I used Vickie Milazzo Institute’s Case Screening Form to quickly analyze the case and came to the conclusion that, although the case was tragic, no deviations from the standards of care had occurred. I did find two pages of the same prenatal record that showed possible tampering by the obstetrician, but that didn’t change my decision on merit.

My attorney-client was skeptical (this was my first case for him) so we spent time addressing the important areas of the record. He jumped when I showed him the possible tampering! He thanked me as he handed me a $500 check, but told me he was going to check with a neurosurgeon. The evidence of tampering would increase the award by tens of millions.

Almost six months passed before he told me the neurosurgeon had agreed completely with my analysis. The attorney now introduces me at legal conferences as “his nurse consultant” and I am involved in all of his law firm’s medical cases.

This case happened when I was a new CLNC^® Consultant and I know without everything I had learned from Vickie and the CLNC^® Certification Program that I easily could have confused the tragedy of the case with the legal merits. Although my fee would have been much higher, I would have led my client astray into an extremely expensive lawsuit that would have failed.

Never doubt that a non-meritorious decision and a small fee can dramatically change your life as a Certified Legal Nurse Consultant.

Guest Blogger Profile

Susan Schaab, RN, BSN, CLNC, is the owner of Schaab Consulting in Montana. She consults on medical malpractice, personal injury and products liability cases for both plaintiff and defense firms.

Every time you interact with your attorney-clients, whether on paper, in person or electronically, you’re auditioning for the next opportunity. It helps to outdo yourself each time anew.

I’m just sayin’

In other words, if you have two or more installed on a computer they may tangle with each other or cause other issues. That being said, it’s better to have one active security suite and some handy malware removal tools than it is to have multiple security suites.

Mac users are still a breed apart and can either elect to “go naked” or try a free security product such as Avast’s Free Anti-Virus for Mac. I won’t recommend either way.

For CLNC^® Windows users, my favorite pay-for-play security suite is Norton Internet Security. It protects you from viruses, malware, bad websites and all other sorts of Internet-based villainy.

If you’re cheap and want free, there’s always Microsoft’s great Microsoft Security Essentials designed specifically for Windows. If you’re not a Microsoft fan but are still running Windows out of necessity, Avast also makes a Windows-based product, but my money’s still spent on Norton.

Whatever you do, only install and run one security suite at a time.

Keep on techin’,

Tom

“There are so many things I love about being a CLNC^® consultant, that it’s hard to nail it down to just one thing. I suppose the best part is the flexibility and growth potential. I have been blessed to work in various areas since I became certified. Just as in nursing, a Certified Legal Nurse Consultant can work in many areas. It is all up to you! Top rated areas I love are:

As an independent practioner:

• Flexibility – The freedom to control my own schedule – I was able to work part-time or full-time/with or without another job.
• The freedom to learn as I went, and choose the types of cases and attorneys I wanted to work with.
• Knowing I make a difference in the lives of those who are injured or sick.
• Writing in my own style, choosing my own direction and planning and marketing for myself… Managing my own destiny.

As an employee of an insurance company:

• Being appreciated, respected and valued for every part of my job by my coworkers and associates and being recognized as ‘intellectual property.’
• Knowing I make a difference in the lives of those who are injured or sick.
• A new exciting case awaits around the corner and there’s always something to do.

I had not expected to be so successful so quickly as a CLNC^® consultant. I did expect success, as I ‘do it all or nothing.’ I have been blessed, and I thank God often for introducing me to Vickie and Vickie Milazzo Institute at just the right time in my life. Life had given me a few lemons at that time… and boy did I make a lot of lemonade that keeps reproducing.”

Tina R. Aluzzi, RN, BSN, CLNC

“For me, being a Certified Legal Nurse Consultant is synonymous with the word freedom; the freedom to choose. This freedom delivers the independence, satisfaction and flexibility that a traditional nursing position cannot provide. I am free to choose to work anywhere and at any time. I am free to choose not to work today, but tomorrow instead. I am free to enjoy a summer morning and the warmth of the sun…even while analyzing a case. I am free to get a massage anytime I feel like it. I am free to spend the day with my sons, daughter and granddaughter without having to worry whether work is being done.

