Medical-Legal Topics » Uncategorized

Jane D. Heron, RN, BSN, MBA is completing her first year at Med League

Pat Iyer — Tue, 05 Jul 2011 10:22:21 +0000

Jane joined the staff of Med League in August 2010. She earned her Bachelor of Science in Nursing from Columbia University and her Masters in Business Administration from Missouri State University. Her clinical background is diverse and includes cardiac rehabilitation, Emergency/Trauma, cardiac catheterization and general surgery. She has worked as a legal nurse consultant for ten years. Jane has also worked in the finance industry.

At Med League, Jane saves our attorney clients time and money by using her thirty years of nursing experience and expertise to provide a variety of services including:

organizing and summarizing medical records

developing case chronologies and timelines

locating expert witnesses

screening cases for merit

developing demonstrative evidence

reviewing medical bills to identify costs that are unrelated to a case

researching medical literature

identifying inaccuracies or tampering in medical records

pointing out what is missing in a record (this often contains information that is critical in a case)

identifying key issues and people in a case

Jane is a member of the American Association of Legal Nurse Consultants (AALNC). She has been on the Board of Directors for the NJ chapter of AALNC for about five years, and is the immediate past president. She is a member of the National Alliance of Medicare Set Aside Professionals (NAMSAP).
Jane understands how a legal nurse consultant can play a key role in helping attorneys win cases. She welcomes the opportunity to discuss this with you.

What are legal nurse consultants?

Pat Iyer — Tue, 31 May 2011 10:24:14 +0000

Legal nurse consulting is the evaluation and analysis of facts and the rendering of informed opinions related to the delivery of healthcare services and outcomes. With a strong foundation based on education and experience, the LNC is qualified to assess adherence to standards and guidelines of nursing practice. LNCs can be successfully used in litigation other than medical malpractice, such as personal injury, toxic tort, product liability, criminal, will disputes, and matrimonial cases.

The LNC is a licensed registered nurse. He or she performs a critical analysis of clinical and administrative practice, healthcare facts and issues, and their outcomes. Services are provided to the legal profession, healthcare professions, consumers of healthcare and legal services, and others as appropriate. The LNC’s services are rooted in his or her expertise as a nurse. The American Association of Legal Nurse Consultants (AALNC) has defined legal nurse consulting as a specialty practice of the nursing profession, a position endorsed by the American Nurses Association in 2006.

Nurses providing legal nurse consulting can be found as employees in many settings, including in the plaintiff or defense firm, the risk manager’s office, federal and state agencies, and the insurance companies. An equal number of LNCs are self-employed (called “independents”) and provide services to clients on both sides of the bar.

LNCs are not paralegals
Some role confusion exists regarding the differences in preparation and functions of a paralegal versus a LNC. By definition, paralegals and legal assistants are qualified by education, training, or work experience to perform specifically delegated substantive legal work for which a lawyer is responsible. Some legal education is typically a requirement for paralegals. Paralegals learn about general law, legal research, torts, legal writing, civil litigation, and technical litigation support. A simple explanation is that the paralegal has some education about law, and the LNC is a nurse who has developed expertise in assisting attorneys with medical issues.

Although many LNCs have acquired knowledge of the legal system through such experiences as consulting with attorneys and attending seminars, legal education is not a prerequisite for the independent practice of legal nurse consulting. Professional nursing education and healthcare experience make LNCs unique and valuable partners in legal processes.

LNCs are not usually nurse paralegals
Many attorneys, unfamiliar with the term legal nurse consultant or its abbreviation, LNC, may refer to the nurse as a “nurse paralegal”. Unless the nurse has taken a paralegal program, this term is incorrect. The correct use of the term refers to a nurse paralegal is a paralegal who is also a nurse. In contrast, a legal nurse consultant is a registered nurse who consults on healthcare issues within the legal arena. Confusion about roles arises also because in some settings legal nurse consultants perform some of the same work that legal assistants and paralegals do, particularly in small law offices.

While LNCs may acquire knowledge about legal documents, such as complaints, interrogatories, requests for production, and the like, most LNCs have no legal training and are not frequently used to draft legal documents. Their focus does not include wills, real estate transactions, and other areas of non-healthcare-related law which is a typical part of paralegal education. These tasks do not make the best use of the legal nurse consultant’s skills.

Legal education programs offered for nurses by legal assistant or paralegal education programs also cause confusion about roles. To the extent that legal education is provided to nurses by legal assistant or paralegal education programs, it should be considered separate from the education of paralegals and legal assistants because of the differences in their practice in the legal arena. AALNC’s position, therefore, is that LNC education should be developed and presented as specialty nursing curricula by nurse educators in partnership with legal educators.

Extracted from Pat Iyer and Deborah D’Andrea, “Working with Legal Nurse Consultants”, in Iyer, Levin, Ashton and Powell, Nursing Malpractice, Fourth Edition, 2011. Get your copy here.

E-prescribing and medication errors

Pat Iyer — Mon, 21 Feb 2011 11:50:50 +0000

A patient sits with her physician at the conclusion of her examination. He talks to her about a new medication she needs, opens up a file on his computer or smart phone, clicks on a drug and sends the prescription directly to the pharmacy. This is e-prescribing. Is it safe and effective, or are there problems with e-prescribing?

The use of e-prescribing shows dramatic growth. Both the benefits and the drawbacks should be considered. According to the 2009 National Progress Report on e-prescribing which is published by Surescripts, the operator of the largest e-prescription network, electronic prescriptions increased 181% from 2008-2009.

