Should we believe what we read in professional journals?

When I pick up a professional journal, I am already convinced that what I read is based on impartial research and evidence. But should I be?
My assumption that articles are being provided by professionals with the public interest as a priority is the wrong assumption. I was unaware until just recently that pharmaceutical companies and medical device companies can be very generous in order to receive positive press about their latest drug or gadget. While, as a health care professional, I would like to believe that other health care professionals can provide unbiased research despite the gifts, I am not that trusting of human nature.
To be fair, journals are taking steps to prevent this practice of padding their publications with articles favouring the “latest and greatest.” Until it becomes routine, and every journal checks the background of their authors, I would suggest a double-check on that research your case may depend on.

Toddlers at risk from codeine

The maternity world was turned upside down in the past few years with the realization that a common painkiller administered to mothers following childbirth was having disasterous results for newborns. Now it has been established by Canadian researchers that toddlers with the same genetic variation as those newborns have died from the same drug given directly to them following surgery.

According to research done at the University of Western Ontario in London and the Hospital for Sick Children in Toronto, the very common drug is acetaminophen and codeine (one familiar brand name of this combination is Tylenol 3). Unfortunately, there are very young children with a genetic variation who convert the codeine into morphine very rapidly. The morphine then slows breathing and a high enough dose will stop breathing resulting in death.

These findings are significant for cases where an otherwise “healthy” young child has undergone an uneventful procedure yet had complications such as respiratory arrest or death. If the child received codeine, that could be the root of the problem.

Avandia Increases Risk to Type 2 Diabetics

In a recent study by Toronto’s Clinical Evaluative Sciences, the drug Avandia (rosiglitazone) demonstrated an increased risk of heart failure and death when compared to the other drug for the treatment of Type 2 diabetes, Actos (pioglitazone).

As published in the British Medical Journal, the study examined the records of 40 000 patients treated with these drugs; 23% were less likely to be hospitalized for heart failure and 14% less likely to die when given Actos (pioglitazone) instead of Avandia (rosiglitazone). This has major implications for the millions of patients treated for Type 2 diabetes in the last several years. Based on the study, for every 120 people taking Avandia, one more was hospitalized and for every 269 people, one would die.

The makers of Avandia, GlaxoSmithKiline, have initiated their own study in response. The results will not be known for several years probably after the two drugs become available as generic formulas.

Dr. Juurlink, principal investigator, has dismissed criticisms from GlaxoSmithKline that the study may have only dealt with patients who were sicker. He points out that you would expect to see more heart attacks if the patients taking Avandia were sicker yet the study revealed that there was no difference in heart attack rates between the two groups.

As Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic, has said, “I guess the final word would be: Who would want to take the chance? Why would you? So from my perspective while you can argue that it may not end the story, in the meantime, what should physicians do? And I think the answer is they should use the safer of the two drugs.”

Changes in Health Care

Health care as an industry is changing in Canada and the US. Budget concerns seem paramount and are apparently the stimulus for these changes. It must be remembered though that fiscal responsibility should not compromise patient care. Already in my nursing practice, I see incidents that lead to unsafe situations for patients and staff. Professional responsibility forms are being filled out at an alarming rate as staff try to stop the tide of unsafe health care sweeping Canada.

This past weekend, the CEO of Alberta Health Services was quoted as saying that just because a unit had a registered nurse running it in the 1990s does not mean it needs to be run by one now. He states that things must change not stay the same. Dr. Duckett could not be more wrong! I shudder to think of the professional liability of health care workers who make mistakes because they are not trained to see the entire medical picture. And let’s not forget the human price of those mistakes—the patient, the family and the staff all pay a high emotional and psychological price for a negative impact on a poorly managed case.

A registered nurse has always been in charge of a hospital unit. Not because of her special status in the hierarchy but because of her experience, skills and education. To have the head of Alberta Health Services not comprehend (or appreciate) the importance of this role is shocking. It also means that negligence and malpractice is about to become a common theme in Alberta trial law.

