#Diabetic Coronary Artery Bypass #Patient, Septic & Noncompliant. #Nursing Duty and Responsibility Questioned.

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Summary:  Patient noncompliance can present serious challenges to
nurses  and physicians providing care.  If aware of the proper measures
to be taken, what happens when the patient does not agree
or comply with the course of treatment?  In this case, a patient after
having a coronary artery bypass grafting developed a sternal infection.
When advised by a nurse to return for treatment, the patient refused.

The patient was known to have Insulin-Dependent Diabetes Mellitus.
She would seek medical attention with a history of Angina (chest
pain).  Following the episode, she was referred for a diagnostic
cardiac catheterization.

"According to latest statistics from the American Heart Association,
roughly 323,000 cardiac catheterizations were performed in the
United States in 1994. The procedure provides doctors with
information about the heart's structure and its ability to function.
Doctors may also use catheterization to perform procedures on the
heart, such as balloon angioplasty.

To perform a cardiac catheterization, a thin catheter is inserted
through a small puncture wound in a blood vessel -- usually the
femoral artery in the leg. Using X-rays for guidance, doctors feed the
catheter through the circulatory system until it reaches the heart."2

Following the catheterization, an emergent multiple bypass surgery
was recommended by the Cardiologist.

"What is coronary artery bypass surgery?

A coronary artery bypass graft operation is a type of heart surgery. It
is sometimes referred to as CABG or "cabbage." The surgery is done
to reroute, or "bypass," blood around clogged arteries and improve the
supply of blood and oxygen to the heart. These arteries are often
clogged by the buildup over time of fat, cholesterol and other
substances.

The narrowing of these arteries is called atherosclerosis. It slows or
stops the flow of blood through the heart's blood vessels and can lead
to a heart attack."3

The patient would refuse and left the hospital Against Medical Advice
(AMA). Three days later the patient would return to the hospital and
provide an Informed Consent to the operation.  It was performed by
the Facility's Cardiac Surgery  Director assisted by a fourth year
resident.

""Revascularization with coronary artery bypass graft surgery
(CABG) and percutaneous transluminal coronary angioplasty (PTCA)
is well accepted as a method of relieving anginal pain and thus
improving quality of life. In addition, CABG has been shown to
improve survival in certain subgroups of patients with coronary
disease, which has led to the widespread use of this procedure in
revascularization. In 1991 407 000 bypasses and 303 000 PTCA
procedures were performed.1 Currently, coronary atherectomy,
various laser techniques, and coronary stents are being evaluated as
additional approaches to revascularization."4

Following the coronary artery bypass grafting, the patient would
remain in the hospital for ten days.

The patient would return for a follow-up visit just under two weeks
later with the surgeon.  Assisted by a cardiac nurse, the midsternal
incision was examined, staples were removed.  A portion was found
to be purulent, draining and healing poorly.

Cultures were obtained and sent, the patient would be scheduled for
another follow up visit a month later.

Four days later, the patient spiked a temperature.  She called the
medical center and spoke to the nurse who had assisted the surgeon.
After listening to the patient's complaints, the nurse instructed her to
return to the medical center for treatment.  She informed the patient
that her test results had come back and multiple infections had been
discovered from the midsternal wound in her chest.

"Approximately 2% to 20% of CABGs are complicated by a surgical-
site infection (SSI).4,5 Much of the literature on SSI following
cardiothoracic surgical procedures focus on deep chest infections,
which, although not frequent (complicating 0.5% to 5% of cardiac
procedures4,5), are important because of the high morbidity,
mortality, and immense costs they add to the healthcare system."5

The patient refused.  She stated that it was almost an hour's drive to go
to the medical facility.   In her "condition" she didn't feel she could
"make" the trip.

She asked the nurse if antibiotics could be "prescribed over the phone"
and started without her being evaluated.  The nurse informed her this
was not an option.

The nurse informed the patient that it would be best for her to return
to the facility where the operation had been performed.  If she
returned her condition could be evaluated and treatment initiated.  The
patient still refused.

Alternatively the nurse stated that the patient should seek immediate
medical assistance and contact her local physician.

The patient was unable to contact a local physician and did not go to
the Emergency Room immediately.  In fact, the patient was not
examined by her physician until almost ten days later.

At that time, ten days after the known Insulin Dependent Diabetic
patient had been informed by the nurse that she had a potentially life
threatening multiple organism infection in her chest, she was
readmitted to a local hospital.

"Surgical-site infection of the sternal wound includes superficial SSI,
deep sternal SSI, sternal osteomyelitis, mediastinitis, and endocarditis.
These often have been pooled together in the analysis of risk factors.
Host intrinsic risk factors that have been linked specifically to SSI of
the sternal wound include obesity,4,9-11 diabetes mellitus,4,9-13
current cigarette smoking,9 and steroid therapy,13 the former two risk
factors being the most frequently reported (Table 1). Kluytmans and
colleagues further demonstrated that the risk of developing SSI was
higher in the diabetic patient using insulin therapy than in the diabetic
patient treated with oral agents.12"5

A sternal infection was verified.  The patient would require
readmission and surgery to debride the wound and bring the infection
under control.  Part of her sternum would be removed in the process.

