A. INTRODUCTION

1. What is a Legal Nurse Consultant?
2. History and Evolution of Legal Nurse Consulting

1. Two Major Systems, Common Law and Civil Law
2. "Law is the Solemn Expression of the Legislative Will" (Louisiana Civil Code)
3. Types of law
• criminal
• civil
• administrative
4. Civil Actions at Law
• contract
• tort
• property
• domestic relations
5. Sources of Law
• Constitution
• Statutes
• Administrative Regulations
• Judicial Decisions

1. Negligence
• breach of duty owed to someone
• resulting in damages
2. Intentional Torts
• Assault/battery
• Mayhem
• Failure to Treat
• Failure to Properly Diagnose
• False Imprisonment
• Defamation
3. Malpractice-a breach of duty (negligence)
• Failure to meet standard of care
• Resulting in injury to patient/client
4. Standards of care
• in that profession
• at that time and place
• proven by expert witnesses
• sources for standards
• standards of performance-competence
• duty to treat
• refusal to treat
• negligent or intentional violation of standards of care

1. Diagnostic Errors
2. Treatment Issues
3. Communication Issues
4. Monitoring
5. Supervision
6. Medication
7. Falls/Restraints
8. Vicarious Liability and Respondeat Superior
9. Failure to Properly Treat

1. Prelitigation Panels
2. Initiation of a Lawsuit
3. Steps to Take
• Summons and Complaint
• Answer
• Interrogatories
• Requests for Production
• Depositions

A. ACCESS TO MEDICAL RECORDS

1. What is a medical record?
2. Standards/Regulations Governing Content
3. Retention of Records
4. Access by Patient
5. Access by Third Parties without Consent
6. Mandatory Disclosure
7. JCAHO: Sentinel Event and Tell-All Standard

1. Introduction to Evidence
2. Hearsay Rule and its Exceptions
3. Public Records Exception
4. Best Evidence Rule
5. Exhibits

1. Requests for Production
2. Request for Admissions
3. Physical and Mental Examinations
4. Depositions
5. Subpoenas

1. Communication to competent patient on proposed treatment
2. Duty: patient/physician
3. Reasonable Person
4. Inherent Risks
5. Material Risk
6. Standards
7. Scope of the Duty
• When Consent must be Obtained
• Whose Duty is it?
• Who can Give Consent
• Exceptions
• No need for treatment
• Emergency situations
• Therapeutic privilege
8. Renegotiation of Consent with Laboring Mothers
9. Overview

1. Origin and History of the Right to Refuse Treatment
2. Competence of Person Refusing Treatment
• Religious Motivation
• Control over Treatment
• Rights of Incompetent Patients
3. DNR orders
4. Living Wills
5. Medical Powers of Attorney
6. Active Euthanasia/Assisted Suicide

1. Wrongful death
2. Wrongful life
3. Violation of right of bodily self-determination
4. Battery
5. False Imprisonment and Defamation
6. 72-hour mental health hold

1. Question of Intent
• General Intent
• Specific Intent
2. Prosecution's burden-beyond a reasonable doubt
3. Evidence
• Testimonial
• Physical
• Scientific
4. Pre-trial Procedures
• Preliminary Hearing
• Arraignment
• Indictment
5. LNC's Role in Criminal Cases
• Child Abuse
• Elder Abuse
• Domestic Violence
• Driving Under the Influence
• Death Investigations

1. Role of the Courts
2. Class Actions
3. Multidistrict Litigation
4. Mass Torts
5. Toxic Torts
6. Product Liability
7. Role of the LNC

A. History of the Specialty Practice of Legal Nurse Consulting

1. Early Nurse Consultant Practice
2. Formation of AALNC
3. Continuing Education
4. Standards and Guidelines for LNCs
5. Scope of Practice for LNC
6. Discussion of Code of Ethics

1. Always a Nurse First
2. Intrapreneurial and Entrepreneurial Skills
3. The Nursing Process in the Legal Environment
• Diagnosis
• Planning
• Implementation
• Evaluation
4. Communication Skills
5. Time Management Skills

1. Nursing Process applied to Legal Nurse Consulting
2. LNC as a Specialty Practice of Nursing
3. Standards of Professional Practice and the LNC
4. Legal Ethics and the LNC

1. Communicating with and interviewing plaintiffs
2. Interacting with defense clients (health providers)
3. Medical Record Analysis
• Compilation of complete medical records
• Review of hospital medical records
• Review of other medical records
• Comparison of allegations with medical records
• Re-review of medical records
• Altered medical records
• Summary of medical records
• Health care bill analysis and auditing
4. Evaluating Professional Negligence Cases
• Key elements of professional negligence claim
• Filing a professional negligence claim
• Negligence in health cases
• Physician malpractice
• Nurse malpractice
• Hospital malpractice
5. The Nurse as an Expert Witness
• Qualifying LNC as an Expert
• Treatment of Expert Witnesses
• Exception to Hearsay Rule
• Cross-Examination of Witnesses
• Scientific Basis for Opinion
• Credibility of Nurse as Witness
• Credentials equal to those of defendant
• Active practice
• Most income does not come from testifying