In 1998, as a single parent to three children, it was difficult to find a job that provided not only the financial requirement, but also the flexibility a single parent requires to raise a family. Becoming a CLNC^® consultant changed all that. Becoming a successful CLNC^® consultant requires a steadfast commitment to effective and clear communication, client retention, meeting or beating deadlines and focus upon business strategies. Is it simple? No! Can it be achieved? Yes! Can you do it? Yes! My faith in God, my dedication and the promise I made to myself to never, ever give up, has paid off exponentially. I am not referring to money (although that is definitely a benefit), rather my relationships, health and way of life being completely changed − 180 degrees!

My freedom to choose has generated P-E-A-C-E-F-U-L living.

P assion

E mpowerment

A utonomy

C reativity

E ndless opportunities

F lexibility

U ncharted paths

L ove”

Suzanne E. Arragg, RN, BSN, CDONA/LTC, CLNC

“When I became a CLNC^® consultant in 1999, it was a reaction to my frustration in hospital administration. Every time a hospital where I was employed was bought, sold or merged, I was downsized right out of a job. Seeing the ads for Vickie Milazzo Institute and the opportunity to be my own boss was very appealing.

As the years have gone by, I have realized how much I appreciate being my own boss and controlling my own schedule. In addition, there is a bonus in that it is never boring and never the same. Each day, each case, each attorney is different and has its own challenges. This is perfect for my lifestyle. I like the fact that no day is routine.

I feel blessed to be in charge and face each day with a new challenge. I am so grateful to have this opportunity to make my life my own.”

Dale Barnes, RN, MSN, PhN, CLNC

“As a Certified Legal Nurse Consultant I have been able to integrate skills honed over the years from various areas of nursing practice with new knowledge and skills learned through Vickie Milazzo Institute. For example, I can utilize the nursing skills that I value such as:

• Direct care, empathic presence, emotional support and listening skills – interviewing victims of sexual abuse as well as parents and spouses, being present to an attorney-client who has lost a meaningful case, listening to colleagues and other members of the team as they grapple with complicated issues such as the senselessness of violence or the defense of a mental health staff whose client murdered his wife and two children before committing suicide.
• Teaching – attorneys and other professionals, subcontractors, nursing students, nursing staff and members of the community.
• Working as a team member – working with attorneys and other members of the legal team, health care professionals or those for whom I am subcontracting.
• Supervising, delegating, and mentoring others – subcontractors.
• Research, data compilation, and reporting – finding data to understand issues, provide accurate and meaningful information, and prepare needed written documentation.

The benefits have been ongoing and important. I can schedule and plan my time, work quietly in my home office when I choose to or work with attorneys and other professionals in their settings. Through Vickie Milazzo Institute, I receive CLNC^® Mentoring, weekly emails with thought provoking information and advice and continuing education offerings such as Advanced CLNC^® Practice-Building Programs and case studies. The National Alliance of Certified Legal Nurse Consultants offers conferences, collegiality, peer review and a vast network of Certified Legal Nurse Consultants ready to assist when needed.

The result is that in my senior years, I have begun (and continue) to develop expertise in a new and exciting nursing specialty – legal nursing consulting. This work has been mentally challenging and stimulating, sometimes frustrating and difficult, but enormously satisfying and gratifying.”

Carolyn J. Bilodeau, RN, BSN, MS, CLNC

“I rediscovered my passion for nursing when I became a CLNC^® consultant in September 2000. I was a nurse with 26 years of nursing experience and was suffering from what I called “Professional Bradycardia”. As a CLNC^® consultant I have experienced professional growth, professional freedom and a new found creative spirit.

The benefits are many. I have gained back the passion for nursing, I have learned to dream once again and I have my CLNC^® compass set to navigate those dreams. Being a CLNC^® consultant literally changed my life forever. Whether it’s working on cases, giving presentations or writing for enjoyment and profit, my nursing career is now and will always be alive and exciting.