At the patient's request, the course of events was examined by the
Physician Medical Review Board.  She alleged that standards of care
had not been maintained.  She stated that negligence on the part of the
surgeon and the nurse had led to her infection and subsequent surgery.

The board dismissed the complaint.  They stated there was no clear
evidence of wrongdoing or negligence on the part of the nurse or
physician.

The patient filed a lawsuit regardless against the physician, facility
and the nurse accusing negligence.  The case was dismissed.

The patient appealed.

Questions to be answered:

1. Did the nurse fail to observe the applicable standards of care in her
conversation with the patient?

2. Was the nurse giving the patient "medical advice" when she
advised her to return for treatment?

3. Did the nurse mislead the patient or make any statements that could
have contributed to the patient's complications?

The physicians and the court when reviewing the nurse's performance
agreed it was appropriate.  The nurse was dealing with a known septic
patient with a history of noncompliance.  She instructed and
emphasized to the patient that an infection was present and required
treatment.

The nurse advised the patient of where the best treatment could be
obtained.  The patient was notified that if she could not return
immediately, that treatment should be sought elsewhere on an
emergent basis.

The nurse was giving medical advice.  In this case, the nurse was
telling the patient exactly what a competent surgeon would have told
her as well.

This is a special situation involving a nurse with advanced skills and
experience in a nursing specialty.  Nurses with specialized training are
recognized as competent to advise patients on pre-defined situations
according to their level of expertise.

A midsternal infection is a known complication of coronary artery
bypass grafting.  The nurse being aware of this was appropriate in her
counseling of the patient to seek immediate care.

The nurse in the eyes of the law would be and was held to the same
standards as a physician in the advice that was given.  The nurse did
in fact, maintain the standards of care expected in the situation.

Her responsibility or "duty" to the patient was to advise her of the
medical condition present (a septic infection), make recommendations
for treatment (return to the hospital), inform her of consequences of
not being treated and present alternatives.

This duty was fulfilled and recognized repeatedly by the medical
review panel and the courts.  It is unfortunate that the noncompliant
patient decided to pursue litigation regardless.

It demonstrates clearly how vulnerable even the most prudent nurses
are to being sued.  Often it is the case that nothing has been done
wrong, nor is there negligence likely.  It's a constitutional right for an
individual to initiate a lawsuit for real or perceived losses.

Makes an excellent case for carrying a malpractice insurance policy.
For the cost of a typical day's pay, you can have protection against
lawsuits without having to depend on an employer's policy being
adequate to protect you.

Related Link Sections:

Cardiac Arrhythmias Links on: The Nurse Friendly
http://www.nursefriendly.com/nursing/directpatientcare/symptoms/cardiac.arrhy...

Cardiac Catheterization (Diagnostic) Links on: The Nurse Friendly
http://www.nursefriendly.com/nursing/directpatientcare/tests/cardiac.catheter...

Cardiac Links, Direct Patient Care on: The Nurse Friendly
http://www.nursefriendly.com/nursing/directpatientcare/cardiac.htm

Clinical Charting and Documentation, Nurses Notes:
http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htm

Coronary Artery Bypass Grafting (CABG) Links on: The Nurse Friendly
http://www.nursefriendly.com/nursing/directpatientcare/cardiac/coronary.arter...

Direct Patient Care Links on: The Nurse Friendly
http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htm

Emergency Department Nurses on the Nurse Friendly:
http://www.nursefriendly.com/nursing/directory/spec/ed.html

Ethics:
http://www.nursefriendly.com/nursing/directpatientcare/ethics.htm

Head Injuries:
http://www.nursefriendly.com/nursing/directpatientcare/head.injuries.htm

Informed Consent:
http://www.legalnursingconsultant.org/legal.nurse.consultants.lnc/informed.co...

Mechanical & Physical Restraints:
http://www.nursefriendly.com/nursing/directpatientcare/mechanical.physical.re...

Medical Legal Consulting Nurse Entrepreneurs:
http://www.nursefriendly.com/nursing/ymedlegal.htm

Operating Room (Surgical) Links on: The Nurse Friendly
http://www.nursefriendly.com/nursing/directory/spec/operatingroom.htm

Sources:

1. 40 RRNL 1 (June 1999).