The government is pushing e-prescribing. This number will continue to grow based on the Centers for Medicare and Medicaid Services “voluntary” incentive program. Although it is voluntary now, the program forces physicians to adopt e-prescribing by transitioning from incentive payments to penalties on covered Medicare charges.

E-prescribing should get another boost as the Drug Enforcement Agency interim final regulations that took effect June 1, 2010, will allow for e-prescribing of controlled substances (typically narcotic pain-relievers) in the US. Pharmacies may not begin to receive these orders for another 6-18 months as the software vendors make the updates to computer systems that will allow prescribers to transmit the medication orders, intermediaries to process the prescriptions, and pharmacies to receive them. Furthermore, as the regulatory barriers to controlled substances become more streamlined patients may be more likely to receive prescriptions for them.

Benefits
E-prescribing can and will benefit quality of care. The following are just some of the ways.

Prevents medication prescription errors caused by events such as illegible hand writing, look-alike or sound-alike drugs, drug-drug interactions, incorrect dosing, drug allergy reactions, duplication of drugs, etc. and, thereby, reduces health care and legal costs

Eliminates illegible prescriptions

Provides for real-time communications between doctors, pharmacies and patients

Provides critical drug alerts and patient specific information at the healthcare professionals’ fingertips

Provides drug pricing information

Provides payer coverage and preferred drug information

Creates a complete patient medication history

Reduces fraud and crime

Increases healthcare professional work efficiency and reduces administrative costs

Expedites refills

Drawbacks
A new technology is not without its drawbacks. Some of the more notable issues with e-prescribing include

Accidental data entry errors such as selecting the wrong patient or clicking on the wrong choice in a menu of dosages or selecting conflicting directions of use.

Inadvertently divulging protected health information on the internet through inadequate security practices. Hospitals and clinics should be protected with firewalls, use strict computer permission settings, and remain vigilant toward signs of intrusion.

Inability to use electronic prescribing when power is out, when the exam room computer has failed, or when providing treatment outside of a standard health care setting.

No standardization of current messaging and data structure for software which ultimately can result in inconsistent prescriber and pharmacy workflows.

About the author: Dave Boblenz, PharmD, is a pharmacist with over 14 years experience. He operates www.pharmacytechniciancertification.com.

Comments
As is true with any prescription, whether handwritten on a prescription pad or sent electronically to the pharmacy. Errors may be made in the drug selection, dosage and route of administration. The physician, nurse practitioner or physician’s assistant may fail to provide education about side effects or provide sufficient details to provide an informed consent about the risks of the medications.

In one study, doctors agreed to be recorded during patient visits as they prescribed drugs new to those patients. Here is the percent of time the doctors gave people the following critical pieces of information:
Reason for taking the drug: 87%
Name of the drug: 74%
How often to take it: 68%
How much to take each time: 55%
Side effects: 35%
How long to keep taking the drug: 34%

In addition to errors in prescriptions covered by a previous blog post, http://krmno.th8.us consider errors in filling e-prescriptions. The pharmacist or technician may have pulled the wrong drug off the shelf or provided the wrong dose. While e-prescribing reduces errors, it does not eliminate them.

References
Use of E-Prescribing Grows Dramatically
Physician Quality Reporting Initiative
A Clinician’s Guide to Electronic Prescribing
Elizabeth Bewley, author of Killer Cure, Dog Ear Publishing, cites the study by Derjung, T., Heritage, J. Paterninti, D. et al, “Physician communication when prescribing new medications”, Archives of Internal Medicine 25 September 2006

Music and the Law: Part 2

Pat Iyer — Wed, 02 Feb 2011 11:56:51 +0000

One day I took out my Ipod and categorized some music. See how many of these songs you know and why they fit into the category. Do you have a contribution? Add it in the comments.

Medical Malpractice
Turn, Turn, Turn – The Byrds
You Take My Breath Away – Queen
Whiter Shade of Pale – Various Artists
Stairway to Heaven- Led Zeppelin
You’re Only Human – Billy Joel
Can’t Take My Eyes off of You – Frankie Valle and the Four Seasons
Communication breakdown – Led Zeppelin
Cool Jerk – Various Artists
Couldn’t Get it Right – Various Artists
Devil or Angel – Billy Fury
Doctor Robert – The Beatles
Fever- Ray Charles
Piece of My Heart- Janis Joplin

Nursing Home
Where’ve You Been – Kathy Mattea
I Forgot to Remember to Forget – The Beatles
Nowhere man – The Beatles
When I’m Sixty Four – The Beatles
Eleanor Rigby – The Beatles
Back When We were Beautiful- Matreca Berg
Bygone Days – Eileen Ivers
Fixin To Die- Bob Dylan
Last Night I had the Strangest Dream – The Weavers
Last Kiss – J. Frank Wilson and the Cavaliers
Memory – Andrew Lloyd Webber
The Old Man – Kate Rusby
Old Hippie- Bellamy Brothers
The Gumby Cat – Andrew Lloyd Webber
Sometimes She Forgets – Travis Twitt
Only the Good Die Young – Billy Joel
That’s How I Remember Yesterday- the Limeliters
You Don’t Know Me – Ray Charles and Friends
When You Are Old – Gretchen Peters

correction

Pat Iyer — Tue, 24 Aug 2010 14:28:36 +0000

This website erroneously published four paragraphs on Dr. James O’Donnell’s method of pain equilibrium written by Lorna Morelli-Loftin and Kevin McMullen. We regret this error. The reader may consult this material in August 2010 edition of the Vesper Trial Notebook.