What Is A Legal Nurse Consultant


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What Is A Legal Nurse Consultant

  1. 1. What is a Legal Nurse Consultant? Presented by the American Association of Legal Nurse Consultants
  2. 2. Legal Nurse Consultant (LNC) Defined Legal = Law Nurse = Professional health care provider Consultant = A person who offers advice
  3. 3. What is an LNC? <ul><li>For over 20 years, legal nurse consultants have acted as educators, collaborators and strategists in medical-legal matters. </li></ul>
  4. 4. <ul><li> </li></ul><ul><li>An LNC’s primary role is to evaluate, analyze and render informed opinions on the delivery of health care and the resulting outcomes. </li></ul>LNC Role as Distinct from the Paralegal and Legal Assistant
  5. 5. What Does an LNC Do? <ul><li>Assists in obtaining medical records and identifying missing records </li></ul><ul><li>Identifies standards of care, causation and damage issues. Helps determine the merits of a case </li></ul><ul><li>Screens for record tampering </li></ul><ul><li>Prepares chronologies of medical events and correlates them to the allegations </li></ul><ul><li>Conducts research and summarizes medical literature </li></ul>
  6. 6. What Does an LNC Do? <ul><li>Educates attorneys regarding medical facts and issues relating to case or claim </li></ul><ul><li>Identifies and determines damages and related costs of services </li></ul><ul><li>Assists with depositions and trials, including developing exhibits </li></ul><ul><li>Organizes medical records and other medically-related litigation materials </li></ul><ul><li>Conducts client interviews </li></ul>
  7. 7. What Does an LNC Do? <ul><li>Locates and procures demonstrative evidence </li></ul><ul><li>Researches and identifies expert witnesses </li></ul><ul><li>Acts as a liaison with attorneys, physicians and clients </li></ul>
  8. 8. What Does an LNC Do? <ul><li>Works in various legal settings including law firms, government and independent practice </li></ul><ul><li>Integrates nursing knowledge with the challenge of criminal and civil litigation </li></ul><ul><li>Prepares chronologies of medical events and correlates them to allegations </li></ul><ul><li>Prepares witness and exhibit lists </li></ul>
  9. 9. What Does an LNC Do? <ul><li>Collaborates with attorneys in preparing interrogatories, deposition and trial outlines, queries for direct and cross examination, and document production requests </li></ul>
  10. 10. Type of Cases LNCs Review <ul><li>Medical and dental malpractice </li></ul><ul><li>Personal injury </li></ul><ul><li>Toxic torts </li></ul><ul><li>Product liability </li></ul><ul><li>Workers’ compensation </li></ul><ul><li>Disability </li></ul><ul><li>Criminal cases with forensic findings </li></ul><ul><li>Risk management </li></ul>
  11. 11. What Qualities Does an LNC Have? <ul><li>Health care knowledge </li></ul><ul><li>Autonomous </li></ul><ul><li>Detail-oriented </li></ul><ul><li>Communication skills </li></ul><ul><li>Organized </li></ul>
  12. 12. Standards of LNC Performance
  13. 13. Standards of LNC Performance <ul><ul><li>Quality of Practice </li></ul></ul><ul><ul><li>Performance Appraisal </li></ul></ul><ul><ul><li>Education </li></ul></ul><ul><ul><li>Resource Management </li></ul></ul><ul><ul><li>Ethics </li></ul></ul><ul><ul><li>Collaboration and Research </li></ul></ul><ul><ul><li>Collegiality </li></ul></ul>
  14. 14. Quality of Practice <ul><li>Participates in quality of practice activities as appropriate to the individual’s role, education and practice environment </li></ul><ul><li>Collects data on the volume, type and results of the activities performed </li></ul>
  15. 15. Performance Appraisal <ul><li>Evaluates his or her own performance in relation to professional practice standards and relevant statutes and regulations </li></ul><ul><li>Reviews and reflects candidly on personal performance and attends continuing education for self-improvement </li></ul>
  16. 16. Education <ul><li>Acquires and maintains current knowledge in nursing and health care issues </li></ul><ul><li>Seeks the knowledge and skills that are appropriate to the LNC practice </li></ul><ul><ul><li>LNCs working on medical malpractice cases attend conferences and seminars on health care issues </li></ul></ul><ul><ul><li>LNCs working with environmental and toxic chemical issues are well versed in public health </li></ul></ul>