2. WTVC NewsChannel 9.  1999.  Cardiac Catheterization: http://www.newschannel9.com/healthwatch/hw594.html

3. The American Heart Association.  1999.  Bypass Surgery, Coronary Artery:  Retrieved July 4, 1999 from the World Wide Web:  http://www.amhrt.org/Heart_and_Stroke_A_Z_Guide/bypass.html

4. American Heart Association.  1994.  Optimal Risk Factor Management in the Patient After Coronary Revascularization.  Retrieved July 4, 1999 from the World Wide Web: http://www.amhrt.org/Scientific/statements/1994/129401.html

5. Infection Control & hospital Epidemiology.  April 1988.  Surgical-Site Infections After Coronary Artery Bypass Graft Surgery: Discriminating Site-Specific Risk Factors to Improve Prevention Efforts. Retrieved July 4, 1999 from the World Wide Web: http://www.slackinc.com/general/iche/stor0498/edit.htm
 

See also:Comparison Shopping

Children and Infants, Clothing and Fashion Accessories, Credit, Financial and Lending, Health & Beauty Aids, Travel, Hobby & Leisure,
Housewares, Home and Garden

The Uniform Resource Locator (URL) or Internet Street Address of this page is
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Created on July 4, 1999

Last updated by Andrew Lopez, RN on Monday, February 28, 2011

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Elderly Patient Repeatedly Injured In Nursing Home "Accidents." Negligence, Coincidence or Abuse?

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See also: Medical, Legal Nurse Consultants, Clinical Nursing Case of the Week, Clinical Charting and Documentation, Nurses Notes, Courtrooms, Disability, Discrimination, Employment, Expert Witnesses, Informed Consent, Medical Malpractice, Nursing Practice Acts, Pensions, Search Engines, Torts and Personal Injury, Unemployment, Workers Compensation, Workplace Safety:

Each week a case will be reviewed and supplemented with clinical and legal resources from the web. Attorneys, Legal Nurse Consultants and nursing professionals are welcome to submit relevant articles. Please contact us if you'd like to reproduce our material.

For a free subscription to our publication:
Please send a blank e-mail to: clinicalnursingcases-subscribe@topica.com

Summary:  As the elderly population continues to increase, more and more families are faced with the decision to place loved ones in nursing homes.  When a family member is placed in a facility, a certain standard of care is expected.  In this case, a resident was injured repeatedly while under their care.  When the patient died a few days after being "dropped" the family sued.

The patient was a 95 year old woman who was placed in a Missouri nursing home when the family was no longer able to care for her needs.

"Approximately 1.5 million people live in the nation's 17,000 nursing care facilities. . .The typical nursing home resident is a woman in her 80s displaying a mild form of memory loss and dementia. Although physically healthy for a woman her age, she needs help with approximately 4 of 5 activities of daily living (eating, transferring, toiletting, dressing, and bathing)."2

During her admission the patient would sustain  multiple injuries over the course of her stay.  In 1993, on two occasions, the patient's legs were broken with fractures diagnosed.  Each time the patient was transferred to the hospital for treatment and then returned to the nursing home.

Each time the documentation would show that the family had been "made aware."  This was reflected in incident reports that had been filed.  The incident reports did not specify which family members had been notified.

A third injury took place in 1995 when the patient was being transferred from her bed.  Documentation of the incident stated that the patient had been "dropped" during a transfer.  The charted notes documented that a head injury was sustained and that family members were notified.

The patient was again transferred to the hospital and was evaluated in the Emergency Department.  Interestingly, when examined by a physician, the day after the incident, the physician stated that there was no evidence of head injury.  Five days following this examination, the patient died.

The family would sue the nursing home.  They would allege that standards of care had not been met.  They would accuse the nursing home of rendering negligent care.

It is no secret that nursing home abuse occurs.  It can take many different forms and have devastating consequences on residents and their families.

"The United States Department of Health and Human Services researchers identified seven categories of abuse. Ninety-five percent of those surveyed said they felt that all seven are problems for nursing home residents:

Physical abuse --infliction of physical pain or injury.

Misuse of restraints --chemical or physical control of a resident beyond physician's order or outside accepted medical practice.

Verbal/emotional abuse --infliction of mental or emotional suffering.

Physical neglect --disregard for the necessities of daily living.

Medical neglect --lack of care for existing medical problems.

Verbal/emotional neglect --creating situations harmful to the resident's self-esteem.

Personal property abuse --illegal or improper use of a resident's property for personal gain."3

The basis of the family's lawsuit centered on the assumption that a certain standard of care, and a "duty" is owed to nursing home residents.   This duty it was assumed, included safe living conditions, freedom from harm and timely medical treatment.  They alleged that these standards had not been observed by the nursing home.

In the initial trial, a review of the charting and documentation showed that in each "incident," facility protocols had been followed.  Upon discovery of the injuries, medical treatment and family notification had been provided.

The Defense moved to have the charges dismissed.  The court agreed.

The family appealed.

Questions to be answered.

1. Was there clear evidence of either neglect or abuse on the part of the nursing home staff in either of the three documented incidents of injury?

2. Had standards of care been met in regard to treating an injured patient and providing safe and reasonable care.

Chiefly due to the timely documentation of the incidents, the records were used to demonstrate adequate care being given.

