How the Legal Nurse Consultant Can Assist an Attorney with a Fall Case

The legal nurse consultant (LNC) assists the attorney by providing services to identify the liability, causation and damages associated with a fall case. These are some of the services.

LNC Services for a Fall Case

A chronology of medical care

The LNC goes through the records of the plaintiff from before and after the fall. The purpose of the review of prior medical care is to determine the baseline or condition of the patient before the fall.

• Was the patient prone to falls?
• Had the patient had a prior injurious fall?
• What were the risk factors that contributed to the fall? For example, a man who had a history of alcoholism tripped on a sidewalk. His blood alcohol was highly elevated when he went to the emergency department.
• Was the patient on any medications that could have caused dizziness?
• Are there any pertinent medical records that are missing?

The attorney uses the chronology to gain a full understanding of the patient’s pre-existing conditions, injuries and the consequences of the fall case.

A timeline

The LNC may prepare a brief outline of all of the significant treatment, including surgeries, hospitalizations, and outpatient treatment. The attorney uses this listing to prepare for depositions and to understand the scope of treatment.

A medical literature search

The LNC may be asked to look at how the literature supports or refutes the causation claims. Are the complications the patient developed after a fall those that could be attributed to the injury?

For example, the patient claims she developed osteomyelitis after an ankle fracture. A patient with pre-existing back injuries claimed he developed herniated discs after falling on the ice on the post office steps. The attorney uses this information to identify the damages caused by the fall.

A comprehensive summary of the medical records

The LNC, who becomes a testifying expert, prepares a detailed summary of the medical records, which explains the symptoms and treatment that resulted from the fall. This role is accepted under the Federal Rule of Evidence 1006, which permits a summary of voluminous medical records. The expert is not expressing opinions but is instead translating the medical records into understandable terms.

More explanation of the role is provided in Pat Iyer, Editor, Medical Legal Aspects of Pain and Suffering, Lawyers and Judges Publishing Company, and Patricia Iyer, Barbara Levin, Kathleen Ashton and Victoria Powell (Editors), Nursing Malpractice, Fourth Edition, Lawyers and Judges Publishing Company. The attorney uses this expert to present the damages.

Location of expert witnesses:

The LNC could be asked to locate experts to address specific points of a falls claim. The LNC may assist the attorney’s analysis of a case in these types of situations, by finding

• a physician expert to provide an opinion that the mechanism of the fall was consistent with the injuries.
• a physician to determine if the patient’s complications are plausibly related to the initial injury (this may be the same expert).
• a nursing expert to address the liability issue.
• a physician expert to determine if medical malpractice occurred after a fall that took place outside of a healthcare facility.

Identification of documents to be obtained during discovery

Using insider knowledge of the medical system, the LNC assists the attorney to determine which documents would be helpful for expert review of a case. The LNC identifies policies, for example, in a nursing malpractice case involving a fall. The LNC reviews the medical records supplied by the facilities and medical practices who treated the patient, and determines if the records are complete. The attorney uses the records to understand the injuries and treatment and to request additional information.

Preparation for deposition and trial

The LNC prepares the attorney for deposition and trial by supplying updated chronologies and timelines, identifying key documents to be used as exhibits, educating the attorney in medical terminology, suggesting questions to ask the witness, and discussing strategy and trial themes. The LNC makes sure the attorney has a thorough understanding of the types of injuries falls may produce.

Pat Iyer MSN RN LNCC is the author of Analyzing Falls, Pressure Sore and IV Therapy Cases, from which this material came. Grab your copy.

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