Legal Nurse Consulting –
Issues, Ideas, Information
Posted by Kathleen on August 19th, 2012
Hand-washing is widely recognized as the single most effective hospital practice to prevent nosocomial infections. The most common way infections are spread by hospital staff is cross-contamination –omission of washing hands between patients. Studies support doctors are the biggest offenders and less than three-quarters of registered nurses are compliant.
Studies estimate that over two million people per year suffer the effects of nosocomial infections in the United States, many of which are preventable. As a result of these statistics, hospitals may be liable under medical malpractice laws for injuries to patients due to a hospital-acquired infection, also referred to as a nosocomial infection
All medical professionals at healthcare facilities have a duty to provide their patients with a safe and clean hospital environment. Methicillin-Resistant Staphylococcus Aureus (MRSA) is most commonly isolated in the enormity of the problem with cross-infection occurring with microscopic holes in surgical gloves, stethoscopes not wiped between neonates, blood-pressure cuffs contaminated with blood & other body fluids as are operating room equipment, hospital beds & linens, side tables & nurse’s uniforms.
Common nosocomial infections that cause prolongation of hospital stays and carry increasingly high mortality rates include central-line associated bloodstream infections, ventilator-assisted pneumonias, catheter-associated urinary tract infections and surgical-site infections. Often, secondary damages exceed that of the original personal injury.
Nosocomial infections may also result from organizational risk factors and consequently, hospitals are at risk for liability relating to cleanliness ranging from the effectiveness of air filtration systems to appropriate measures taken to ensure sterility of medical instruments & services.
Hospitals carry the burden of a liability risk when negligent acts of medical professionals cause hospital-acquired infection. Medical Centers nationwide are rapidly implementing costly educational Infection Prevention programs to boost in-house compliance with hand-washing standard of care guidelines. While studies support compliance rates that have reached unacceptable levels from 30-50%, adherence to hospital policies support a significant decrease in hospital-acquired infection rates that is increasing patient safety and saving lives.
A Legal Nurse Consultant is a medical expert in meritorious evaluation of nosocomial infections and clincal infrastructure of medical centers.
Please contact Kathleen A. Mary, RN, Certified Legal Nurse Consultant for further information.
Tags: damages, doctor, guidelines, healthcare, hospital, hosptial-acquired, law, liability, medical malpractice, medical negligence, medical professional, nosocomial infection, omission, patient, patient safety., personal injury, registered nurse, standard of care
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Posted by Kathleen on August 12th, 2012
The 2012-13 Best Children’s Hospitals features 80 different hospitals that ranked among the top 50 in at least one of 10 specialties: cancer, cardiology and heart surgery, diabetes and endocrinology, gastroenterology, neonatology, nephrology, neurology and neurosurgery, orthopedics, pulmonology, and urology. Of the 80 ranked hospitals, 12 were named to the Honor Roll for high scores in three or more specialties.
Out of 5,000 hospitals in the U.S., only 1 in 30 has the clinical expertise to provide the appropriate standard of care for children with serious conditions. Medical experts estimate that deaths from hospital medical negligence and physician error would be the third most common cause of death if accurate statistics were properly kept.
Please contact Kathleen A. Mary, RN, Certified Legal Nurse Consultant for further information.
Tags: clinical expertise, death, expert, hospital, legal nurse consultant, medical negligence, patient, physician error, standard of care
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Posted by Kathleen on August 5th, 2012
U.S. News published its annual report of the best hospitals for 2012-13. The list recognizes 17 medical centers, less than 0.4 percent of the 5,000 hospitals nationwide that excel across a broad spectrum of patient standard of care and standout as experts in more than six medical specialties. Johns Hopkins 21-year reign as No.1 was displaced for the first time by Massachusetts General Hospital.
The rankings were found not to be favorable for many of the nation’s hospitals. This was also true for many of the countries best hospitals which did not perform well. Experts estimate that deaths from hospital medical negligence and physician error would be the third most common cause of death if accurate statistics were properly kept.