The family's lawsuit chiefly targeted the "handling" of the incidents rather than the "cause" of injury.  The documented interventions and notifications on the part of the nursing staff provided sufficient proof that standards were upheld.

It is common knowledge that documented nurses' notes and the medical chart are legal records.  They should be written and treated at all times as if a jury will later examine them.

Had the incident not been documented as thoroughly or had incident reports not been filled out, it might have been a different story.  It was the clear and concise charting of the nursing homes staff's handling of the incidents that saved the facility from a potentially costly lawsuit and trial.

This was particularly evident when the family accused the nursing home staff of "failure to notify" the family members.  As long as efforts were documented in the notes to notify the family, the facility was covered.

It is a bit strange that the specifics as to "who" was notified was not included in the chart.  Under a different set of opinions, this could easily be interpreted as a "red flag."  In this case it was not.

This documentation of  "notification" could have been seen as the nursing home staff charting to cover themselves regardless of whether a family member had been contacted.

To minimize suspicions of impropriety it is suggested that when a family member is contacted, the name and phone number also be documented.  All evidence is subject to interpretation.  This can be applied to physician notification as well.

When a patient has an attending, consulting physicians and residents responsible for their care, "MD made aware" leaves much room for debate as to who was notified.  If the name of the physician is noted, the guesswork is removed and accountability easier to establish.

What was not addressed in this case was the nature of the "accidental" injuries.  It is not difficult to imagine a 95-year-old patient falling as she tries to get out of bed.  It is common for patients to fall on their way to or from the bathroom.  The pertinent question is "could the injuries have been avoided."

It is clear from published studies that indeed many can be.

""We found that neither complaint investigations nor enforcement practices are being used effectively to assure adequate care for Nursing Homes residents and the prevention of nursing home abuse and neglect. As a result, allegations or incidents of serious problems, such as inadequate prevention of pressure sores, failure to prevent accidents, and failure to assess residents' needs and provide appropriate care, often go uninvestigated and uncorrected."4

Lawsuits against nursing homes are common and on the rise.  If you are working in a nursing home, you need to be aware that you are responsible for documenting adequate care.  You are equally responsible for prevention.  If a dangerous condition or "accident waiting to happen" is identified, steps must be taken and documented to correct it.

If a patient is at risk for falling they may refuse to call for assistance.  If they try to get out of bed anyway, it should be documented that the patient was instructed to "call for assistance," and did not.

If a patient is clearly a danger to himself or herself and others, restraints may be indicated.  The family or the physician may refuse to allow or write an order for them.  The nurse must document that the need for them was communicated, to whom and the response.

Even with adequate care being given accidents can happen with legal consequences.  Nursing homes are currently the focus of intense governmental supervision and regulation.  The effectiveness of the regulation is debatable.  There are many that feel that the only "solution" to correcting problems are legal actions against nursing homes.

If this approach is to be paralleled to eliminating medical malpractice, a solution may be a long way off.  What can be anticipated is increased pressure from the government, from consumers and the courts.  This will result in increased litigation and increased pressure on nursing home staff and facilities.  Each member of the nursing staff would be wise to document carefully daily care and especially incidents that result in injury.

Related Case Studies:

June 13, 1999: Felony Child Abuse Conviction, Made Possible Thanks to Nurse's Documentation.
State v. Gillard, 936 S.W. 2d 194 - MO (1999).
http://www.nursefriendly.com/nursing/clinical.cases/061399.htm

June 6, 1999: Emergency Department Nurse Verbally Abused, Physician History Well Documented
Gordon v. Lewiston Hospital, 714 A.2d 539 - PA (1998)
http://www.nursefriendly.com/nursing/clinical.cases/060699.htm

May 30, 1999: Patient Left Unrestrained, Patient Injured. Nurses Judgement Call
Gerard v. Sacred Heart Medical Center - 937 P. 2d 1104 (1997)
http://www.nursefriendly.com/nursing/clinical.cases/053099.htm

Related Link Sections:

Abuse:
http://www.nursefriendly.com/nursing/directpatientcare/abuse.htm

Clinical Charting and Documentation, Nurses Notes:
http://www.nursefriendly.com/nursing/linksections/directpatientcarelinks.htm

Emergency Department Nurses on the Nurse Friendly:
http://www.nursefriendly.com/nursing/directory/spec/ed.html

Ethics:
http://www.nursefriendly.com/nursing/directpatientcare/ethics.htm

Head Injuries:
http://www.nursefriendly.com/nursing/directpatientcare/head.injuries.htm

Mechanical & Physical Restraints:
http://www.nursefriendly.com/nursing/directpatientcare/mechanical.physical.re...