  17. 17. Collegiality <ul><li>Contributes to the professional development of peers, colleagues and others </li></ul><ul><ul><li>Shares knowledge and skills </li></ul></ul><ul><ul><li>Provides peers with constructive feedback regarding their practices </li></ul></ul><ul><ul><li>Contributes to an environment that is conducive to the health science education of legal team members </li></ul></ul>
  18. 18. Ethics <ul><li>Decisions and actions are determined in an ethical manner </li></ul><ul><ul><li>Maintains confidentiality as per HIPAA regulations and the attorney/client privilege </li></ul></ul><ul><ul><li>LNC who testifies as an expert witness confines testimony to his or her area of expertise </li></ul></ul><ul><ul><ul><li>- The LNC who is an expert in nursing home care would not testify when an LNC expert in obstetrical nursing is needed </li></ul></ul></ul>
  19. 19. Collaboration <ul><li>May collaborate with legal professionals, health care professionals and others involved in the legal process </li></ul><ul><li>Examples: </li></ul><ul><ul><li>The LNC confers with an obstetrical nurse when reviewing fetal monitor strips. </li></ul></ul><ul><ul><li>The LNC confers with transportation and highway specialist when reviewing motor vehicle accidents. </li></ul></ul>
  20. 20. Research <ul><li>Recognizes research as a methodology to further the LNC’s practice </li></ul><ul><ul><li>Participates in research activities, education and practice environment </li></ul></ul><ul><ul><li>Develops an extensive database of authoritative medical research in order to support the cases </li></ul></ul>
  21. 21. Resource Management <ul><li>Considers factors related to ethics, effectiveness and cost in planning and delivering client service </li></ul><ul><ul><li>Selects expert assistance based on the needs of the case or claim </li></ul></ul><ul><ul><li>Assigns tasks based on the knowledge and skill of the selected provider </li></ul></ul><ul><ul><li>Assists legal professionals and others in identifying and securing appropriate services available </li></ul></ul>
  22. 22. Case #1 Negligence
  23. 23. Case #1 – Negligence <ul><li>A resident of a long-term care facility was severely injured during a transfer to a wheelchair. </li></ul><ul><li>A review of the record and of the documents provided from the state and the nursing home, showed a pattern of low levels of staffing, frequent staff turn over, and very poor compliance with the regulations. </li></ul>
  24. 24. Case #1 – Negligence <ul><li>Further review by the LNC found that the facility did not follow the nursing process in relation to the assessment of the patient. </li></ul><ul><li>Although assessments had been made related to care needs, the resident care plan was incomplete and not current for interventions necessary to meet the needs of the resident. </li></ul>
  25. 25. <ul><li>The nursing assistant providing care was not informed of the care needs of the resident. </li></ul><ul><li>This patient required, but did not receive, proper assistance and transfers from bed to wheelchair. </li></ul><ul><li>The resulting injuries subsequently lead to death. </li></ul>Case #1 – Negligence
  26. 26. Case #2 Working Outside Scope of Practice
  27. 27. Case #2 – Scope of Practice <ul><li>The resident of the long-term care facility had suffered wounds to the coccyx. </li></ul><ul><li>The facility had acknowledged that there had been an error on the part of the facility, but not to the extent that the plaintiff described. </li></ul><ul><li>One of the wounds did not respond to treatments and continued to worsen. </li></ul>
  28. 28. Case #2 – Scope of Practice <ul><li>After careful review of the records by the LNC, it was noted the documentation for the assessment and treatment of the wounds was vague and not reflective of what other caregivers were charting in the records for this resident. </li></ul><ul><li>The LNC discovered the care provider was a student nurse and was working outside the limits of her practice. </li></ul>
