The Value of Federal Rule 1006 Summaries

The nurse who prepares a Federal Rule 1006 summary is retained to explain the medical records to the jury. This role has been in existence for at least 25 years but has gained increasing acceptance after a decision of Judge Sabatino of Mercer County Court, New Jersey. Gerald Stockman, Esq. presented a nurse to summarize the medical records of a woman who died of lung cancer. The case was based on an allegation of a delay in diagnosis of lung cancer. The defense objected to the use of a witness for this purpose. Judge Sabatino ruled that this was acceptable. The judge found that the nurse’s singular presentation was an efficient and less costly alternative and was “also apt to be more cogent than piecemeal accounts from each doctor.” This case is Heinzerling 359 NJ Super 1 Appellate Division; it settled before trial.

Judge Sabatino made reference to Rule 1006 of the Federal Rules of Evidence, which permits the use of summaries. The rule provides that when there are voluminous writings, recordings or photographs which cannot be conveniently examined in court, that a chart, summary or calculation may be presented.

The nursing expert is qualified to perform this role by virtue of experience in reviewing and interpreting medical records, which is part of the requirements of working as a healthcare professional. When selecting such an expert, look for the person who has excellent oral and written communication skills, and the ability to be analytical, well organized, and convey complex material in a clear manner. Based on medical training and experience, the expert is able to make conclusions about sensations associated with medical procedures. For example, nursing witnesses know that certain procedures cause pain, such as insertion of Foley catheters, debridements, and wet to dry dressing changes. Other procedures cause unpleasant sensations, such as suctioning or irrigation of a nasogastric tube. The expert fact witness uses this information in analyzing records and in preparing the report.

The nursing expert is able to read medication administration records to calculate the doses of pain medication given to the patient, and to review the laboratory records to determine how often and at what time blood specimens were obtained. Nursing notes detail how the patient responded to painful stimulation and reveal the factors that give rise to helplessness. For example, many patients find it very stressful to be on a ventilator, with their hands tied down, and unable to speak. The medical record may refer to agitation, fighting or bucking the ventilator.

There are typical types of cases in which such a role is helpful. A common one is the case of the patient who had a period of pain and suffering prior to death. Another is the patient who has suffered extensive injuries, such as burns, paralysis, multiple fractures, head trauma, surgical misadventures, drug reactions, delay in diagnosis of cancer, and so on. The role is also useful when the patient has a language barrier or other communication barriers, such as may occur in children and the elderly. The role is NOT useful when the patient was killed instantly, when there are no medical records, or the patient had a brief period of pain and suffering before going into a coma and dying. The expert fact witness needs to provide an objective, detailed, and balanced summary of the medical record.

A Federal Rule 1006 report may be useful in a case involving:

In the rare event that such a case goes to trial, judges tend to appreciate the convenience of having one witness explain the medical treatment, rather than bringing in a host of healthcare professionals, each of whom would explain their piece of the care. The expert fact witness’s job is to use understandable language to teach the mediator or jury so each person gains an appreciation of the experiences of the plaintiff.

Read about how Jane Heron Med league’s legal nurse consultant helped an Ohio jury understand the medical records. Download the article here. 1006 Summary Witness

Med League provides Federal Rule 1006 Summaries to Attorney’s. Call us at 908-788-8227 to discuss your needs.