Medical Legal Consulting Nurse Entrepreneurs:
http://www.nursefriendly.com/nursing/ymedlegal.htm

Nursing Homes, Long Term Care Links:
http://www.nursefriendly.com/nursing/nursing.homes.long.term.care.htm
 

Sources:

1. 40 RRNL 1 (June 1999)

2. American Health Care Association.  September 1998. Profile: Nursing Facility Resident: Retrieved June 27, 1999 from the World Wide Web:  http://www.ahca.org/secure/nfres.htm

3. Seniors-Site.  No date given.  Nursing Home Abuses to Senior Citizens.   Retrieved June 27, 1999 from the World Wide Web: http://seniors-site.com/nursing/abuses.html

4. United States Senate.  March '99. Excerpts from Committee On Aging Hearings.  Retrieved June 27, 1999 from the World Wide Web: http://www.jeffdanger.com/

The Uniform Resource Locator (URL) or Internet Street Address of this page is
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Created on Saturday May 23, 1999

Last updated by Andrew Lopez, RN on Monday, February 28, 2011

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856-415-9617, (fax) 415-9618

150,000 + Nurse-Reviewed & Approved Nursing Links

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http://www.nursingexperts.com
http://www.nursinghumor.com

Personal Injury Claims Assistance, Legal Nurse Consultants on: The Nurse Friendly

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Carol J. Rhodes RN, LNC, Medical-Legal Remedies Inc (MLR):"Medical-Legal Remedies Inc (MLR) provides medical-legal Litigation Support Services for Legal Professionals that include Legal Nurse Consulting, Paralegal Litigation Support, a Medical Information Service called Virtual Legal Nurse and Medical Expert Referral Service for Attorneys, Insurance Companies, Hospital Risk Managers, Government, and Claims Management. MLR MLR's Paralegal Staff and Legal Nurse work together as a team to assist our legal clients with comprehensive medical-legal litigation issues and are committed to serve clients by offering our extensive experience and expertise to provide specialized high quality medical-legal litigation support services. By utilizing Medical-Legal Remedies Inc Paralegal/Legal Nurse Team allows the litigator to control costs and increase revenues while securing the competitive advantage with superior work products. So whether your firm or company needs a Paralegal, a Legal Nurse, or both - MLR will assist your firm or company with any medical-legal litigation case project."
Carol J. Rhodes RN, LNC
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Jacksonville, FL 32250
(904) 223-3969
Carol@JaxLegalNurse.com or Carol@VirtualLegalNurse.com
LinkedIn: http://www.linkedin.com/pub/carol-j-rhodes/30/81b/685
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Andra DeCarlo, RN, Summit Medical Litigation Consulting, Inc.:"Andra DeCarlo, owner of Summit Medical Litigation Consulting and her team of nurses provide Legal Nurse Consulting for both defense and plaintiff attorneys looking for a clear explanation of what actually happened with the client. Is there a case? Is there a defense? We specialize in looking outside-the-box to help find the key to the case. Nursing home neglegance, PI, Medical Malpractice and more."
1586 El Tair Trail
Clearwater, FL, 33765
E-mail Address: andradecarlo@tampabay.rr.com

Social Networks: Ecademy.com, Facebook, Gather.com, LinkedIn, Twitter
http://summitmlc.com or http://www.andradecarlo.info/
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Kathy Christopherson, RN, President and CEO, Critical Consults, Inc.:"Kathy Christopherson, RN, President and CEO, has been a practicing Registered Nurse for over 26 years and a Legal Nurse Consultant for over 13 years. Her clinical experience includes critical care/intensive care, emergency department, cardiac rehabilitation and nursing education. She remains active in teaching nurses and patient care technicians in the hospital setting and participates in orientation of new staff, credentialing and is an Advanced Cardiopulmonary Life Support (ACLS) and Basic Life Support (CPR) instructor. As a Legal Nurse Consultant, Kathy has been both an independent consultant and an in-house consultant, working for both plaintiff and defense attorneys throughout the southeast. She has been an expert witness on nursing issues as well as a fact witness for the medical record. She provides services to assist the attorney See List of Consulting Services. Kathy also provides valuable medical library and online literature research."
Greater Atlanta Area
http://www.criticalconsults.com/

Kathy Christopherson, RN, Bryan M. Pulliam, LLC:"Ms. Christopherson has over 23 years of nursing and hospital experience. She has worked in the areas of critical care, rehabilitation and nursing education. Ms. Christopherson has been doing legal consulting for lawyers–both plaintiff and defense–for more than 10 years. Ms. Christopherson has also served as an expert witness for both plaintiff and defense lawyers. Ms. Christopherson is also a member of The American Association of Legal Nurse Consultants."
http://lawpulliam.com/nurse.php