| Rank |
|
Hospital |
|
|
Specialties |
| 1 |
|
Massachusetts General Hospital, Boston |
|
|
16 |
| 2 |
|
Johns Hopkins Hospital, Baltimore |
|
|
15 |
| 3 |
|
Mayo Clinic, Rochester, Minn. |
|
|
15 |
| 4 |
|
Cleveland Clinic |
|
|
14 |
| 5 |
|
Ronald Reagan UCLA Medical Center, Los Angeles |
|
|
13 |
| 6 |
|
Barnes-Jewish Hospital/Washington University, St. Louis |
|
|
12 |
| 7 |
|
New York-Presbyterian University Hospital of Columbia and Cornell, N.Y. |
|
|
11 |
| 8 |
|
Duke University Medical Center, Durham, N.C. |
|
|
11 |
| 9 |
|
Brigham and Women’s Hospital, Boston |
|
|
10 |
| 10 |
|
UPMC-University of Pittsburgh Medical Center |
|
|
9 |
| 11 |
|
NYU Langone Medical Center, New York |
|
|
8 |
| 12 |
|
Northwestern Memorial Hospital, Chicago |
|
|
10 |
| 13 |
|
UCSF Medical Center, San Francisco |
|
|
7 |
| 14 |
|
Mount Sinai Medical Center, New York |
|
|
6 |
| 15 |
|
Hospital of the University of Pennsylvania, Philadelphia |
|
|
7 |
| 16 |
|
Indiana University Health, Indianapolis |
|
|
6 |
| 17 |
|
University of Michigan Hospitals and Health Centers, Ann Arbor |
|
|
6 |
Please contact Kathleen A. Mary, RN, Certified Legal Nurse Consultant for further information.
Tags: expert, hospital, legal nurse consultant, medical, medical negligence, patient, physician error, standard of care
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Posted by Kathleen on July 22nd, 2012
The Leapfrog Group, the nation’s leading non-profit promoting transparency and patient safety in hospitals, released its first-ever alarming report highlighting the country’s best hospitals and warning against the worst. The report is a bold step forward to educate consumers by drawing attention to unsafe hospital practices that kill and gravely injure a significant number of patients on a daily basis. The hospital report card showed that 47% of hospitals reviewed nationwide were graded C or below for patient safety. The Hospital Safety Score analysed data from 2,652 hospitals nationwide based on 26 exclusive patient-safety hospital measures that are calculated using publicly available data on patient injuries, medical, surgical and medication errors, bloodborne infections, falls & trauma, and preventable complications such as retained surgical foreign bodies and hospital-acquired pressure ulcers. The Group estimates that 400 patients die each day from hospital error, one medication error per day occurs for every hospital patient, and 180,000 Americans die every year from these rampant preventable hospital-error occurrences which ranks as the third leading cause of death. 1.4 million Americans each year are seriously injured by hospital error (stats apply only to Medicare patients) – What happens to other patients is less clear because most hospital errors go unreported while hospitals report only a fraction of things that go wrong.
729 hospitals earned an A, 679 earned a B, and 1243 earned a C or below. Those hospitals receiving a C or below are given until November to improve their results or they will be issued a grade of D or F. 41% of California hospitals reviewed fell into the worst-hospital category. New England outscored every other area in the nation. Massachusetts and Maine hospitals were found to be the safest in the nation – 76% graded A in Massachusetts, and 74% graded A in Maine. Not one hospital measure dominated the A category and not one received top scores for readmission or communication.
Leapfrog produced this report using collective leverage to initiate breakthrough improvements with hopes to save lives and lower costs by pushing hospitals to work harder at reducing thousands of preventable injuries and deaths each year. By hospitals allowing transparency, they promote opportunity to improve standard of care while benchmarking their own progress.
Leapfrog believes little progress has been made to improve patient safety since a report from the Institute of Medicine in 1999 noted that hospital errors were responsible for causing up to 98,000 deaths and over one million injuries to hospital patients each year. This report served as a catalyst for hospitals to begin scrambling to improve their patient safety initiatives including implementing electronic medical records, hand-washing techniques, and cleaning up medical record charting.
Consumers are encouraged to understand these new patient safety scores rather than rely on hospitals’ advertisements and accolades. Anything less than an A is worrisome, and an A does not guarantee safety. While some hospitals have sterling reputations for providing preeminent medical-surgical care and the latest technology, yet surprisingly scored B, C, or below on patient safety because they still made preventable hospital errors that caused a significant number of deaths. The Hospital Safety Score website – http://hospitalsafetyscore.org/ – allows consumers to search hospital scores for free, and also provides information on how the public can protect themselves during a hospital stay.
Tags: bloodborne infections, charting, electronic medical records, falls, hand washing, hospital acquired pressure ulcers, hospital error, medical, medical-surgical care, Medicare, medication errors, patient safety., preventable hospital error occurrences, retained surgical foreign bodies, safety, serious injury, standard of care, surgical, trauma, unreported hospital errors, worst hospital
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Posted by Kathleen on July 20th, 2012
Physicians are expected to adhere to certain standards of treatment in their medical practices. These clinical practice guidelines of appropriate treatment are developed by health care experts and professional organizations and are typically understood to set the minimum standard of care.
