Legal Nurse Consultants: What I Learned from Handling Volumes of Cases (Part One)

Volumes of legal nurse consulting cases can radically change your business. I did not know what was ahead of me when I received a call from a defense attorney who approached me to assist his firm and client defend a series of claims involving an orthopedic device.

He was handling dozens of cases which had volumes of medical records. At the time of this request, I had one other legal nurse consultant working with me, as well as two support staff. I hired a third nurse and also realized that to handle the volume of cases, I would need a fleet of subcontractors. My staff and I met to discuss how to handle the volume of legal nurse consulting cases, what systems we needed in place, and how to train the subcontractors.

A Sample Case

We began by asking for the opportunity to receive a set of medical records to use to develop a sample work product. We used the experience to get a feel for the amount of work involved and to develop a format that the attorneys found useful. Ultimately, through experimentation and feedback, we created a consistent set of reports for each case:

• a medical summary,
• an analysis of the issues/strengths and weaknesses of the case,
• chronology,
• list of missing records,
• list of exhibits (key documents),
• photocopies of the exhibits, and
• a timeline.

After the LNC organized the medical records, each case had to be completed using the same format. The attorneys used the work product to grasp the facts and then prepare for depositions.

Recruiting Subcontractors

Since I did not have a pool of subcontractors we’d previously used, I posted on a legal nurse consultant list serv that we were looking for help. We got a flood of responses. How do you select who to work with? This was our first venture at hiring LNCs for this kind of case (previously, I’d hired only expert witnesses.)

As the president, I made the ultimate decision about who to send a contract to. I looked at the degree of experience the LNC had. I rejected people who had resumes with typos or did not use the same word processing software we did. And some potential subcontractors rejected us because they were not willing to accept the hourly rate we could offer. We started with a group of 60 LNCs.

Training Subcontractors

Drawing on my background in staff development, I put together a self learning module on how to complete the reports our client needed. I included a description of the hardware, how it was used, what the plaintiffs were alleging, and the possible defenses. Everyone received a one inch binder that contained this information and samples of the reports.

The Legal Nurse Consulting Cases Arrive

A truck backed up to our office front door and offloaded 30 banker boxes containing medical records. It is hard to imagine how much space this many boxes takes up. We carried them up to our library and began the process of separating them into cases, organizing them alphabetically by last name of the plaintiff, and logging them into our database. We then stored the cases in our basement until it was their turn to be sent to our subcontractors.

In Part Two, I describe the lessons learned from working with the subcontractors.

Pat Iyer MSN RN LNCC was president of Med League at the time she got involved handling these cases.