Kathy Christopherson, RN, Linked-In Profile

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Rhonda K. Alfredson RN CLNC CRRN CCM COHN, Georgia Legal Nurse Consultants:"Discovery Partners provides a multitude of comprehensive nurse consulting services to attorneys, small and large businesses, and insurance companies. Services include Legal Nurse Consulting (med. mal, PI, WC, toxic torts, fraud, soc. security, PL, criminal, gen. negligence) , Disability and Workers' Compensation Case Management, Hearing Conservation Program Consultation and Administration, Ergonomics Consultations, Occupational Health Services Consultation, Medical/Health Related Educational offerings, as well as other consultative and support services."
P.O. Box 555
Conyers, Georgia 30012
Phone number: 770-602-4531
http://www.nursingentrepreneurs.com/dpclnc

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M. Fay Bacher, Legal Advantage Services:"It is our commitment that LNC Advantage Services will provide objective and comprehensive Legal Nurse Consulting Services for personal injury, workers compensation, negligence, malpractice, fraud, product liability, and elder issues cases to individuals, plaintiff and defense attorneys, insurance carriers, private employers, government agencies and healthcare facilities."
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Sheryl D. Bisson, R.N., CLNC, California Legal Nurse Consultants:"I offer services to aid in the resolution of medical-legal issues. I work for law firms, insurance companies and healthcare facilities. My services include, but are not limited to: medical record review and analysis; identifying applicable Standards of Care and deviations from the Standards; identifying records, policies and procedures and other essential documents for complete case reviews."
Specialty Areas: Coronary Care, Health law, Intensive Care, Medical Malpractice, Personal Injury, Worker's Compensation
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Phone number: 585-266-6574
Fax number: 585-266-6574
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http://www.nursingentrepreneurs.com/callan/

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Louise Cardillo, R.N. B.S., Cardillo Consultants:"Legal Nurse Consulting firm for ten years. I am a strong liason between attorney's, clients and experts. The strength of all cases is in meticulous attention to detail of medical records and choosing the appropriate expert. This aspect of consulting will bring your cases to closure with damages often above expectation. Experience in this field is critical to the success of working with a Legal Nurse Consultant. In addition, the nurse must have a strong clinical foundation and education.
1190 Honeoye Falls 5 Points Rd.
Honeoye Falls, New York 14472
E-Mail: louLNC@frontiernet.net
http://www.nursingexperts.com/cardillo/

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Natalie A. Cole, RN, BHSA, CMCN, LNC, West Virginia Legal Nurse Consultants:"I provide medical record reviews and case analyses for attorneys working in medical malpractice, wrongful death, personal injury, and general negligence. My skills and education as a Registered Nurse, in addition to my training as a Legal Nurse Consultant, eases the burden of other legal team members by allowing them to concentrate on other important areas of a case."
5167 Procious Maysel Road
Procious, West Virginia (WV) 25164
Phone number: (304) 587-7010
http://www.nursingentrepreneurs.com/cole

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Lisa Desimon R.N, D.C, CLNC, Illinois Nurse Entrepreneurs:"Certified Legal Nurse Consultant business, serving as a consulting expert and testifying expert on a variety of medical/legal issues/cases."
7358 Timberwolf Trail
Fairview Heights, Illinois 62208
http://www.nursingentrepreneurs.com/desimon

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Janelle Elliott RN BSN CCM CLNC, JDE Medical-Legal Consulting:"Consulting on Med malpractice, personal injury law suits, work comp emphasis. Can do all types of cases."
http://www.nursingentrepreneurs.com/elliot/

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Nancy Emma, RN, LNC, MLC Legal Nurse Consulting Services:"Screening of cases for merit, pagination & organization of medical records, Expert witness, Obtain expert witnesses for lawyers, identification of adherences to and departures from Standards of Care. Medical Malpractice, Personal Injury, Workman's Compensation both Defense and Plaintiff issues."
Specialty Areas: California Nurse Entrepreneurs, Consulting, Expert Witness, Emergency Department Nursing, Expert Witness (And Locating of Same), Medical Malpractice, Personal Injury, Workman's Compensation
http://www.nursingexperts.com/emma/

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Debra L. Fore, RN, MSN, Vista HealthCare Consulting:"Legal Nurse Consultant, primarily Medical Malpractice and Personal Injury, Social Security Claimants' Representative."
Specialty areas: Adult Critical Care, Disability, Legal Nurse Consultant, Medical Malpractice, Oncology, Personal Injury, Renal Dialysis, Social Security Claims Telemetry-Step Down
http://www.nursingexperts.com/fore/

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Deborah Hafernick, RN, CLNC, Hafernick Legal-Nurse Consulting, Texas Legal Nursing Consultants:"Medical-legal consulting practice in Houston, Texas, specialing in evaluating cases for merit and interpretation of the medical record for both plaintiff and defense attorneys to help them save money by organizing their cases faster and win because they understand them. Also research and provide medical literature/standards of care for issues that support their case. Testifying expert identification and location, demonstrative evidence development, etc."
Specialty Areas: Cardiac Cathetherization Lab, Medical Malpractice, Nursing Education, Personal Injury, Product Liability, Social Security Disability Claims, Toxic Torts, Workers Compensation
http://www.nursingexperts.com/hafernick

