Did you spend three years in law school learning medical definitions and abbreviations? What about how to organize records into hospital chart format? That was never part of my curriculum in law school. Which is precisely why attorneys and paralegals should not be trying to read their own medical records in cases involving injuries or other medical issues without the assistance of a nurse consultant or nurse analyst.
Who can help?
You may have heard of legal nurse consultants; there is a certification available to those who meet the educational and experience requirements, and pass the certification exam. But certification is not required or necessary to reap the benefits of a nurse’s medical knowledge. Nurses with a four-year Bachelor of Science degree in nursing (BSN) or Master of Science in nursing (MSN), as well as some real life clinical experience with patients, are likely going to be your best bet, but Registered Nurses (RN) and Licensed Practical Nurses (LPN) may also meet your needs in certain circumstances.
What can they do?
1. Help you read and understand the alphabet soup
Besides the numerous abbreviations doctors use (some are easy – SOB for shortness of breath, but CABG for coronary artery bypass graft is a little harder, and do you even really know what SVC – superior vena cava syndrome – is?), one of the first challenges to conquer is, “Can you read their handwriting?” Nurses and medical transcriptionists have been looking at this scribble for years and they know that what may look like a complete scrawl to you actually means “Advise low-salt diet.” Even typewritten records can be difficult to sort through when the facility has “rolling records” and every time the patient is seen, they repeat the notes from the prior visit. It’s enough to make your eyes cross.
2. Define and describe the medications, their indications and usages
Another benefit to working with a nurse on case preparation is understanding the pharmacy records and medication usage. Unless you are willing to look up every medicine a patient is taking, plus the generic versions, and alternatives with similar actions, you would do well to have nurse input. Nurses will also understand the differences in dosages, and know the side effects of medications that may have an impact on the claimed illness. What’s an ACE inhibitor? What’s the difference between an inhaler versus a nebulizer? Do you need a prescription for nitroglycerin when you have chest pain? A nurse will know.
3. Provide clarification and insight on key issues
As you go through medical records, you will inevitably see things that you may glaze right over, but that could be a huge mistake. Tricia Mason, RN, BSN and Director of Medical & Scientific Services at Womble Bond Dickinson, says that many times the “needle in the haystack” is found deep within the medical records, and requires more than a cursory review and a basic understanding. In one case she reviewed during her nearly 30 years of work with attorneys, she identified MRI evidence of a preexisting arteriovenous malformation (AVM - tangling of arteries and veins in the brain). While everyone else was focused on another issue, she was able to point out, and a neurosurgeon later testified that, the AVM would have resulted in a shortened life expectancy. This mitigating factor led to a greatly reduced settlement in a wrongful death case. Complicated medical issues can put you in the awkward position of not knowing what you don’t know, but having a nurse on hand is a great equalizer.
4. Won’t let you pay more than you should
How many times have you gotten a stack of medical bills from opposing counsel as “proof” of damages? How many of those bills actually had to do with the claimed injury as opposed to the ones for completely unrelated issues? Can you sort them out? You may be able to in some instances, but what if it’s a lengthy hospitalization? Or just two hundred pages of lines of insurance records? Nurses can identify procedure codes for surgical and diagnostic procedures unrelated to the medical claim, potentially saving your client thousands of dollars. It would be good to know the total amount of the truly claim-related medical bills before telling the judge you disagree with the numbers.
It’s good to know a nurse
If you have a medical malpractice, personal injury, wrongful death or tort case, or any other case involving injuries or medical/scientific issues, a nurse can be a great ally, saving you lots of time and headaches. And the nurse will do it better and faster because, unlike you, the nurse DID earn a nursing degree in school.