  29. 29. Case #2 – Scope of Practice <ul><li>In further review, it was determined that student nurse who was assessing and providing wound care to the resident was working outside her capacity and that there was no RN oversight of the student. </li></ul><ul><li>In this case, the LNC pointed out the nursing process, which involves providing individualized nursing care after identifying the needs of the patient, was not followed. </li></ul><ul><li>The case settled for $750,000. </li></ul>
  30. 30. Case #3 Quality of Life
  31. 31. Case #3 – Quality of Life <ul><li>A young woman, who was on birth control, became pregnant. The doctor deduced that it was a Molar pregnancy, and recommended a D & C. </li></ul><ul><li>However, after performing the D & C, the doctor did not follow up with the required labs. Several months later, the woman was still pregnant. </li></ul>
  32. 32. Case #3 – Quality of Life <ul><li>When the LNC was retained, this breach in the Standard of Care had already been established by a qualified obstetrics doctor. </li></ul><ul><li>The LNC needed to show how this breach effected the baby’s outcome and quality of life. </li></ul>
  33. 33. Case #3 – Quality of Life <ul><li>The LNC identified 17 congenital defects, most affecting the heart and lungs. The child also had no functioning spleen and swallowing problems. </li></ul><ul><li>The defect was explained in layman’s terms and compared the defect to a normal heart function, so that the attorney had the complete picture. </li></ul>
  34. 34. Case #3 – Quality of Life <ul><li>This child was being cared for exclusively by his family, as they had trouble getting home health due to the fact that they were in a rural area. </li></ul><ul><li>Fortunately, the mother was very educated on his care, but as he needed constant care, the family needed additional assistance. </li></ul>
  35. 35. Case #3 – Quality of Life <ul><li>The LNC met with the mother to discuss the equipment the child was utilizing in the home. </li></ul><ul><li>With a home health background, the LNC had a good understanding of what was needed for this child in the way of supplies, and was able to deduce what he would need to sustain some semblance of a quality of life. </li></ul>
  36. 36. Case #3 – Quality of Life <ul><li>At this time the child was three, and was unable to sit unassisted, or speak. He was however, able to make a clicking sound with his tongue to get attention from family. </li></ul><ul><li>He had already undergone two major surgeries, and needed at least two more to remain viable, but was not a candidate at this juncture, due to several health issues. </li></ul><ul><li>As a result, life expectancy could not be established. </li></ul>
  37. 37. Case #3 – Quality of Life <ul><li>A one year cost analysis was done based primarily on what he was utilizing at present, but taking into consideration his growth, should he survive. </li></ul><ul><li>The attorney utilized the report and cost analysis to mediate the case. The case settled for an undisclosed amount, but the LNC was told that it was a favorable outcome for the child. </li></ul>
  38. 38. Case #3 – Quality of Life <ul><li>The interesting thing about this case is “wrongful birth” cases are very difficult to win, as most juries feel that any life, is not a bad outcome. </li></ul><ul><li>The attorney felt the LNC’s contribution was the “edge” he needed to prevail on this case. </li></ul>
  39. 39. Case #4 Slip and Fall
  40. 40. Case #4 – Slip and Fall <ul><li>The plaintiff, who was inspecting a bridge construction, slipped and fell several feet from a scaffold onto his back. </li></ul><ul><li>Plaintiff was never seen or taken to an emergency room for evaluation. </li></ul><ul><li>He drove himself home, but stopped at the chiropractor on his way. </li></ul>
  41. 41. Case #4 – Slip and Fall <ul><li>As the plaintiff continued with chiropractic treatments, he continued to experience lumbar discomfort and pain. </li></ul><ul><li>The diagnosis was lumbosacral and thoracic sprain/strain. A few months later, the plaintiff presented with erectile dysfunction. </li></ul>