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Angela Halley RN, BSN, CLNC, River View Legal Nurse Consulting:"We specialize in providing legal nurse consulting services to attorneys (plaintiff and defense), insurance companies, workman's compensation firms, and individual institutions for risk management services. Our firm has over 20 years of nursing experience in psychiatric, labor and delivery, pulmonary, neurology, medical/surgical nursing, and many areas of nursing management. River View Legal Nurse Consultants provides a time efficient and cost effective answer to your legal nurse consulting needs."
64 Deenie Dr
Bidwell, Ohio 45614
Phone number: 740-245-9891, Fax number: 740-245-0153
E-Mail: angelahalleyrn@wmconnect.com
http://www.legalnursingconsultant.org/halley

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Kirk Herbert, RN, CLNC, Herbert & Associates, Arizona Legal Nurse Consultants, LNCs:"Herbert & Associates is a Legal Nurse Consulting firm specializing in Medical Malpractice. Our firm will assist you in all aspects of a Medical Malpractice case Plaintiff or Defense. We will perform an initial case review for merit, identify all defendants, address Standards of Care issues, identify necessary expert witnesses, assist with the acquisition of the expert witnesses, and develop reports ranging from a simple brief to a comprehensive report including chronologies."
1152 Middlebrook Rd
Prescott, Arizona 86303
Phone number: (928) 778-2509
E-Mail: azclnc@nursingexperts.com
http://www.nursingexperts.com/azclnc/

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Josephine M. Kelley, RN, Nurse Paralegal, Medical-Legal Consultant, Medical Chronology Preparation, Medical Malpractice, Medical Record Review, Personal Injury
http://www.nursingentrepreneurs.com/kelley/

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Gerry A. Kinjorski, BS, RN, CLNC, Aidant Research Nurses, Inc., Florida Nursing Entrepreneurs:"Aidant Research Nurses, Inc., is a legal nurse consulting firm that serves the patient-client and the attorney. If you have questions concerning negligence or medical-malpractice, personal injury or assault, toxic tort, worker's comp or any medical injury you may need Aidant."
7 So. Aurora Ave.
Clearwater, Florida 33765-3517
Phone number: 727-448-0455 or 866-384-0455 toll free
Fax number: 727-448-0455
http://www.nursingexperts.com/aidant/

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Sally Farney Lett, RN, DC, Michigan Nurse Entrepreneurs, Nurse-Owned Businesses, Michigan Legal Nurse Consultants
Categories: Domestic Violence, Elder Law, Medical Malpractice, Negligence, Personal Injury, Toxic Tort Litigation, Workers compensation
http://www.nursefriendly.com/lett/

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Jeanne T. Mills, BSN, RN, CRN, LNC, Expose Consulting:"Independent Legal Nurse Consultant."
North Carolina Legal Nurse Consultants
http://www.nursingentrepreneurs.com/mills/

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Darlene Norton, RN, CLNC, Verum Dictum, Inc., Michigan Legal Nurse Consultants:"Legal Nurse Consulting in the areas of: Medical Malpractice, Personal Injury, Toxic Tort and Environmental, Criminal, Products Liability and Class Action Suits."
964 Sugarbush Lane Beulah, Michigan 49617

E-mail Address: NurseNorton@hotmail.com
http://www.legalnursingconsultant.org/norton

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Donna M. Post, RN, BSN, MBA / HCM, CLNC, LNCP-C , Mid-Valley Legal Nurse Consulting, Inc., California Nurse Entrepreneurs, Legal Nurse Consultants:"Mid-Valley Legal Nurse Consulting has over 24 years of experience clinically and administratively, in cardiac, adult and pediatric critical care, and dialysis. Our experience extends to both the inpatient and outpatient settings. MVLNC provides effective identification of practice standards, regulatory standards, adherence and/or deviations to these standards. Our background provides our clients the added benefit of understanding healthcare infrastructure, budgets, and healthcare labor issues. This extensive experience allows for identification of medical and nursing issues in any case that involves health, illness and injury. The clients we serve are attorneys, insurance companies, healthcare facilities and others. At Mid-Valley Legal Nurse Consulting, our goal is to provide our clients with cost-effective, efficient, review and analysis – providing you with winning services while critically defending your bottom-line.
2491 Alluvial #7
Clovis, Ca 93611
Phone: 559-294-7580 or 877-532-5676
Email: midvalleylegalnurseconsulting@gmail.com
http://www.mvlnc.com
http://www.nursingentrepreneurs.com/post/

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Maureen Richards, RN, MS, CCRN, CHPN, CLNC, Florida Legal Nurse Consultants:"Maureen Richards & Associates, Inc. offers Certified Legal Nurse Consulting services to organizations in need of medical records review, interpretation or analysis. We offer services for plaintiff as well as defense.
821 Overbrook Dr.
Fort Walton Beach
Florida 32547
Phone number: 850-863-9913, Fax number: 850-863-8413
http://www.legalnursingconsultant.org/richards