With Vickie Milazzo Institute’s specialized knowledge etched into my brain back in 2000, I then experienced the burning desire to start my own business which led to my faith that my Certified Legal Nurse Consulting business would succeed, and succeed it did, over time and with persistence. My imagination led me through my marketing process by creating audio recordings that would educate attorneys to my CLNC^® services. I still sell my nursing knowledge to attorneys via the audio cd format.

I discovered my “Theory of Nurseativity” as a direct result of being a CLNC^® consultant.

E= nmc²

Enthusiasm is equal to a nurse’s mind times their untapped capabilities squared. The reverse of this equation also holds true. When a nurse opens their mind and recognizes all their untapped capabilities, then and only then, will the nurse experience Enthusiasm and Excitement in their career!

We all have seeds of greatness within us and for me it was Vickie’s CLNC^® 6-Day Certification Seminar that made sure those seeds in me had the proper environment in which to germinate and grow. Thank you Vickie for your green thumb. Thank you Vickie for being you!”

Lawrence H. Frace, RN, CLNC

“My favorite thing about being a Certified Legal Nurse Consultant is the ever present and continuous opportunity for lifelong learning. I loved being a nurse caring for patients and then progressing through the administrative ladder to become a senior vice president of patient care services in a multi-hospital system. I did however, tire of the 365 day a year responsibility. Once my first grandchild arrived in 1998, I knew I absolutely wanted more free time in my life, but certainly did not want to give up nursing. I completed Vickie’s CLNC^® Certification Program in 2005 and now I am able to fully utilize my extensive nursing experience to defend nurses.

I find the learning experience different than dealing with life and death situations in the ICU, but equally satisfying in that when I seek to expand my knowledge, I am doing so in an unhurried and largely unpressured setting. I do believe that what I do and the expertise needed to be a CLNC^® consultant is most important to the clients I serve who are other registered nurses.

The decision to become a CLNC^® consultant and the accompanying success has changed my life in many ways, but most important to me, is the baby born in 1998 is 13 and he will graduate with honors this year. I will be there early to find a front row seat. I have not missed a school ceremony, sporting event or a simple request to take him somewhere since 2005. My grandchildren are now 13, 9, 3 and the baby turns 2 today. I enjoy watching them grow, playing with them, taking them to the zoo and being there for them as well. I expect that my successful CLNC^® business and the accompanying pleasures of my family life will continue. Thanks Vickie!”

Margaret M. Gallagher, RN, BSN, MSN, CLNC

“One of my favorite things about being a CLNC^® consultant is the freedom and independence I now have. I no longer have to worry about sticking to a set schedule. Owning your own business gives you the ability to work where you want, when you want. In the winter I have more of a set schedule, working most days during the day, but summertime is more challenging. As the days get longer, I want to be outside more so I need to be creative with my work schedule. I spend most of my workdays outside in my backyard on my laptop working on cases. Since most of my cases are delivered to me electronically, this is very easy to do. I love being able to sit by the pool and take in some fresh air while researching injuries and going through medical records. I still manage to schedule breaks so I can go for a swim. I would much rather sit by the pool and work than work a 12-hr shift in the hospital.”

Dorene Goldstein, RNC, CLNC

“My absolute favorite thing about being a CLNC^® consultant is independence. I can make my own choices, and I have immense flexibility in my schedule that matches my own personal lifestyle. Because my husband and I are empty nesters and have vacation timeshares, we travel a couple of times a year. We like to make sure we get away from the pressures of everyday life, and becoming a CLNC^® consultant has afforded me the ability to make this a reality. I can create flexibility by scheduling cases around my schedule, or for pressing matters, I can bring work with me on my laptop and stay in touch with my attorney-clients through email communication, even when I am out of the country. I can make time for me!

Becoming a CLNC^® consultant has put me in the driver’s seat of my professional and personal life. No holidays, weekends, 12-hr shifts or hoping no one else wants the same vacation week I requested. Although there are times when a case demands long hours or the attorney-client needs a quick review or response, necessitating an unexpected shift in my priorities, I am in control and make decisions that are in my best interests. I have grown, personally and professionally, in confidence, self-reliance and self-esteem. I have taken control of my life, and that is a well-deserved and well-earned change for the better!”

