Legal Nurse Consulting: The
Next Big Trend
By Neal R. Bevans
September/October
2003 IssueThirty years ago,
the archly conservative world of lawyers began to see a quiet
revolution. The staff members who had always worked for lawyers, and
without whom lawyers could not function, began to organize themselves
into separate groups. One such group was paralegals or legal assistants.
This group was composed of individuals who worked hand-in-glove with
attorneys, researching the law, interacting with clients and doing much
of the legal grunt work. They began to organize, network and demand
higher pay for a job that called for intensive training, discipline,
long hours and dedication. That same process is beginning again, but
with a different group of individuals. This group is legal nurse
consultants, and they will be the next big trend to hit the legal field.
“I think that legal nurse consultants
are getting more popular because attorneys are starting to appreciate
the benefits of using someone with a medical background,” said Mary Ann
Shea, president of the American Association of Legal Nurse Consultants.
“In the past, they would have used doctors. Legal nurse consultants are
a lot more cost effective.”
What is a
Legal Nurse Consultant?
A legal nurse consultant is usually a registered nurse who
acts as a legal consultant on medical issues in lawsuits. They work with
law firms on a case-by-case basis to review medical records and patient
treatment. Some also work in-house as salaried employees for law firms.
They are brought in on a wide variety of cases, from personal injury to
product liability research.
Patric Lester, an attorney in St.
Louis, uses LNCs in his cases. “The obvious ones are personal injury
areas,” Lester said, “such as auto accidents, medical malpractice,
workers’ compensation and Social Security. The not as obvious include
criminal cases where the medical cause of death is in question, child
abuse cases, will contests and domestic relations.”
With their medical background, LNCs can
educate attorneys about standards of medical treatment, explain medical
procedures and provide assistance with discovery requests, deposition
questions and selection of expert witnesses.
Nancy Blevins, a San Diego-based LNC,
works in-house for one of the nation’s largest law firms, Gray Cary Ware
& Freidenrich. “My role varies from case to case,” she said. “Sometimes
I give presentations to the attorneys to help them understand certain
medical issues.”
Beyond that, Blevins’ work often casts
her in the role of a medical detective. “In product liability cases,
I’ll research the issues surrounding the approval of a product. I’ll
search the FDA (Food and Drug Administration) database for incidents of
adverse reactions and other material. Sometimes, I’ll investigate what
went wrong with a particular device.”
Jennifer Fleigelman has been an LNC in
North Carolina for two years. “When I was in nursing school, I always
loved the legal aspects of the profession.” After five years as an RN,
she wanted an alternative career. “I wanted something different. I
wanted a new challenge,” she said.
Fleigelman immediately thought of the
law. She read about LNCs in national magazines and wanted to know more.
“I found a course at Kaplan College and finished it in a year. Once I
was finished, I began marketing myself to attorneys.”
Fleigelman now works with law firms in
personal injury and medical malpractice cases as an independent
contractor. She often is called in to review medical records, prepare
chronologies of medical treatments and to evaluate patient care. “I see
myself as a behind-the-scenes consultant,” Fleigelman said. “I assist in
reviewing cases for merit. I look through the medical records and tell
the attorneys where they should concentrate their discovery requests, or
I tell them about omissions in the records.”
For instance, in one case, Fleigelman
said the nurse’s and doctor’s notes were missing from 1 a.m. to 10 a.m.
on a particular day and, oddly enough, that is the day the substandard
care was alleged to have occurred. She brought this to the attorney’s
attention, and they conducted a follow-up discovery request.
When attorneys call in Shea, she gets
into the specifics of the patient’s care and the complications that
arose during treatment. “I determine if the complication was an
acceptable risk,” she said. “That requires research into the medical
literature. I also ask, ‘Was this procedure necessary?’ A legal nurse
consultant can help the legal team focus on the important medical
issues.”
A Growing
Industry
Like legal assistants, LNCs have already formed their own
organization. Nurses have been advising attorneys on legal issues for
decades, but it was only in the late 1970s that nurses who did so began
referring to themselves as LNCs. By 1988, groups of LNCs had organized
in Arizona, California and Georgia, and AALNC was founded in 1989.