  42. 42. Case #4 – Slip and Fall <ul><li>Not contained in the initial report was that the radiologist missed a compression fracture. </li></ul><ul><li>Studies showed the presence of advanced degenerative disc disease. </li></ul><ul><li>The plaintiff’s back pain slowly began to radiate into his left leg. </li></ul>
  43. 43. Case #4 – Slip and Fall <ul><li>The plaintiff never reported a prior history of back pain. He was treated by a chiropractor and his physician. </li></ul><ul><li>There were several other incidents placing a strain on his back. This included lifting grandchildren. </li></ul><ul><li>The plaintiff’s demand was $10 million with a consortium loss for his spouse at $1 million for a total of $11 million. </li></ul>
  44. 44. Case #4 – Slip and Fall <ul><li>As discovery continued, more medical evidence came forth to the defendant that the plaintiff had pre-existing disease processes which could affect the outcome of the case. </li></ul><ul><li>The LNC reviewed the medical evidence as this case was headed for trial. This included analysis and updating of the medical chronology. </li></ul>
  45. 45. Case #4 – Slip and Fall <ul><li>The employer accommodated this employee by assigning light duty work. The employer placed him on a desk job with occasional on-site visits to construction areas, well within his functional limitations. </li></ul><ul><li>The employer provided a private log/diary as to the employee’s paid time off while he suffered from this alleged injury. </li></ul>
  46. 46. Case #4 – Slip and Fall <ul><li>Eighteen months after the original incident, the employer reported the plaintiff worked in the yard, changed tires on a car, drove to another job site 1½ hours away from the office, went out of town to build a deck on his son’s house, and went fishing. </li></ul>
  47. 47. Case #4 – Slip and Fall <ul><li>Eventually, the plaintiff went to his employer and decided to “retire” because the pain was too great and the plaintiff could not tolerate the discomfort. </li></ul><ul><li>The attorney had an LNC review the case. The employer provided a diary and log, which was included into the medical chronology. </li></ul>
  48. 48. Case #4 – Slip and Fall <ul><li>When the attorney reviewed the incorporated employer’s information against the medical information, he saw there was a pattern developing. </li></ul><ul><li>The attorney presented the additional information within his opening statement. </li></ul><ul><li>The plaintiff’s attorney called for an immediate settlement conference. </li></ul>
  49. 49. Case #4 – Slip and Fall <ul><li>The case settled for $800,000 total, saving the client, the carrier, over $10.2 million dollars. </li></ul>
  50. 50. Certification Legal Nurse Consultant Certified LNCC
  51. 51. Certification Objectives <ul><li>The LNCC designation is a sign of an experienced LNC – a designation earned through experience and demonstrated mastery of content </li></ul><ul><li>The American Legal Nurse Consultant Certification Board (ALNCCB) supports a high level of competence in legal nurse consulting through the management of this formal certification and recertification process </li></ul><ul><li>Recertification assures that LNCCs continue to meet the high standards established by the ALNCCB </li></ul>
  52. 52. Certification Objectives <ul><li>The LNCC designation is the only LNC certification program accredited by the American Board of Nursing Specialties </li></ul><ul><li>The LNCC designation is the only LNC certification program that is board-certified and endorsed by the American Association of Legal Nurse Consultants, the industry’s not-for-profit professional society </li></ul>
  53. 53. Certification Eligibility Criteria <ul><li>Current unrestricted registered nurse (RN) license in the United States or its territories </li></ul><ul><li>Minimum of five years experience practicing as an RN </li></ul><ul><li>Evidence of 2,000 hours in legal nurse consulting within past three years </li></ul>
  54. 54. Professional Resources for the LNC
  55. 55. Nursing Continuing Education <ul><li>Professional conferences to keep abreast of current nursing practice </li></ul><ul><li>Membership in nursing organizations </li></ul><ul><li>Subscriptions to nursing journals to keep current on new therapies, practice and medications </li></ul>
