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Can you use a legal nurse consultant? These specially trained and experienced nurses can be frontline protectors against liability suits. (Feature Article).

Legal nurse consultants are specially trained registered nurses who review and analyze clinical outcomes for compliance with standards of care. The legal nurse consultant is used by both plaintiff and defense counsels. Although the way in which a professional nurse interprets standard-of-care questions depends on the facts of the case, the timing of the case, and who is paying for the review--plaintiff or defense--professional judgment is a critical element of interpretation.

The legal nurse consultant can be used in a number of roles:

* Consulting expert

* Testifying expert

* Facility-based investigator

* Trainer and in-service presenter

* Peer reviewer

* Quality improvement, risk management, claims management

* Liability insurance marketer and clinical resource

Standards of care change constantly, and the medical and nursing staff must know the current standard to develop or modify policies and procedures. Policies and procedures that are modified, as well as those that are outdated and replaced, must be maintained and secured indefinitely. They will be used if or when the facility is sued to establish what the current standard of care was at the time of the occurrence. They also provide the legal nurse consultant with the basis from which facility documentation will be judged for compliance.

The minimum length of time the modified policies and procedures should be kept is the time frame of the statute of limitations in the individual jurisdiction. In most jurisdictions, the statute of limitations is two to three years.

Training is essential for all healthcare providers, to ensure that they are familiar with the current standard of care. If the management team does not allow staff to attend continuing education programs; does not provide economic incentives for professional growth, development, and training; or does not provide adequate orientation, the facility is at significant risk. If sued, the facility is in an indefensible position.

As noted, the legal nurse consultant can be used as either a consulting expert or a testifying expert. As a consulting expert, the legal nurse consultant is the clinical expert who reviews the medical record, provides clinical interpretation, and assists counsel by recommending and selecting other medical and/ or nursing experts. When the legal nurse consultant is used as a testifying expert, legal counsel will rely on this professional nurse's testimony to establish the standard of care for the judge and/or jury.

Nursing facilities and other organizations can use the legal nurse consultant's expertise more proactively. In situations in which a resident has experienced an adverse outcome, the legal nurse consultant can be used for clinical record review, to identify areas of risk, and needed clinical modification. These recommendations can be executed by the facility's Quality Improvement or Safety Committee, and policies, procedures, and systems modified to be consistent with existing standards of practice.

The legal nurse consultant can also function in the role of investigator. Investigation of resident adverse outcomes is typically not in-depth or comprehensive in most organizations. It is also often difficult to protect the investigation from discovery. If the investigations are done by the nurse consultant in collaboration with and under the direction of defense counsel, the investigation is protected as attorney-client work product.

The investigation will often include "statements" by staff members, which are used by both plaintiff and defense counsel during the litigation process. Often these statements are poorly written, inconclusive, or damaging for the defense. The legal nurse consultant can interview staff and provide directed questioning to ascertain the facts of the case, after which the employee signs and dates the statement or document to verify its authenticity. Working with defense counsel, the legal nurse consultant can help protect this critical information and ensure that it is comprehensive, integrated, and consistent.

The legal nurse consultant can work as a peer reviewer, providing on-site training to help the nursing facility document in a legally and clinically sound manner. The review of the legal nurse consultant is then incorporated in the facility-wide quality-improvement program.

Depending on the skills of the legal nurse consultant, these professionals can also be a resource for claims management. Working on behalf of the facility, they can coordinate and facilitate activity between the insurance company claims staff and the defense counsel. Often the facility believes that it is in a helpless position, with no one involved in the claims process actively fighting for its rights and position. The legal nurse consultant can be a primary asset for the facility in its discussions with liability insurance carriers. In today's dwindling insurance marketplace, the nurse consultant who knows the organization can independently communicate to the insurer his/her findings and professional opinion concerning the quality, risk, and safety status of the organization.

Legal nurse consultants, used effectively, can be a tremendous asset toIf the Hoyas finish the regular season as the sixth seed they most likely would play Boston College, a much more difficult opponent, in the first round.

Hoyas coach Craig Esherick refused to make himself or his players available for comment yesterday.

A win by Georgetown and a Rutgers loss to Seton Hall tonight almost would guarantee the Hoyas a spot in the Big East tournament with three games to play. That would give them a comfortable two-game cushion over the Scarlet Knights.

A loss to the Friars and a Rutgers win would put the Hoyas right back in the division basement with the Scarlet Knights. If the Hoyas and Scarlet Knights finish with identical conference records, Rutgers would go to the Big East tournament as the sixth seed because it holds the tiebreaker over Georgetown.

No team that has played in the Big East tournament's first round has won the championship. That would be Georgetown's only way to get into the NCAA tournament and salvage what has been a disappointing season. The top two teams in each division receive a bye to the quarterfinals.

After tonight, the Hoyas still have three tough games. Georgetown plays host to No. 15 Syracuse on Saturday at MCI Center, travels to West Virginia on Monday for a game that was rescheduled because of last week's snow storm and finishes the season at home against No. 9 Notre Dame.

Winning its four remaining games is a tall order for Georgetown; the Hoyas haven't beaten a Big East opponent this season with a winning conference record. That's why tonight's game is so important.

The Friars have a three-game winning streak. Providence coach Tim Welsh has deployed a new starting lineup in the past two games, victories over Miami (79-59) and Villanova (70-60).

Welsh has started freshman guard Donnie McGrath, junior guard Sheiku Kabba, junior forward Marcus Douthit, sophomore forward Ryan Gomes and sophomore forward Rob Sanders. The 6-foot-7 Gomes is Providence's leading scorer (18.3 ppg) and rebounder (9.7 rpg), but the key to the Friars' success is Kabba.

The Friars have gone 9-1 this season when Kabba scores 10 or more points. Against Villanova, the 6-2 Kabba scored a career-high 25 points.



PROVIDENCE (13-11, 6-7 Big East) at GEORGETOWN (12-11, 4-8)

When: 7:30. Where: MCI Center. Radio: AM-570.

Line: Georgetown by 51/2.

Series: Georgetown leads 33-17.

Outlook: A win tonight over the Friars pretty much would guarantee the Hoyas a spot in the Big East tournament, especially if Rutgers loses to Seton Hall tonight. That scenario would give Georgetown a two-game cushion over Rutgers with three games left for sixth place in the Big East's West Division. The top six teams in each division qualify for the Big East tournament. The Hoyas have won two of their past three games - both on the road - against East Division cellar-dwellars (Virginia Tech and Miami). Providence has won three straight. Ryan Gomes, a 6-foot-7 sophomore forward, leads the Friars in scoring (18.3 ppg) and rebounding (9.7 rpg). Georgetown could be in trouble if the game comes down to free throws. The Friars are the second-best free throw shooting team in the nation at 79 percent.
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Article Details
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Author:Chizek, Mardy
Publication:Nursing Homes
Geographic Code:1USA
Date:Feb 1, 2003
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