Last September, The Bar Association of San Francisco’s Paralegal Section hosted an engaging CLE workshop titled, “Utilizing Legal Nurse Consultant Expertise to Benefit Your Legal Practice”, presented by Mitzi Wortman, RN-BC, CCM, LNCC and Rita Kae Restrepo, RN, BS, CPAN.

Legal Nurse Consultants (LNCs) have different roles. They can be fact witnesses in Independent Medical Examinations (IMEs) or Defense Medical Examinations (DMEs), can testify as expert witnesses in a medical malpractice case, or be non-testifying consultants whose focus is research and evaluation.

LNCs’ responsibilities include:

• Being an advocate for examinees, according to stipulations of the exam made by plaintiffs’ attorneys responding to IME or DME requests
• Creating summary reports after attending exams and testifying in depositions and trials about observations
• Reviewing medical records and state/federal regulations that relate to the issues in the case
• Analyzing and identifying medical issues and key evidence where damage occurred (i.e., lack of care or treatment delay), and confirming the merits of the case
• Strategizing with the attorney and his/her legal team to implement a strategic plan
• Providing medical research regarding specialization issues and causation
• Submitting reports as to standard of care, chronology, and Bates-numbered “hot docs”
• Assessing death certificates and autopsy reports

Wortman’s case study involved a passenger on an airplane that crash-landed onto a runway and later could not perform her duties as a hand neurosurgeon due to injuries to her arm. She qualified for a Postraumatic Stress Disorder (PTSD) diagnosis under the eight criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as she is still suffering from PTSD four years later.

Restrepo’s case study involved a 36-year-old husband and father of three who was admitted for knee surgery and died the next day from opioid overdose complicated by sleep apnea and due to inadequate monitoring. Using an IV and syringe, she demonstrated the importance of the entry point of medication and IV flow rate.

According to The Joint Commission summary data of reported opioid-related sentinel events (i.e., any unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a patient not related to the natural course of the patient’s illness):

1. 47 percent of reported events were the result of a wrong dose.
2. 29 percent from improper monitoring.
3. 11 percent due to other factors such as excessive dosing, medication interactions, and adverse effects.

It’s crucial that people who snore or have sleep apnea be monitored closely, particularly when given opioids.

• Snoring is a warning sign, as it indicates airway obstruction
• Even subtle snoring can evolve into complete obstruction of the airways in a sedated patient
• Patients must be repositioned and monitored frequently

Attorneys: You can retain LNCs with specific specialties who provide medical expertise, client advocacy, referrals to specialists, and expert opinions at a fraction of the cost of a medical specialist. Locate LNCs by searching Bay Area Chapter of Northern California (BACNC.org) or the American Association of Legal Nurse Consultants (ALLNC.org).

This presentation is available OnDemand.

About the author
Ana Fatima Costa, RPR, CSR is the Marketing Coordinator for BASF’s Paralegal Section. For more information about the section or become a member, visit www.sfbar.org/cle/sections_paralegal.aspx.