However, LNCs only recently came into
their own. Part of that is a result of intensive marketing and lobbying
by AALNC. With a member newsletter, a quarterly journal, an extensive
Web page, www.aalnc.org, and a lot of chutzpah, AALNC appears in venues
as diverse as the Association of Trial Lawyers of America annual
conference and various regional paralegal meetings. According to
Christine Bennett, marketing manager at AALNC, the future looks bright.
“We have 50 chapters across the country, and we see a huge boom in the
profession coming. Part of that is because we have gotten the word out.
Lawyers are hearing about legal nurse consultants and realizing the
benefits of having one on the team,” Bennett said.
AALNC has a rapidly expanding
membership of 3,500, and has chapters in nearly every state. In addition
to providing resources for practicing LNCs, the association also offers
certification through its LNCC (Legal Nurse Consultant Certified)
program. In order to be certified, a legal nurse consultant must meet
the following criteria: 1) Licensure in good standing as an RN; 2) 2,000
hours of work as an LNC in a three-year period; 3) successful completion
of the Legal Nurse Certification exam; and 4) a minimum of five years
experience practicing as an RN. The certification exam takes four hours
to complete and is, by all accounts, extensive and thorough. AALNC has
even produced its own text, “Legal Nurse Consulting: Principals and
Practice,” for use in the LNC training programs popping up all over the
country.
The option of becoming an LNC is an
attractive alternative for RNs who have grown weary of the long hours
and the strenuous working conditions. Another reason they are likely to
become the next big thing to hit the legal field is they have already
fought many of the battles legal assistants are waging now. They have
taken on doctors and hospital administrators, and earned their respect.
They will take their cue from the long battle fought by legal assistants
for recognition, and pay, commensurate with their abilities.
The problem Fleigelman had when she
decided to become an LNC was that there were few, if any, courses
available. “My choice was a correspondence course or a weekend seminar,”
she said.
That paucity of choices is quickly disappearing. Colleges across the
country are adding LNC courses and degrees faster than you can say
“career alternative.” A quick search on many of the major Internet
search engines brings back hundreds of hits for LNC programs. Courses
are popping up at major universities and community colleges across the
country.
Mary Fakes, coordinator of the
Emergency Nursing Program at St. Louis Community College in St. Louis,
recently started an LNC program as a partnership between the nursing and
paralegal departments. The response has been incredible. “We have been
inundated with calls,” she said. “Our first two courses sold out
immediately, and we have waiting lists for future courses.”
Most programs are similar to the one
offered at St. Louis Community College: The program lasts for one year,
and students are awarded a certificate in Legal Nurse Consulting upon
completion. Even a cursory Internet search for LNC programs reveals a
vast array of seminars, private courses and college-based instruction.
Universities and colleges have not been
slow to pick up on the signals. Some are beginning Internet-based LNC
programs to make it easy for RNs with varying schedules to take courses.
Most of the college-based courses require LNC students to have a current
RN license, with one or two years of clinical experience and either an
associate’s or bachelor’s degree in nursing. More and more nurses will
turn to these courses to launch a new career in the legal field.
Branching Out
The word is out: There is a big group of highly trained
medical professionals who want to share their training and experience
with lawyers. And lawyers are paying attention.
“The lawyer who handles a case without
a nurse consultant on the team is just asking for trouble,” Lester said.
“Sometimes a nurse consultant can head you off when you are unwittingly
going down a blind alley.”
In a recent case, Anissa Dougherty, a
Virginia-based LNC, played a major role in securing a $6.5 million
verdict in a medical malpractice case. The case is the largest such
award in Virginia history. Dougherty compiled an exhaustive timeline of
the patient’s treatment, researched the medications and reconstructed
the entire course of treatment. “She was amazing,” said Melissa Cole, a
legal litigation assistant with Allen, Allen, Allen & Allen who worked
with Dougherty during the case. “She had total mastery of the file. She
sat through the entire trial, and when one of the defense experts said
something that contradicted the notes, she was right on it. Her analysis
of the interaction of the steroid treatment on the patient’s spinal
swelling was so good it was actually admitted as evidence.”
If LNCs are going to be the next big thing to hit the legal field,
should you, as a legal assistant, be worried? Will these upstarts take
over legal assistant positions? The answer is no.