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Kathryn Spilker RN, BSN, LNC, Lifeline Medical/Legal Consulting L.L.C.:"As Legal Nurse Consultants, we use our nursing experience, and knowledge of legal issues in preparing cases related to health care issues. Screen cases for merit, prepare chronologies, summaries, timelines and analysis of the medical records. Identify standards of care, causation issues, locate experts, research and review medical data and literature. Assist attorneys with all aspects of discovery and trial preparation. The success of your medically related cases relies on qualified, detailed, and accurate assessment of the facts.
3034 Ridgetop Ct., St. Peters, Missouri 63376
E-Mail: educate5@verizon.net

Homepage Address: http://www.nursingentrepreneurs.com/spilker/

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Pam Steinacher, RN, LNC, Illinois Legal Nurse Consultants:"Assist plaintiff and defense attorneys with injury-related cases by reviewing for merit, standards of care, duty, breach of duty, causation and damages. Location of appropriate experts, medical literature research, IME's where appropriate, assist with demonstrative evidence, deposition questions and interrogatories. Screen records for missing records or tampering; assist in any way that is deemed necessary and appropriate to win cases."
http://www.legalnursingconsultant.org/steinacher ******************************************************

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Colorado personal injury trial lawyers - Chalat Law Offices...

Colorado personal injury trial lawyers specializing in serious personal injury claims....
http://www.chalatlaw.com

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Victoria L. Rayner, Center for Appearance and Esteem:"Ms. Rayner consults with attorneys as an expert on disfigurement cases pertaining to personal injury. Because of the temporary scarring from a facial burn she suffered in 1972, Victoria Rayner has a special empathy for people with facial disfigurements. As she began to work with patients such as herself she realized more and more that cosmetic rehabilitation and image development can be extremely important to a patient's overall well-being, and for some is a last resort whe they can benefit no further from medical or surgical treatment. Ms. Rayner learned that there was a real need for medical esthetic skills, but a notable lack of appropriately trained candidates to perform practices. "
Center for Appearance and Esteem
50 California Street * Suite 1500 * San Francisco, CA 94111 Phone: (415) 398-6013 Fax: (202) 667-6297
victoriarayner@hotmail.com
http://www.victoriarayner.com

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MedMal Consulting:'MedMal Consulting is a Physician owned and operated full-service medical malpractice evaluation and medical negligence consulting support firm. MedMal Consulting has doctors, legal nurse consultants, and medical legal litigation support personnel to assist with every aspect of your medical negligence case. Established in 1992, Dr. Herman and MedMal Consulting have over 18 years of experience in the medical legal field and have assisted in obtaining more than $147 million dollars in verdicts and settlements in medical malpractice cases."
MedMal Consulting, Inc.
P.O Box 391153
Cleveland, Ohio 44139
Phone: (216) 744-8907
Fax:(440) 248-8257
eMail: info@medmalconsulting.com
http://www.medmalconsulting.com/

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Workplace Fairness:"Workplace Fairness is a non-profit organization that provides information, education and assistance to individual workers and their advocates nationwide and promotes public policies that advance employee rights."
Workplace Fairness
44 Montgomery Street, Suite 2080
San Francisco, CA 94104
Phone: (415) 362-7373
Fax: (415) 677-9445
info@workplacefairness.org
http://www.workplacefairness.org

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See also: Medical, Legal Nurse Consultants, Clinical Nursing Case of the Week, Clinical Charting and Documentation, Nurses Notes, Courtrooms, Disability, Discrimination, Employment, Expert Witnesses, Informed Consent, Medical Malpractice, Nursing Practice Acts, Pensions, Search Engines, Torts and Personal Injury Unemployment, Workers Compensation, Workplace Safety:

See also:

Personal Injury, personalinjurylawyer.com:"A personal injury is described as any harm caused to a person, such as a broken bone, a cut, or a bruise. Any type of bodily injury as a result of an attack, negligence, or accident can also be categorized as a personal injury, and you can file a lawsuit to recover damages from whoever is responsible for your injuries. On average, 11,200 disabling accidental injuries take place every hour each year. Falls are the most common accident at construction sites. Each year, nearly 11,000 Americans suffer a traumatic spinal cord injury. Many of them suffer permanent disabilities."
TOLL FREE 1-800-631-5158
http://www.personalinjurylawyer.com/

The Uniform Resource Locator (URL) or Internet Street Address of this page is
http://www.nursingexperts.com/pi/

The Uniform Resource Locator (URL) or Internet Street Address of this page is
http://www.nursingexperts.com/pi/

Send comments and mail to Andrew Lopez, RN

Created on January 30, 2000

Last updated by Andrew Lopez, RN on Monday, January 31, 2011

via nursefriendly.com

Click on the "via" link for the rest of the article.

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Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
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