Debra Good-Zeiner, RN, BSN, CLNC

“For me the best part of being a Certified Legal Nurse Consultant is the variety – from the cases to the people to my day – it’s always something different.

My life has changed in many ways. I am able to continue working as a nurse using my skills mentally instead of clinically. When it really sunk in that I wasn’t going to be able to work in a traditional nursing role, it was difficult. In my mind, my worth as a nurse had a great deal to do with my ability to do the physical work.

The CLNC^®  Certification Program taught me that I do have a lot offer – I already had the basic ingredients to be successful on my own.

Working independently gave me the luxury of being able to be home when my kids were young. If they were sick, I didn’t have to make that difficult decision whether or not to call in or find someone to stay with them while I was at work. I went on field trips, was a room mother and I was always home after school.

I have grown as a person, becoming much more confident in everything I do.”

Jane Hurst, RN, CLNC

“As a new CLNC^® consultant, I had initially envisioned working many cases for many attorneys when I resigned from my job. However, my former CEO persuaded me to consult for the acute general inpatient rehabilitation facility where I was previously employed. Later, I engaged in a second contract with a sister facility, handling and coordinating appeals for Medicare denials. Three more facilities followed suit. While I do consult with attorneys on a regular basis, it’s for ALJ (administrative law judge) hearings.

Medicare ALJ hearings focus on proving medical necessity and requesting the judge to agree to order payment for services Medicare has previously denied. While we frequently receive favorable decisions, it is necessary to be vigilant that all the facts of the case are presented.

Frequently, just presenting relevant research in the lower-level written appeals is sufficient to receive a favorable decision before resorting to the hearing process. In these and many other areas, CLNC^® preparation was excellent training for this work. In addition, I provide staff and physician education regarding documentation to help the facility avoid denials.

My favorite part is helping the facility to argue the medical justification for the rehabilitation stay and helping the facility get paid for that care as a result. Acute general inpatient rehabilitation facilities have an important role to play in patient care. Their care can affect a patient’s level of recovery and quality of life, for the rest of his life. Knowing I am doing my part to help that care continue to be available is very satisfying. It’s also wonderful to set my own hours, and to be able to work around family needs as they may arise.”

Camille Joyner, RN, BSN, CCM, CLNC

“When I decided to take the CLNC^® Certification Program in 2006, I remember thinking not just that this was a great way to use my 20 plus years of nursing experience, but more importantly, it was a way for me to expand my horizons. Expanding my horizons is an understatement.

Being a CLNC^® consultant has opened so many doors for me and given me great opportunities to be a creative, independent and self motivated woman. I love having the ability to decide who I want to work with and when I want to work. Being a Certified Legal Nurse Consultant also allows me to take my work anywhere I want to go.  If I am on a trip, I just take my laptop with me.

One of my CLNC^® friends always says, ‘Have case, will travel.’

However, I think the thing I like the most about being a CLNC^® consultant is how this job has given me a sense of personal security. The professional growth I have gained is great, but being a CLNC^® consultant has taught me that I can do anything I set my mind to. I have always been confident in my ability, but my CLNC^® career has provided me with the avenues in which to pursue all my professional dreams and goals. It gives me a feeling of strength and fulfillment that no other job has ever done. I learn something new almost every day and that has made all the difference in my success.”

Millie Mannion, RN, BSN, CNOR, CLNC

“Becoming a Certified Legal Nurse Consultant was the smartest career move I have made since becoming a registered nurse in 1987. Throughout my nursing years, I gained valuable experience in many areas, including ICU, dialysis, labor and delivery, midwifery and teaching/education. In all of these settings, I was always under the control of the agendas, schedules, rules and regulations of the management system. As a CLNC^® consultant, I am my own boss. I absolutely love the freedom to work at my own pace and on my own schedule. I can truly plan my work around my family and life, not vice versa. I make significantly more money as a CLNC^® consultant and the freedom and independence are priceless. I also enjoy collaborating with other CLNC^® consultants who have experienced this same transformation and are of the same mindset in the approach to business. I only wish I had become a Certified Legal Nurse Consultant sooner in my nursing career. I am finally receiving the compensation and respect that reflect my nursing experience and knowledge.