I wonder if Dr. Duckett has budgeted for increased insurance , settlements and claims?

Can there be a budget during a pandemic?

It is well established that we are about to face a flu season that will take a heavy toll on health care workers as well as the general public. Meetings are held to provide information and plans on how to cope, but there are also phrases like “we still have stay within budget” from administration. This sets a dangerous environment where the cost of caring for the ill and dying takes precedent over the actual care needed. Can there be a budget during a pandemic? Bureaucrats and politicians think so. Front line health care providers do not. Managers are pressured to keep their budgets under control under all circumstances.

As a nurse, I have to question just how safe patient care will be during this crisis. Increased staff shortages will be a certainty with health care workers ill themselves or caring for family members. Paying overtime for replacement staff is already discouraged so how do units replace badly needed staff to care for the ill in the hospitals? There will be a lack of equipment as unit budgets are stretched to pay for supplies. There are already reports of defective protective equipment from poor quality sources and from being stored under the wrong conditions.

The fallout from the H1N1 pandemic will resound for years. No doubt it will also find its way into lawyers’ offices and court rooms. Perhaps there the question of how much a pandemic will cost will be answered.

Cutting the Heart Out of Health Care

As a Registered Nurse at an acute care hospital in the province of> Alberta since 1988, I would like to call attention to an issue that will have a devastating impact on the quality of health care and patient safety in this province.

Health Minister Liepert announced that the nursing shortage in Alberta went from 1400 nurses to 30 in a single day. This was not some miracle. What it means is that a hiring freeze was implemented and vacant Registered Nurse positions mysteriously disappeared. I am writing to tell you that the nursing shortage is NOT over in Alberta and that we need to hire RN's more desperately than ever.

"Replacing" RN's with Licensed Practical Nurses and Patient Care Assistants is not the answer, but rather a question of fiscal short-sightedness. Studies show that investing in Registered Nurses can SAVE money in the long run, with reduced hospitalization times and fewer adverse patient outcomes. If immediate action is not taken, the situation is likely to worsen.

Recruiters from other provinces and other countries have become very active here and we are in serious jeopardy of losing more nurses. Senior nurses are looking to retire in the next few months rather than face more cutbacks like those we had in the 1990s. Memories are vivid of the last cutback experience from which Alberta has never truly recovered.

Registered Nurses are the very heart of health care, and many of us fear that Minister Liepert's dangerous experiment of cutting RNs will leave Alberta's health care system dead on the operating table.

Canadian Health Care

There is a concerted effort in the US to establish a health care system which combines private health care and publicly funded health care. In some ads, the Canadian public health system is villified with "facts" which are not accurate. I will be the first to admit that our system has its problems but patients in urgent need do get timely care and their families are not financially devastated by that care.

That being said, the real truth about health care in Canada is that a private system has always co-existed with the public one. There has always been an option to pay a fee for access to private clinics, private diagnostic facilities and private surgical services. It is a business which exists within its own world and much of the general public remains completely unaware that a dual system exists.

I have worked within both of these health care options in Canada. Each has its strengths and its weaknesses. The future of health care will be a blend of the two and it remains to be seen if the mix will create a better system or weaken the one that is already in place. Holding health care institutions and providers accountable will ensure that patients will not have to pay a high price along the way.

Personal Injury Lawyers Need to Consider This

A personal injury claim can be a complicated process. A client can present with injuries that seem to have been minor but turned much worse. Under the current conditions of an overloaded, budget-cutting health care system like the one we currently have in Canada, as an attorney, you need to consider the timeline of medical care provided to your client.

It is not unusual for me as a practising RN to hear of patients being delayed care that would have made receovery that much easier and faster. Only ten days ago, I heard from a friend who went to see a physician for a suspected broken ankle. The wait to see a doctor was five hours with no pain relief or comfort measures. He was given a requisition for an x-ray. A full week later, he receives a call to return for a cast... he really does have a broken ankle. The long term consequences of having a fracture in joint that will now not heal properly are immense. Surgeries, physiotherapy, degenerating joint health all that could have been prevented by an immediate diagnosis and treatment with a cast.

