfortably on a daily basis when delivering medical care. We ask our patients on admission to any facility if they have a Living Will and a designated health care surrogate to act upon their wishes should they become incapacitated. If they don’t currently have one, we print up a standard form, have them fill it out, sign it, get witnesses and within minutes we create a Living Will for them! It has taken over two decades, but I believe that at this point in the evolution of health care practice, the general public can converse on the subject of “Living Wills”. Big sigh of relief.
But….now we have come to new crossroads. One new issue we face relates to the importance of choosing an appropriate & faithful health care surrogate. What’s the point of creating a Living Will and designating someone as a health care surrogate if–at the time you need them to speak out in your behalf–that person decides to go against your wishes? How is that ethical? How is that fair? What duty does your health care surrogate have to uphold your wishes once you are unable to make decisions for yourself? And, what is the consequence of choosing a different decision than the one that person initially wanted? At this point in time, there is no legal consequence. The health care surrogate has the final word. Thats a powerful role to assume!
In my region of Florida, our critical care units deal with a very elderly population. My colleagues & I encounter this type of situation all too frequently. A 93-year old widower with severe COPD gets admitted from an assisted living facility with his fourth bout of pneumonia in 2 years. He comes to us in bad shape…confused, agitated, hypoxic, shocky, dehydrated. His kidney status is bordering on renal failure. We receive his Living Will and health care proxy forms which state that his only child, a son in Pennsylvania, is his health care surrogate.
Read the rest of this entry »
Tags: dialysis, DNR status, end-of-life decisions, health care proxy, Health Care Surrogate, hemodialysis, ICU, legal nurse consultant, linkedin, Living Will
Posted in Legal Nurse Consultants | 6 Comments »