My favorite benefit is the satisfaction that I receive by knowing that this specialty truly demonstrates my commitment to upholding both the best in patient care and the best in nursing and medical practice. I am willing to work for either the plaintiff or the defense, because ‘I call it as I see it.’ Reviewing medical cases and having the opportunity to advocate for patients, nurses and medical professionals reminds me of why I became a nurse in the first place. Nursing is truly a caring profession. And being a Certified Legal Nurse Consultant provides an outstanding avenue for the demonstration of caring and advocacy. Quality cannot be sacrificed or compromised; this is proven over and over again by the work of CLNC^® consultants. I am so thankful and blessed to be a member of the CLNC^® community. The future is exciting as the opportunities for growth of the profession are endless!”

Jody L. Perez, RN, MS, CNM, SANE, CLNC

“Owning my own CLNC^® business has brought me financial freedom. Although I live in the ‘Last Best Place,’ Montana has a population of less than one million and ranks near the bottom of per capita income. My town of 35,000 is the fourth largest city in the state, has the highest cost of living and has some of the lowest nursing wages. Five years ago, I chose Vickie Milazzo Institute because it was the only program that taught me how to create and run a successful business. I purchased the VIP CLNC^® Business System and by following all of Vickie’s recommendations, I have built a successful CLNC^® business billing $125/hr and quadrupling my hospital income.

My life changed in late 2010 when I walked away from the low paying hospital position and became a full time CLNC^® consultant. My husband was laid off a few months later, and instead of facing significant financial hardship and uncertainty, I was confident my growing business would make up for his lost income. I was right!“

Susan Schaab, RN, BSN, CLNC

“My favorite thing about being a CLNC^® consultant is being able to build and grow my own new and unique career using the tools and skills Vickie taught me coupled with my favorite part of being a nurse, which is teaching. I enjoy educating and explaining the results of my case analysis with my attorney-clients, and helping them understand the medical issues and terminology involved. I enjoy feeling that I am a valued member of the litigation team. I remain confident knowing that they need my expertise for their successful outcomes. I love that each case is different, and that I am able to perform many types of CLNC^® services. The work of a CLNC^® consultant is always interesting and exciting; it never gets boring. I have such a great balance with my CLNC^® business, clinical practice, family time and personal time. I am able to be my own boss, work when it is best for me, and adjust each day and week on my own terms. I also love explaining to people and contacts that I meet about what I do as a CLNC^® consultant when they ask what kind of business I operate. I have such a sense of pride that I built my own successful CLNC^® business and that spills over into all aspects of my life!”

Julie Soman-Becker, RN, BSN, CLNC

Thanks to all the CLNC^® Pros for sharing how their lives have changed since becoming CLNC^® consultants and why they love it.

Success Is Inside!

Short of an epiphany, there aren’t many things that can change your life in those wee hours before dawn, but 100% dark cocoa in your coffee is one of them. It’s good enough that for the time being I’ve abandoned my whipped creamer (much to Tom’s dismay, but that’s for an appropriately rated blog and video). Now I can have my coffee, love it and not feel guilty about it. Plus, chocolate pumps up those endorphins that add pleasure to the day (Maybe we should take some to the hospitals and dump it into the AC ducts).

Nurses love coffee and nurses love chocolate. There’s no better match. The next time you fill up your NACLNC^® 7-Day Weekend souvenir coffee mug with coffee, top it off with a tablespoon of 100% dark cocoa. If it doesn’t change your life, it will at least change your morning.

I’m just sayin’

The basis of any computer is its operating system. Any Certified Legal Nurse Consultant still running Windows XP in their legal nurse consulting business should move up to Windows 7. Win7 is more stable, faster and is fully supported (for now) while Windows XP support ends on April 8, 2014. That sounds like it’s far away but trust me, it’ll be here before you know it. With that in mind, I recommend Windows^® 7 Home Premium edition (with current service packs).