  56. 56. Legal Continuing Education <ul><li>Membership in legal areas to keep current in legal trends and practice </li></ul><ul><li>Membership in bar associations and other legal associations to develop relationships with the legal community </li></ul><ul><li>Professional conferences to keep abreast of the latest legal news and practice </li></ul>
  57. 57. American Association of Legal Nurse Consultants
  58. 58. What is the AALNC? <ul><li>The American Association of Legal Nurse Consultants (AALNC) is a nonprofit organization dedicated to the professional advancement of registered nurses practicing in a consulting capacity in the legal field. Founded in 1989, AALNC serves as a resource to its members and provides a forum for education and the exchange of information. </li></ul>
  59. 59. Industry Standards <ul><li>Code of Ethics and Conduct </li></ul><ul><li>AALNC Code of Ethics provides guidelines for professional performance and behavior and includes helpful interpretive discussion </li></ul><ul><li>Scope and Standards of Practice </li></ul><ul><li>Designates specific standards and guidelines that nurses need to know in order to practice as an LNC </li></ul>
  60. 60. AALNC Publications <ul><li>Legal Nurse Consulting: Principles and Practice - Second Edition </li></ul><ul><ul><li>Written by LNCs for LNCs, an educational tool for nurses pursuing the LNC profession </li></ul></ul><ul><li>The Journal of Legal Nurse Consulting </li></ul><ul><ul><li>Quarterly publication that provides current information on medical, legal and consultant practice issues </li></ul></ul>
  61. 61. AALNC Educational Advancement <ul><li>Annual conferences and pre-conference workshops at the national and local level </li></ul><ul><ul><li>Medical issues </li></ul></ul><ul><ul><li>Legal issues </li></ul></ul><ul><ul><li>Areas of practice for the LNC </li></ul></ul><ul><ul><li>Computerized technologies for the new and practicing LNC </li></ul></ul><ul><ul><li>Various other pertinent areas of discussion </li></ul></ul>
  62. 62. AALNC Educational Advancement <ul><li>Annual professional LNC courses </li></ul><ul><ul><li>Geared to not only the novice LNC but to the more seasoned LNC as well </li></ul></ul><ul><li>Independent-study programs </li></ul><ul><li>Certification courses and independent studies for certification </li></ul><ul><li>Teleconferences on pertinent issues </li></ul>
  63. 63. AALNC Career Development <ul><li>Mentoring programs within the chapters </li></ul><ul><ul><li>Set up within chapter structure </li></ul></ul><ul><ul><li>Individual members offering mentorship, either in-house or independents </li></ul></ul><ul><li>Networking opportunities with professionals in similar fields, including attorneys, paralegals, legal assistants, physicians and other specialists </li></ul>
  64. 64. Return on Your Investment
  65. 65. Why should you hire an LNC? <ul><li>Experience </li></ul><ul><li>Background of clinical experience, which includes interpretation of medical records, documents and medical-legal issues </li></ul><ul><li>Cost-effectiveness </li></ul><ul><li>Utilizes nursing background and knowledge of health care standards to identify strengths and weaknesses of a case </li></ul>
  66. 66. Why should you hire an LNC? <ul><li>Resourcefulness </li></ul><ul><li>Possesses a network of medical and professional resources and contacts </li></ul><ul><li>Knowledge </li></ul><ul><li>Thorough understanding of medical issues and trends related to the total litigation process, custom-designed for the attorney, client and jury </li></ul>
  67. 67. Where Can I Find an LNC? <ul><li>Visit the LNC Locator at www.aalnc.org/locator to search for an LNC by state or specialty area </li></ul><ul><li>Use the results of the search to contact an LNC or expert witness to help you with your case </li></ul>www.aalnc.org
  68. 68. For more information, contact <ul><li>American Association of Legal Nurse Consultants 877/402-2562 </li></ul><ul><li>312/321-5177 E-mail: info@aalnc.org </li></ul>www.aalnc.org
  69. 69. Presentation Contributors <ul><li>Jan Aken, RN IBCLC </li></ul><ul><li>Nancy Blevins, BSN RN LNCC </li></ul><ul><li>Sarah McLain, RN </li></ul><ul><li>Pattie Patterson, RN LNCC </li></ul><ul><li>Diane L. Reboy, MS RN DABFN </li></ul><ul><li>Lenora Smith, MSN RN </li></ul>