Clinical practice guidelines are often introduced as the legal standard of care in medical malpractice cases. However, compliance with these guidelines should not provide physicians and hospitals with complete immunity from medical negligence claims.
Research by The Journal of the American Medical Association (JAMA) suggests that guidelines do not significantly alter physician behavior and that they struggle to adhere to them. Many barriers exist that keep physicians from following guidelines, particularly the inability to keep up with the vast amount of medical literature that may present as confusing, a lack of familiarity with the guidelines that prevents physicians from knowing how to follow them, and a lack of agreement that the guideline is indeed an appropriate treatment for a medical condition. As many as 16 percent of physicians simply refuse to adhere to them at all. Guidelines concerning mammograms, for instance, were formally rejected in by more than 40 leading medical centers within 48 hours of their introduction.
Tags: adherence, clinical practice guidelines, healthcare experts, Journal of the American Medical Association, mammogram, medical, medical malpractice, medical negligence, non-compliance, physician, professional, standard of care
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Posted by Kathleen on July 13th, 2012
A medical expert witness is a professional who has a specialized background and expertise that qualifies them to credibly testify on legal cases which include medical-related cases such as personal injury, medical malpractice and workers’ compensation. Medical experts are qualified according to a number of factors, including but not limited to, the number of years they have practiced in their respective field, work experience related to the case, published works, certifications, licensing, training, education, awards, and peer recognition.
An expert witness is essential in most medical negligence and medical malpractice lawsuits. Attorneys and courts rely on the expert witness to convey the proper standards of care in order to establish whether those standards were met or not, and whether those breaches in the standard of care resulted in a negative outcome.
Most physicians with a minority interest in legal medicine need time-consuming education in legal concepts and requirements. The plaintiff advocate must not only be bilingual in medicalese but understand in depth the ways the concerns and constructs of medicine and law are dissimilar. With patience and practice, the medical malpractice lawyer can learn to word questions so that the expert medical witnesses reply in legally meaningful format.
A master skill for a litigator’s success is the ability to identify early the fatal flaws in the vast majority of enquiries, and to invest time and money only in the relatively few which will probably succeed. A Legal Nurse Consultant assists the attorney in the primary case screening for merit as well as the secondary medical phase to locate experts. Because the Legal Nurse Consultant knows every case detail with intimacy, they are best postured to locate the perfect-fit expert witness. They conduct extensive interviews with expert witnesses as well as provide a comparative analysis of their published works which are subject to discovery in order to make the best possible recommendation.
Behind the scenes, a Legal Nurse Consultant walks alongside the attorney through every phase of litigation –They assist in preparing the expert for deposition while refining case strategy every step of the way. A Legal Nurse Consultant is a proven invaluable asset during discovery serving as a trusted liaison between the medical expert witness and the attorney.
To help locate a preeminent medical expert from my personal nationwide network of board-certified specialty physicians for your next case, please contact me directly.
Tags: advocate, attorney, board-certifed physician, court, discovery, lawsuit, legal, legal nurse consultant, litigation, medical expert witness, medical malpractice, medical negligence, medicine, merit, personal injury, plaintiff, screening, standard of care, succeed, success, workers' compensation
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Posted by Kathleen on July 2nd, 2012
ICU Nurses are trained to care for patients in critical condition. An ICU nurses’ expertise; training and skills make for a preeminent LNC.
ICU Nurses are responsible for evaluating and monitoring readings, communications between all healthcare professionals and a patients’ family while seamlessly multi-tasking in a critical clinical setting. Unlike other areas of the hospital, there is minimal communication directly with the patient due to life-threatening health conditions which leaves the ICU nurse to critical thinking and skilled assessments to determine patient needs and deliver quality patient care.
All of the above criteria lead to the following characteristics that create a very well qualified LNC.
1. Critical thinking: Skills such as quick thinking, good judgment, strong assessment skills are all needed for an ICU nurse who needs to make emergent decisions in times of clinical stress. The ability to rapidly assess any situation and decipher the best plan of care is imperative for an ICU nurse. Having honed critical thinking skills is imperative for a LNC, as you need to meticulously review the whole case with a detailed analysis and provide the plaintiff attorney with a strong fact-based supporting foundation.
2. Patient Advocate: As an ICU nurse you are trained to be mindful of your patient without exception. Your goal is to represent the patient in accordance to the patient’s choices. An ICU nurse is also trained to respect the values, beliefs and rights of the patient and help them obtain necessary care. If your client is deceased, as a patient advocate, a well-trained ICU nurse working as a LNC always holds a patient’s rights and standard of care at the forefront of your case.