“The role of a legal nurse consultant
is very different from a paralegal,” Blevins said.
These positions are not competitive and
complement each other, according to Lester, who uses both paralegals and
LNCs.
“The whole idea is to form a flexible
litigation team of differing capabilities that is flexible enough to
justify it’s use from economic, time and results viewpoints. The members
of that team can differ with each case. You might not have a nurse
consultant on every case just as you might not have a paralegal on each
case. Some cases you might need both,” Lester said.
Although an LNC does have a solid
medical background, and that background can be invaluable, it will only
be applied in a narrow way. Your job as a legal assistant makes you a
generalist. You have to shift gears constantly, going from phone
interviews to research to billing, all in a few moments. LNCs don’t have
the specific skills and training legal assistants have. They can be a
valuable addition to the team in a particular case, but they will never
take your place at the firm.
How LNCs Can
Assist a Law Firm
Is there a way that you, as a legal assistant, can take
advantage of this trend? In fact, there are several reasons why you
might suggest bringing in an LNC on a particular case. After all, an LNC
could help take some of the burden directly off you. For example, what
if your firm has just taken on a huge medical malpractice case and you
don’t have the time it will take to prepare the file? Here are five
reasons why you might suggest the firm bring in an LNC:
1. Organizing the
Medical File
Although a legal assistant can do an excellent job organizing the
medical records, notes and other minutiae in a file, this is a skill
that often takes years to develop. LNCs work with these records every
day. They know what to look for and can point out how a patient’s course
of treatment was unusual.
According to Shea, the best time to
bring in an LNC is at the beginning of a case. “Don’t wait until the
case is filed and then bring in an expert to see if the case has merit.
LNCs are tremendously beneficial in the screening stage. The LNC is
going to provide information about the case that will help the attorney
decide if the case has merit. He or she can help fill in the knowledge
gap,” Shea said.
2. Searching the
Records and Assisting with Discovery
Another advantage LNCs bring to a case is a general feel for what
is normal treatment. They can often spot “missing” information, such as
the night shift nurse’s notes that should be in the file, but have not
been provided. An LNC also can help with discovery requests by pointing
out the types of records that should be requested, and asking for
follow-ups on records that should be there. “They can separate out
procedures that could have been used from the ones that should have been
used,” Fakes said.
3. Interpreting
Notes
One of the biggest problems facing attorneys in personal injury,
medical malpractice and other cases involving medical issues is
deciphering what medical notes actually say. Medical professionals have
their own abbreviations and language. An LNC knows all of these terms
and can decipher the records quickly and easily. For instance, a legal
professional might not understand this entry: “Pt c/o severe LUQ pain.
Dr. Smith not. –DB.” A LNC could easily translate it as: “Patient
complains of severe left upper quadrant pain. Dr. Smith notified. –DB
(the nurse’s initials).”
4. Preparing for
Depositions
LNCs really shine when it comes to deposition preparation. A good
LNC can point out obvious problems with medical procedures, alternate
procedures that should have been tried and even general background
information.
According to Shea, “a nurse’s medical
knowledge extends a lot farther than her specialty.” An LNC can advise
attorneys on a wide variety of topics and turn a confusing deposition
into a fact-finding mission.
5. Locating
Expert Witnesses
LNCs also can help locate expert witnesses. Many times they know
these experts personally, or can find others who do. We have all had the
experience of dealing with an expert who looks great on paper, but makes
a terrible personal impression. An LNC can steer you away from that
mistake. “We have a thorough understanding of the medical community,”
Blevins said.
LNCs are here to stay. Take advantage
of what they have to offer and lighten your burden, while at the same
time improving the overall service your firm offers to its clients.
LNC Web Site
Resources
American Association of Legal Nurse
Consultants:
www.aalnc.org
University of Delaware:
www.continuingstudies.udel.edu/noncredit/legalrn/index.shtml
California State University, Hayward:
www.extension.csuhayward.edu/html/lnc.htm
St. Louis Community College:
www.stlcc.edu
Western Piedmont Community College:
www.wpcc.edu
Kaplan College:
www.kaplancollege.com
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