Productivity software is a different story. Before you spend your tax refund on a suite of new software, consider that you can start your CLNC^® business with only the following:

• Adobe^® Acrobat^® Reader (free from Adobe.com) – for reading PDF files. or;
• Adobe Acrobat XI or later full version – for creating and editing PDF files. For Office 2007, 2010 and 2013 products, Microsoft^® has a free plug-in that will save in PDF (portable document format). If you’re too worried by Adobe’s security issues, a free PDF writer, such as CutePDF can be used in place of Acrobat.
• Microsoft Office 2010 (or 2013) Home and Business version (with current service packs). You can buy 1 user – 2 pc versions which contain:
  • Word – The most commonly used word processing program. Used to create everything from simple letters to complex reports.
  • Excel^® – A spreadsheet program. Used to create billing records and to track time.
  • PowerPoint^® – Used to create presentations.
  • Outlook^® – Used for email and contact management.
• QuickBooks Pro^® 2013 or later – Small business financial tools including time tracking, invoicing and check writing.
• A web browser of your choice. I recommend the most current version of any of:
  • Internet Explorer (will come with Win7); or
  • Mozilla Firefox; or
  • Google Chrome browser.

That’s enough software to get you started and allow you to research cases for your attorney-clients, write reports and keep track of your billing. Remember to always update your software after installation and turn on the automatic updates, if offered.

Keep on techin’,

Tom

Success Is Inside!

We can all manage our energies a little better by looking for the good or slipping the shades on more often. Lighten up to loosen up and feel more energetic every second of the day.

I’m just sayin’

So when it’s time to clean your computer screen, I recommend using a microfiber cloth. Microfiber because it won’t scratch your screen like paper towels, cotton diapers or floursack cloths will. Don’t use industrial solvents, toxic waste or any glass cleaners that contain ammonia. Instead, I recommend a fifty-fifty mixture of plain old household vinegar and water (You’re being green!) in a small spray bottle. Don’t spray the mixture onto your screen though. Instead spray it onto the microfiber cloth to dampen it. Then you do a half-Miyagi – “Wipe right, wipe left.” Followed by a whole-Miyagi – “Wipe up, wipe down, wipe right, wipe left.”

That should clean any computer display as well the 80” 3D HDTV in your rec room. If you’re a laptop-using CLNC^® consultant you’ve got one more step. Turn off your laptop, undock it (if you dock it) then open it up and clean the screen. I’m fanatical about keeping my dual monitors clean but get pretty annoyed with myself when I open my laptop up on an airplane and find a warren of dust bunnies clinging to the screen.

Keep on techin’,

Tom

Case Facts

A 45-year-old married woman died of metastatic breast cancer 15 months after her initial diagnosis. The plaintiff, husband of the decedent, filed a lawsuit against the patient’s surgeon and a radiologist as well as the group practices to which each belonged.

Her medical records indicated the presence of fibrocystic disease in both breasts from age 25. Family history indicated that her mother had died of breast cancer. At age 32, the first mammogram cited in these records showed dense breast tissue with some asymmetry of parenchymal pattern. When compared to a previous mammogram (not in these records) no changes were noted. Her first visit to the defendant-surgeon occurred shortly after this mammogram because the patient noted a small lump in her right breast which had not been visible on the mammogram. A small fibroadenoma was excised.

Over the next 11 years the patient had routine mammograms plus additional ones as needed, as well as breast exams done by her gynecologist, primary care practitioner and the defendant-surgeon. During this period the patient also had ultrasounds, biopsies and excisions as necessary to evaluate thickening breast tissue and remove fibroadenomas in both breasts.

At age 44, the patient had a screening mammogram which showed extremely dense breast parenchyma with modularity in both subareolar breasts but was unchanged from previous exams. Two weeks later the patient saw the defendant-surgeon for an annual follow-up. The surgeon noticed more pronounced thickening in the right breast and performed a fine needle biopsy which revealed invasive carcinoma.

The patient underwent a right mastectomy and axillary node dissection. Two months later she began five months of chemotherapy. At the completion of chemotherapy, the patient experienced a marked resumption of energy lasting five months. She returned to work, exercised vigorously and even considered becoming pregnant. Two weeks after a physical exam which found no evidence of disease, the patient suddenly complained of abdominal pain. The workup revealed extensive metastatic disease within the liver and skeletal system and she died within a month.

