Medically-Based Enterprise Risk Management
Legal Nurse Consulting
Initial Merit Review of Claimed Medical Problems
Challenge:
A lawyer representing a national homebuilder received a complaint involving claimed respiratory symptoms related to environmental molds and toxins in a home basement. The attorney requested a quick review of the medical records and environmental testing results so that he could get a sense of the merits of a case early in litigation process.
Solution:
One of our seasoned legal nurse consultants reviewed the medical records, environmental sampling data and performed an initial review of literature. We provided a preliminary verbal opinion concerning the strengths and weaknesses of the case based on our proprietary "before, during, and after exposure" chronology. We discussed what the results of the environmental testing indicated in the context of potential health risks, and had our building scientist advise the attorney of inadequacies of the environmental tests as performed. Inconsistencies found within the medical records were enumerated, and potential alternate reasons for symptomatology were given. Essential medical records which should be obtained for review were identified.
Reflection:
An early preliminary review of available records by our seasoned legal nurse consultant well positioned the attorney for negotiations and successful mediation.
Initial Merit Review – Medical Malpractice
Challenge:
A plaintiff lawyer met with a prospective client regarding the death of the client's wife during a hospitalization. The attorney and client believed that the death had resulted from improper medication administration by hospital staff. The attorney asked the legal nurse consultant to review the medical records to evaluate the medication administration so that the attorney could understand the value of the case.
Solution:
One of our seasoned legal nurse consultants (LNC) reviewed the medical records and performed a brief review of the medical literature regarding the patient's medical illnesses. The LNC determined that medication administration was not an issue. However, she determined from review of the records that the client's wife had developed a severe infection while hospitalized and the hospital's negligence in handling the infection had probably led to the patient's death. The LNC provided a preliminary verbal opinion concerning the strengths and weaknesses of the case to the attorney, discussing her findings, deviations in the Standards of Care and documentation regarding the medications and hospitalization. The need for medical expert witnesses from various disciplines was identified and discussed.
Reflection:
An early preliminary review of available medical records by a seasoned legal nurse consultant assisted the attorney to understand the correct issues and potential value in this matter prior to filing the complaint.
Detailed Analysis of Medical Billings and Estimate of Future Medical Costs
Challenge:
A lawyer representing a housing organization received a complaint alleging permanent respiratory illness related to environmental molds in an apartment. The attorney requested a detailed review of the medical records for residency timing, alternate residencies and vacations. The attorney also requested a detailed review of the medical billing for relevance to the complaint and a comparison of full medical expenses, insurance payments and out-of-pocket expenses. An estimate of future medical costs and expenditures was desired.
Solution:
One of our seasoned legal nurse consultants reviewed the medical records, identified residency periods and periods of travel away from the apartment, and plotted them in a visually-friendly graphic. The graphic also included the period of residency as stated by the claimant and the known incubation period for the acquired illness. The legal nurse consultant discussed the inconsistencies with the attorney and identified alternate sources of exposure potentially contributing to the illness.
The legal nurse consultant developed a table by comparing medical records to insurance records, identifying ICD-9-CM billing codes, billing rates and whether the billed charges were usual and customary for the same geographic area. Estimates of future anticipated charges for medical care were developed based on these findings. Additional insurance data that the attorney should request was identified for the attorney along with explanations of its relevance.
Reflection:
Through thorough review of available medical records and collateral records our seasoned legal nurse consultant well-positioned our client attorney for settlement negotiations and trial.
Other Case Studies