3. Detail Oriented: ICU nurses are excellent at flawless multi-tasking as they need to record all actions & patient responses of caregiving, remember medications & associated synergies, timings, readings and report to physicians all changes. A LNC must be detail oriented, as they need to review medical records microscopically, always finding key elements to the case that an attorney may have missed.
4. Excellent Communication Skills – Nurses not only need to communicate effectively to the patient but also to all healthcare providers and patients’ families. It is imperative to get the proper message across in a way that is precise and comprehensible to the person receiving it. A LNC can communicate with medical precision to attorneys all case details in a way they can understand the medical jargon, but also provide the attorney with jury simple language so the message comes across clear to the jury as well.
5. Work Ethic: The nursing profession is not for the faint of heart. You must love what you do and be passionate about the quality of care you are providing. Long day/night work hours are tempered with positive and negative outcomes that occur each day. The very same work ethic is what makes an ICU nurse stand tall as a LNC as they exceed the attorney’s every expectation.
A preeminent LNC does not only look for case merit and interpret medical records, they formulate intricate timelines, locate perfect-fit expert witnesses and walk alongside an attorney adding and refreshing medical insight with unparalleled clinical expertise to the case throughout the entire litigation process.
Tags: advocate, clinical expertise, healthcare professional, hospital, icu nurse, legal nurse consultant, litigation, medical record, medicaltion, negative outcome, patient rights, plaintiff attorney, preeminent, quality care, standard of care, timeline, work ethic
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Posted by Kathleen on June 24th, 2012
Medical malpractice at its simplest definition is the substandard care or treatment of a patient by a medical professional.
Medical malpractice usually means that some sort of negligence, error or breach in standard of care has occurred. This can mean a misdiagnosis, surgical error, prescription errors, improper charting, anesthesia errors or medical negligence that leads to the injury or death of a patient.
Medical negligence is the lead cause of medical malpractice suits. Medical negligence is defined as the act of omission in treatment of a patient by a medical professional, which deviates from the accepted medical standard of care.
Standard of care is the basis for which is acceptable health care and treatment. It’s imperative in a medical malpractice case to number one educate the court on what the standard of care is and two, show where the breach in care occurred. Revealing these aspects of the medical record can prove that malpractice has occurred.
The plaintiff attorney must establish the following in a medical malpractice lawsuit:
- The existence of the physicians’ duty to the plaintiff or the accepted Standard of Care
- The applicable Standard of Care and it’s violation
- What the injuries or damages of the violation are
- And finally, prove that the damages were caused by the violation in Standard of Care.
According to the Journal of the American Medical Association some 225,000 deaths annually (in the US) are attributed to medical malpractice, making it the third largest cause of death. About 82% of these are due to either adverse reactions that should have been anticipated to medications, another 18% are caused by miscellaneous errors and unnecessary surgery or medication errors.
Do you have a client that is filing a medical malpractice suit?
By hiring a legal nurse consultant you can determine up front if your case has merit. Proper review of the entire medical record can reveal breaches in standard of care, extent of primary & secondary injuries, causation & contributory parallels that may impact merit.
Tags: applicable standard of care, damages, deviation from standard of care, health care, improper charting, Journal of American Medical Association, legal nurse consultant, medical malpractice, medical malpractice lawsuits, medical negligence, medical professional, medical record review, medical standard of care, medical surgical anesthesia errors, merit, misdiagnosis, patient death, patient injury, physicians duty, plaintiff attorney, prescription errors, standard of care, standard of care breaches, substandard care, surgical error, unnecessary surgery
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Posted by Kathleen on June 17th, 2012
Proper charting of medical records is imperative in providing safety and proper standard of care for patients. Often improper charting leads to adverse consequences for the defense in medical malpractice litigation. The medical record serves as the basis of argument for the plaintiff attorney in any medical malpractice case. Meaning if the records are incomplete, inaccurate, illegible, or altered the plaintiff attorney has very strong merit to pursue the case.
Rule of thumb? “If it’s not in the record, it didn’t happen.” Improper documentation in a medical record determines the outcome of a case. Below are five medical record charting errors that can prove fatal to the defense’s case.
1. Lack of Notes: Many doctors record their visits just for this reason, speaking into a handheld recorder during/following the visit can be helpful for proper documentation later. Every conversation the physician has between themselves and the patient regarding, care, treatment, preventatives and testing should be documented in the chart.