Is your client a pharmaceutical firm facing claims about side-effects and adverse reactions involving long-term injuries? Evaluate how quickly the client was seen by a doctor, how soon were they given treatment for the symptoms? Did they spend days in a hallway in a crowded emergency room?

Unfortunately, this is not an unknown story in hospitals and doctors' offices. Perhaps you have more than an injury claim... perhaps you also have a negligence claim against a hospital.

IV drug for nausea causing problems

It has been reported in the “Annals of Cardiac Anaesthesia” that ondansetron (also administered under the brand name Zofran) has caused severe cardiovascular complications for adults and children. The drug is given to prevent or treat nausea and vomiting. It has been rapidly replacing dimenhydrinate (also known as Gravol) in acute care settings in Canada.

Documented cases have revealed that even when properly administered there has been a drop in heart rate to as low as 16 beats per minute. There have also been reports of adverse events such as unusual heart rate patterns and fatal heart patterns.

Further study has been proposed for this drug and the present suggestion is for caution when using the drug at the current time.

If you have a case involving cardiac irregularities which resulted in an adverse outcome, consider checking the chart for the administration of ondansetron.

Ultrasound Gel—Moms and babies at risk

Two infectious pathogens have been found growing in bottles of ultrasound gel in Canadian health care facilities. The connection was discovered by tracing skin infections on moms and babies who had recently had ultrasounds.

Ultrasound gel is often kept in squeeze bottles left with the machines that require it. Ultrasound machines and fetal monitors are the most common places you would find the gel. It does not contain any anti-bacterial properties.

The theory is that the nozzle of the bottles are coming in contact with the patient’s skin thereby contaminating the tip and allowing the pathogens to then find a great place to grow within the bottle. Gel that is heated only speeds the process of bacterial growth. Then this gel is used on the next patient. Suggestions for preventing the spread are to ensure bottles do not have direct contact with the skin and cleaning the nozzles of the bottles with an anti-bacterial wipe after each use.

A concern which crosses the mind of a nurse is one of infections that were missed. How many new moms developed wound infections following delivery because of the ultrasound gel used on their abdomens throughout the labour or prior to their caesarean section? How many babies developed skin infections that were never traced back to the gel?

Technique is so important to the outcome of a patient's care. And more attention needs to be paid to the systems in place to prevent infection and how they are actually followed on the front line of health care.

Specialized training program too expensive?

In the North American world of obstetrics, there is a specialized program that is considered a “gold standard” of maternity care. It provides information and training sessions for the care of women during pregnancy and delivery. It is a valuable tool for teaching health care providers of all levels from obstetricians, family physicians, registered nurses, and midwives on the multitude of skills necessary for the modern practice of obstetrics. Lawyers who work on maternity cases will often ask if this program was in place to train the staff to an expected standard of care.

However, in the current environment of budget reviews and the “business” of health care that is an emerging trend in Canada, this program is about to disappear. Deemed “too expensive” by administrators, the program is expected to be gone by the end of 2009.

It takes at least two years of full-time work for a nurse new to the area to begin to feel comfortable with anything that can be thrown at her during labour and delivery. We don’t have that kind of time anymore and the training program helped fill that need of skill building because we are losing experienced care providers to retirement. They will not be there to provide the support and hands on training for a bevy of young nurses just starting to get their skills established in this very specialized area which relies very heavily on the expertise of the RN to identify and apply interventions necessary for the well-being of the mom and her baby.

Too expensive to train health care providers? How much are the two lives of mom and babe worth? How much value is there in traumatized staff who only wanted to provide the best care?

Can H1N1 be contained in hospitals?

The last few months have seen the outbreak of the H1N1 virus. It has been appearing all over the world and varies from mild to severe, sometimes resulting in death.

