A nursing expert who writes a pain and suffering report to explain the details of cancer treatment may structure the report in different ways. Pain is usually one of the major cancer symptoms.

Pain
Review of the medical record reveals the types and amounts of pain medication that were administered to the patient. This information may be displayed in a simple text-based chart or in a chart that incorporates graphics created by Adobe Illustrator. When a considerable amount of pain medication is needed, sometimes it is useful to graphically display this information.

Awareness of prognosis
Medical records may reflect conversations between the patient and treating healthcare professionals. Psychologists, social workers, physicians, and nurses may document the patient’s statements about his or her awareness of the prognosis.

Example:

Mrs. Tucker knew that her chances of beating cancer were minimal. There were several entries in her medical record reflecting conversations with doctors about her poor prognosis. Examples of these comments include:

“In addition, the non-curability of the patient’s disease was discussed with the patient. The poor prognosis was discussed.” Dr. Quill 3/4/11

“That her disease is incurable, she is well aware of.” Dr. Hooper 4/4/11

Dealing with the social and financial implications of cancer
Cancer may affect every aspect of life. The cancer victim may experience social withdrawal or avoidance of friends who are uncomfortable in interacting with the victim. When income is lost because of the need for treatments, or weakness, the financial disruption may follow.

Example:

Mrs. Tucker’s ability to be independent was removed when her illness began. She had to learn how to cope with a colostomy and all of the care that it entailed. Dr. Lyndstrom’s medical records state that on 6/7/11, Mrs. Tucker reported having an accidental spill of stool at a store when her colostomy bag fell off. She was embarrassed when people stared at her soiled clothing. As she weakened, she became dependent on her husband to drive her to the oncology clinic, a trip that was one and one-half hours away. In September 2011, Mrs. Tucker was having severe difficulties coping with the huge medical bills that were accumulating from the surgeries and therapy. Due to her financial problems, Mrs. Tucker had to delay getting a prescription filled for an antibiotic that was needed to fight infection at the catheter site.

Assessment of level of consciousness and infliction of pain
The medical record can be used to establish if the patient had conscious pain and suffering or some level of awareness. The patient’s level of consciousness may decline as the patient is nearing the terminal phases of cancer.

Light levels of pain may be inflicted by rolling or pressing a pencil over the fingernails or toenails. Pinching the skin may be used also, although if done repetitively, can result in bruising. When the patient reacts to this type of pain, the medical record may state that the patient “localized” the pain, meaning she withdrew from painful stimulation. Deeper levels of pain are used when light pain does not elicit a reaction. This more vigorous infliction of pain is performed by pinching the shoulder muscle, pressing the fingers on the bony ridge above the eyes, or using the knuckles to press on the sternum. Older and less common methods include pinching the nipples, scrotum or inner area of the thigh. Patients who are unable to localize or withdraw from the pain may grimace. No response to painful stimuli is synonymous with a deep level of sedation or coma.

The documentation of the level of awareness or consciousness should be correlated with the treatment being rendered in order to determine what stimuli the patient would have been exposed to during that time frame. The documentation concerning level of awareness or consciousness can be presented in a simple checklist chart.

Description of death
Having explained the injuries, treatment, and condition of the patient from the point of the diagnosis of cancer, the expert witness may conclude the report by describing the patient’s condition at the time that the medical records end.

Example:

Ms. Steinway was in the hospital for three days before she died. The medical record shows that she was anxious and became tearful, stating “I don’t want to die.” She complained of pain in her stomach and chest, difficulty swallowing, dizziness, and shortness of breath.

At 4:35 AM on 10/9/09, Ms. Steinway woke up feeling short of breath. She said she had difficulty swallowing and abdominal pain. She became incontinent of urine and was pulling the oxygen tubing away from her nose and putting it in her mouth. She was spilling water on the floor. Ms. Steinway requested a respiratory therapy treatment to help her breathe. Her doctor’s answering service was notified. At 5:30 AM, the doctor returned the call and ordered respiratory therapy. Ms. Steinway was given Morphine 2 mg intravenously. Fifteen minutes later, the respiratory therapist provided the treatment. Wheezing in her lungs was heard.

At 6:15 AM, Ms. Steinway was complaining of shortness of breath. The nurse asked the resident to evaluate her. Ms. Steinway was found dead at 6:30 AM. A cardiac resuscitation effort was begun and lasted for one half hour. Ms. Steinway did not respond to any of the medications, or the eight applications of electroshock to her chest. A pacemaker was inserted, without success. Ms. Steinway was pronounced dead at 7:40 AM. An autopsy showed the extensive spread of cancer throughout her body, with the exception of her brain.

Example:

By 5/2/10, Mr. Kelley’s Morphine dose had stabilized at 9 mg/hour with bolus doses of 2 mg every 5 minutes. On the day of his death, 5/6/10, the home care nurse obtained an order for a Tylenol suppository for a fever over 101. The time of his death is listed as 5:00 PM. The cause was identified as metastatic malignant melanoma. He was 49 years old.

Plaintiff attorneys: contact us for help with your cancer cases. Med League provides an expert witness for Pain and suffering (also called Federal Rule of evidence 1006) cases or other types of healthcare experts. Call us for assistance