A. LNC Evaluating Toxic Tort Cases

1. Introduction to Toxic Torts
2. Physics of Chemical Exposure
3. LNC rule in establishing and evaluating causation
4. Identifying experts

B. LNC evaluating Criminal Cases

1. Mental capacity of defendant
2. Physical capacity of defendant
3. Extent of injuries to victim

C. LNC Evaluating Damages

1. Personal injury cases (auto accidents, etc.)
2. Malpractice cases
3. Life-Care Planning
4. Vocational and Hedonistic Damages

D. LNC Evaluating Professional Negligence Cases

1. Key elements-the 4 D's
• Duty owed by defendant to plaintiff?
• Dereliction of that duty?
• Damages as a result of this breach of duty?
• Due to (or direct result of) negligence of the provider
2. Was this action the proximate cause of the injury?
3. Exception to proximate cause-loss of chance
4. Selecting the best expert witnesses
• Well educated and experienced
• Current active practice
• Does not always testify for the same side
• Articulate, sophisticated presenter
• An effective teacher
• No prior malpractice cases against expert
• No "skeletons" in the expert's closet
• Consistent opinions
• Expert testimony a small part of the expert's annual income
5. Defense LNC-realizing when a case is indefensible
6. Effective triage of medical malpractice claims

E. ALTERNATIVE DISPUTE RESOLUTION

1. Mediation
2. Arbitration
3. Other private dispute resolution means

A. LEGAL NURSE CONSULTANTS IN THE LAW FIRM

1. Interaction with Clients (interview with plaintiff)
2. Interaction with Lawyers
3. Instructional Role of LNC
4. LNC in malpractice defense firms (liaison with defendant)

B. LEGAL NURSE CONSULTANTS IN THE INSURANCE INDUSTRY

1. Claims Consultant/Adjuster
2. Case Manager
3. Benefits Coordinator
4. Workers Compensation Manager
5. Medical Policy Coordinator
6. Utilization Review Coordinator
7. Risk Manager
8. Medical Malpractice/Liability Consultant
9. Credentials and Certifications-specialized fields

C. LEGAL NURSE CONSULTANTS IN PRIVATE PRACTICE

1. Consultant to various law firms
2. Avoiding Conflicts of Interest
3. Managing the Business
4. Marketing and Nurse Ethics

D. LEGAL NURSE CONSULTANTS IN GOVERNMENT SERVICE

1. State government-clinician and investigator
2. Assist law enforcement
3. US Department of Justice-investigators

E. LEGAL NURSE CONSULTANTS IN RISK MANAGEMENT

1. Assessment-Identifying Sources of Risk
2. Management of Losses
• Loss Control
• Loss Prevention
3. Claims Management
4. Role of LNC
• Risk Assessment Consultation
• Risk Education
• Qualitative Claims Analysis
• Report Preparation

F. MEDICAL RECORD ANALYSIS

1. Compilation of Complete Medical Records
2. Records that May not be Part of the "Medical Records"
3. Other types: Visiting Nurse or Home Care
4. Incomplete Medical Records
5. Organization of Records-job for LNC at law firm
6. Indexing and Paginating of Medical Records
7. Review of Other Medical Records
8. Altered Medical Records
9. Minimizing Loss, Fabrication or Concealment of Record
10. Pitfalls in Medical Record Analysis

A. LEGAL WRITING

1. Actually, there is no such thing as " Legal Writing"
2. Consider the Potential Audience
• Judges
• Lawyers
• Witnesses
• Medical witnesses unfamiliar with legal proceedings
• Experts in law or medicine.
3. Forms of Legal Writing
• Informative Writing
• Commemorative Writing
• Inquisitive Writing
• Persuasive Writing
4. Reader-Friendly Writing
• Brevity
• Short Words
• Short Sentences
• Short Paragraphs
• Omit redundant words
• Omit personal beliefs
• Rigorous Editing is required
5. Use Plain English
• French and Latin words had a place in the law, but not today
• Clear transition from one idea to another
• Organize your text
• In a logical sequence
• With informative heading
• For long documents, a table of contents.

B. LITERATURE RESEARCH

1. Research Process
• Assessment
• Issue Identification
• Outcome Identification
• Planning
• Implementation
• Evaluation
2. Textbook Research
3. Computerized Literature Searches
• National Network of Libraries of Medicine
• Internet Access to Biomedical Communication

C. STARTING A BUSINESS AS AN INDEPENDENT LNC

1. Legal and Economic Considerations
2. Finding a Business Lawyer
3. Finding the Right Business Entity
4. Writing a Business Plan
5. Conclusion-on your own!!!