Many nurses have spent their careers in different parts of the health care system. This diverse experience allows them to bring exclusive knowledge to medical malpractice cases. Legal nurse consultants (LNC) review medical documentation, seeking information about the patient’s condition regarding a medical malpractice case. LNCs are better suited to find the cause and effect of ongoing medical care. They are more than testifying experts since, regarding medical malpractice, solidly understanding how the health care system works is essential to understanding the standards of care. Helping the lawyer with expertise and experience has been found to bring a medical malpractice case to the best resolution.¹

Since many LNCs have most likely worked in many areas of the health care system, they understand policy policies and procedure. Talking with doctors and seasoned nurses builds the ability to understand medical terminology. Reading documentation ensures an understanding what occurred before the patient was admitted and what to expect to facilitate discharge.¹In addition, most nurses work hard to become certified in different areas of the health care system like:

• Critical care
• Anesthesia
• Infusion
• Diabetes
• Wound care

These certifications allow the nurse to understand the standard of care for the specialty. Each certification has other requirements, including years of experience, the number of continuing education points, and the tests each must take. Certification ensures that the nurse’s education level, experience, and passion will help provide the best patient care.

How LNCs Help Paralegals

LNCs work with paralegals rather than against them. As discussed previously, they offer medical knowledge, the ability to read medical documents, and write summaries that clarify and explain the claim's merits.¹ These summaries are used to support the motions that become an essential part of each case—creating a chronological list of the papers to include data needed for defendants’ case. The document often lists doctors, hospitals, medical treatments, and locations.¹

Case Study 1

A patient was admitted to the Intensive Care Unit (ICU) after an accident. His care was flawed, as one mistake after another happened. The result was that he could not care for himself or his family. The case went to a lawyer who searched for a certified critical nurse. He found a LNC with previous experience as a critical care nurse. The LNC read the documentation and showed where the standard of care was breached. The nurse could see how the wound progression was hindered by comorbidity, medications, and missed treatment caused by the breach of duty.

Case Study 2

A patient was admitted to a trauma hospital after a near-fatal accident and put in a advanced patient bed to help to reduce the risk of pressure injury. Although the patient survived the many injuries, he acquired a pressure injury. He was discharged to a rehab facility for continued physical therapy and wound care.

On admission to the rehab facility, it was noted that the patient had a stage II pressure injury, as recorded by the hospital. The family was present during a stay at the rehab facility and recorded the care as seen.

After one month, the patient was admitted to a local hospital. The family was dissatisfied with the wound care the patient received during that month and stated they would not want the patient to be discharged back to the rehab facility. When the patient entered the hospital, the wound care coordinator was called to assess the wound and take pictures of the wound for documentation. It was determined that the patient had sepsis and stage IV PI with exposed muscle. The hospital also noted the patient had pelvic osteomyelitis. Pelvic bone and spine infections may often be related to the introduction of infectious organisms through the open wound. However, it is difficult to assess how osteomyelitis started or where it originated without good documentation and pictures.^2-3 The treatment notes, pictures, and documentation from the rehab facility lacked in this case. Without proper documentation and physician orders from the rehab facility, there was no indication of how the pressure injury progressed from stage 2 to stage 4 with the presentation of infection.^2-3

Assisted by the wound care coordinator, the physician ordered an MRI, specialty hospital bed, dietician, and infectious disease specialist. The wound care coordinator used traditional dressings of sodium hypochlorite soaked gauze. The use of gauze has been replaced by more advanced dressings after research from 1962 that showed how wound healing is better optimized with moist healing.⁴

Unfortunately, the patient died after being discharged. The family had the option to have surgery and weeks of IV antibiotics based on the results from the bone biopsy. The patient and his family refused since the surgical risk of mortality was high, and he would loose mobility if he survived.

The standard of care is evidence-based and what a prudent nurse or doctor should do in this case. A certified wound care nurse should know how comorbidities affect healing and then implement interventions that give the wound the best chance of healing. This case shows how facilities can vary treatment quality and what aspects a legal nurse consultant will look for. The rehab facility did not apply appropriate care, as observed and documented by the patient’s family. Unfortunately, since the family did not document the progression of osteomyelitis, its root could not be definitely traced. The local hospital mostly used appropriate standard of care and documented the care thoroughly. However, the care received at the previous facility and the family’s omission of surgical care contributed to the patient’s passing. With the help of a legal nurse consultant, the family’s legal team would be able to differentiate the level of care delivered by each facility and file litigation appropriately.

Conclusion

Having an LNC review documentation and orders is essential since they have training and experience lawyers or paralegals would not. A wound care nurse with many years of experience and knowledge brings a different insight into the standards of care and how to support those standards. Much like other experiences each LNC has, the wound care nurse brings their knowledge to help lawyers and clients get fair judgments.¹

References

1. Costa FA. Paralegal Corner: How Legal Nurse Consultants Benefit Your Practice. The Bar Association of San Francisco. Published January 24, 2018. https://www.sfbar.org/blog/paralegal-corner-how-legal-nurse-consultants…
2. Bhat V, Anandram S, Lobo AC, Davis A, John DS. Chronic pelvic osteomyelitis: case report of a rare complication of bone marrow biopsy. Cureus. 2021; 13(12): e20599. doi: 10.7759/cureus.20599
3. Bodavula P, Liang SY, Wu J, VanTassell P, Marschall J. Pressure ulcer-related pelvic osteomyelitis: a neglected disease? Open Forum Infect Dis. 2015; 2(3): ofv112. doi: 10.1093/ofid/ofv112.
4. The Wound Pros. Traditional Wound Care vs Advanced Wound Care: Evolution Of The Industry. The Wound Pros. Published January 31, 2023. https://www.thewoundpros.com/post/traditional-wound-care-vs-advanced-wo…

Further Reading

1. Cutting KF, White RJ, Mahoney P. Wound infection, dressings and pain, is there a relationship. Int Wound J. 2013; 10(1): 79-86. Doi: 10.1111/j.1742-481X.2012.00947.x

About the Author

After graduating college, Lydia Corum RN, MSN, CWCN looked for her passion. Once she started working in home health care, she found the wonderful world of wound care and how she could help people through healing. Seeing someone return to work or walk when after they were told they would have their leg amputated was beautiful. After home health care, she entered a wound clinic to learn about hyperbaric oxygen therapy and how wounds were created. Her journey continued. She worked at a skilled nursing home and finally moved to California to work at several acute care hospitals.