2. Inadequate history taking: Physicians need to take the necessary steps of interviewing patients about their past medical history, allergies, drug use, family history and names of other doctors that are treating them. Having all of this information can prevent illness, adverse drug interactions, and allergic reactions and even prevent hereditary conditions. Improper history taking can result in patient harm and even death.
3. Fields left blank: If the question was answered, even with a negative or unknown answer this should be made known in the medical record. For instance if the patient has no known drug allergies, instead of just leaving the drug allergies section blank, NKDA should be recorded in the field.
4. Careless Handwriting: Something as minor as reading an A as an O can cause patients harm. “A Texas case involving a filled prescription which was misread because of illegibility resulted in a $450,000 verdict against a physician; jurors said they were angered that the patient died because of illegible handwriting and indicated their verdict would have been higher had the patient’s attorney asked for more compensation.” – MSV.org
5. Medication Problems: Prescriptions and refills must be adequately documented. Improper documentation of medications prescribed can lead to adverse drug reactions between different drugs the patient is on, overdoses and general patient harm.
Medical records play a lead role in medical malpractice lawsuits, as case outcomes depend on what is in or isn’t as it may be, in the medical record.
A Legal Nurse Consultant can help a plaintiff attorney recognize where these charting errors have occurred. Often these errors are determiners in whether a case holds merit and can be brought to settlement.
Tags: adverse drug reactions, angered jurors, attorney, careless handwriting, charting errors, defense, drug allergies, inadequate documentation, lawsuits, legal nurse consultant, litigation, medical malpractice, medical records, merit, plaintiff, settlement, standard of care
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Posted by Kathleen on June 12th, 2012
Digital Medical Records or Electronic Medical Records [EMR] are electronic health record systems that are employed by hospitals, insurance companies and other medical institutions to keep track of patient information. Of course when implementing any new system or technology there will always be pros and cons. Below is a quick synopsis of the potential benefits and causes for concern switching to electronic medical records will bestow.
As a Legal Nurse Consultant I spend countless hours reviewing medical records for cases. Recently you may have read my blog post on error reporting and why it’s important to report all errors as they happen for the standard of care and patient safety. “Medication Errors Injure 1.5 Million People and Cost Billions of Dollars Annually” according to The National Academy of Science.
The system is certainly flawed. But, there are measures that can be taken to minimize the affects of those flaws. And, electronic medical records may just be the next step in reducing incidence of death and injury.
The article on Mashable.com, “Why Digital Medical Records Could Save Your Life”, reviews potential benefits and causes for concerns within digital medical records.
Benefits:
- Access to good care becomes easier and safer when records can easily be shared.
- Important information such as prescribed drugs, medical conditions and history can be accounted for much more quickly.
- Can save time for the physician’s office – no more filing!
- Can be lifesaving in an emergency – quick access to answers that emergency decision makers need to make.
- Better in cases of natural disasters – those with medical records are able to be more easily treated and with less chance of error, also it lowers the risk of records being destroyed.
- Saves money – just as stated above, time is money. So, saving the office time is part of saving money, but also it will cut down on costs of paper and file folders and make an office much more efficient.
- They are already being used successfully in other areas of healthcare. Take veterans hospitals for instance. They are currently using a system called VistA. This electronic medical records program allows for records to be shared so even if the service man or woman is in a hospital over seas, the medical establishment still has access to all the proper medical information.
Concerns:
- Lack of Standards
- Privacy Issues – as with any electronic database you run the risks of security and potential system hacks.
- Potential errors:
- Errors made while transferring information from paper records to digital records
- Record Sharing – beneficial in many ways, however if a mistake was made but not recorded or corrected can cause a ripple effect of problems
- Speech to text transcribing isn’t always totally accurate, a human transcriber should review to make sure there are no mistakes, such as similar drug names being mixed up
President Obama has called for the U.S. to switch to digital medical records completely over the next 5 years. He stated, “This will cut waste, eliminate red tape and reduce the need to repeat expensive medical tests.” As well as, “save billions of dollars and thousands of jobs; it will save lives by reducing the deadly but preventable medical errors that pervade our health-care system.”
The need to be meticulous is imperative in how quickly we switch over and in making sure that we are implementing checks and balances throughout the transition to ensure accuracy and minimize any errors in the system.
What are your thoughts on Electronic Medical Records? Please share your opinions and thoughts in this comment section on how you believe EMR’s are impacting the healthcare system & legal aspects of the healthcare system, such a medical malpractice suits.
Tags: electronic medical records, EMR's, error reporting, healthcare system, hospital, insurance company, legal nurse consultant, lifesaving, medical, medical malpractice, patient, standards
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