My CLNC^® Role

The defense attorney requested that I review the patient’s medical records over a twenty-year period and look for the word “breast.” When I found the word “breast,” I was to document the date, patient’s comments, provider observations, studies/procedures, results/findings, interventions, recommended follow-up and lab tests. I created a table and listed findings in chronological order with the words “left breast” and “right breast” in bold. This report was to be completed by New Year’s Eve. In addition to submitting the timeline, I discussed the strengths and weaknesses of both plaintiff and defense. I was informed that the timeline was to be used to create appropriate medical illustrations.

One month later the attorney asked me to review a website tool that assists physicians in making estimates on the probable benefit that cancer patients would receive from receiving adjuvant therapy following surgery. I discussed the tool, pointed out how the plaintiff’s attorney might use this tool and cited reasons why the assumptions the plaintiff’s attorney might use would not be valid. I also forwarded excerpts from this website to the attorney along with my report.

Plaintiff Allegations

The plaintiff alleged that the surgeon was negligent in failing to recognize, diagnose and treat the thickening that she observed in the patient’s right breast one year prior to the diagnosis of breast cancer. Additionally, the plaintiff alleged failure to obtain an ultrasound and biopsy, failure to consult with others and failure to inform the patient of risks and alternatives to her course of treatment. The plaintiff alleged that the radiologist failed to identify and report suspicious microcalcifications in the patient’s breast, failed to recommend further imaging studies or biopsy, failed to inform the patient of risks and alternatives to her course of treatment and failed to consult with others.

The plaintiff further alleged that as a result of these deviations from the standards of care, the patient experienced premature and preventable death. If acceptable standards of care had been met, the patient’s condition would have been diagnosed and treated one year earlier, and more likely than not the patient would not have suffered a premature and preventable death.

Additionally, the plaintiff alleged that the group practices that employed the surgeon and radiologist were vicariously liable for the negligence of these two employees.

Defenses

The defense stated they had evidence to show that at all times during their care and treatment of the patient, the surgeon and radiologist complied with acceptable standards of care and that no alleged act or omission caused the plaintiff’s injuries, or contributed to her death.

Several experts stated that the surgeon’s care was appropriate in view of the physical and diagnostic findings. Also, expert witnesses would testify that this particular breast cancer was extremely aggressive based on its primary features together with its exceedingly aggressive clinical course. Despite surgery and aggressive chemotherapy, the patient died 15 months after diagnosis. Most probably, the metastases existed at least a year before the surgery, and because of the resistance to chemotherapy, earlier diagnosis and treatment would not have changed the outcome. One of these expert witnesses, a pathologist, would testify that it takes many years for a metastatic lesion to measure four centimeters, the size of one of the liver metastases; therefore, these metastases were present as long as two years prior to the diagnosis of breast cancer. Even if the alleged delay in diagnosis had occurred, this alleged delay would have had no effect on prognosis or outcome.

Evidence would be introduced in defense of the radiologist that the mammogram in question was appropriately interpreted and that findings were consistent with the findings of mammograms over the past several years. In addition, each mammogram was double-read, meaning that a second radiologist reviewed the mammogram and wrote up his findings without knowing the interpretation of the first radiologist. Interpretations were consistent. Furthermore, a mammogram taken three weeks before the diagnosis of breast cancer (a year after the mammogram in question) and read by two different radiologists (neither was the defendant) showed findings consistent with every previous mammogram.

Outcome

The case went to trial and the jury rendered a defense verdict. I felt excited and happy to begin my new career in such a tangible way on such an interesting case. And to think, it all started on Christmas Eve.

Guest Blogger Profile

Carolyn J. Bilodeau, RN, BSN, MS, CLNC, has more than 30 years experience in clinical, administrative, educational, consulting and research in behavioral medicine, medical-surgical nursing and pastoral care. She has extensive experience in emotional and psychological reactions to illness, end of life issues and death. Since becoming a Certified Legal Nurse Consultant in 2009, she has reviewed more than 200 Hepatitis B and Hepatitis C cases and more than 30 sexual abuse cases. In addition to her CLNC^® business, Carolyn is a guest lecturer at Boston College and a volunteer coordinator of pastoral visitors at her local hospital.