People present to the hospital for various reasons. Some are staff. Some are visitors. Some are injured. Some are booked surgeries and diagnostic tests. Some are very ill. When word of an outbreak occurs, everyone assumes that doctors, nurses and other hospital staff will take every precaution to protect themselves and others so that the infection cannot be spread within the hospital itself.

But is this true?

Sadly, it is not. The worst culprits are often doctors. Doctors who make dangerous assumptions. They discount the need for isolation precaution procedures already in place. They ignore nurses who tell them of the risk and precautions necessary before, during and after patient contact. They don't wash or sanitize their hands before and after seeing a patient. They contaminate the charts and the desk area where others work.

Often it is only after they receive as positive lab result (sometimes days later) that they acknowledge what they have done... and only to themselves.

Patients who develop complications after a hospital visit-- no matter what they were doing there-- need to have a thorough examination of the timeline. There is a very good chance it is a case of "white coat" contamination. Questions that need answers include: were isolation procedures implemented, reinforced and carried out at all times? Was any caregiver diagnosed with the same illness or treated with anti-flu drugs due to an unprotected exposure? Detective work by someone who knows how a hospital works behind the scenes can provide the answers.

Physical Condition of Hospitals

When was the last time you spent time in a hospital ward looking closely at the physical condition of the building?

Did you notice the chipping paint? The peeling wallpaper? The cracks in the floors? The stained ceiling tiles? The upholstery that was worn thin and so stained it can't be cleaned anymore? The blinds that are missing slats and won't open or close? The curtains that are worn and stained? The bed linens that are stained? The clutter of equipment in the hallways and rooms?

I notice these things every time I step into the hospital ward I work on. I do my best to make sure stained linen is changed before my patient ever goes near the bed. That stained curtains are taken down and replaced. But it is impossible to hide the deterioration of everything else.

The patients who are admitted to hospital are acutely ill or requiring some immediate intervention. Mothers are arriving to deliver their babies. The physical environment should be one of impeccable cleaniless and condition. Yet Canadian hospitals are often falling far short of this standard under the guise of fiscal restraint. Even if the money would be spent to restore the units, there isn't any place to physically put patients while the work is done.

Can a hospital defend its infection rate and care when it can't provide patients with an environment that promotes health and healing?

Canadians give clear message on health care

As early as July 2008, Leger Marketing did a study which showed 70% of Canadians believe prescription medications are prescribed more often than necessary. The same study showed one third of Canadians do not believe the Canadian health care system meets their needs.

The lack of confidence in health care to meet their needs is a powerful commentary on the current state of healthcare in Canada. Recent changes to some provincial health care systems will result in even less ability for Canadians to access the care they need, when they need it.

Patients who enter a system when they are already doubting their care may be more likely to seek compensation for negligent care. Adding to this atompshere is the lack of trust simmering between front line staff and management. Internal strife directly impacts patient care-- and the patients know it.

A legal nurse consultant assists attorneys faced with these claims primarily through careful analysis of the choronology and the care records to determine if the facts translate into merit. This "weeding out" process helps reduce costs while also establishing a base for claims which move forward.

Changes to Care for Moms with Breech Pregnancies

The standard of care in Canadian hospitals since 2000 has been to deliver all breech babies by caesarean section. This method of delivery was based on solid research which showed the risks for potential harmful outcomes to the baby were too high for vaginal delivery. The Society for Obstetricians and Gynegologists of Canada has recently announced that this standard care will be reversed.

It is a basic premise of mechanics. The largest part of a fetus is the head-- and breech babies have their heads delivered last. There is always a risk that the head will prove too large for the mother's pelvis which results in fetal death and dismemberment as well as major injury to the mother during attempts to save the baby.

The other harsh reality is that delivery with best outcomes for mom and baby requires genuine finesse and loads of experience-- neither of which is easily found in our latest generation of obstetricians. They haven't seen or done enough breech deliveries to be good at it.

As a labour and delivery nurse in her third decade of experience, I have seen the time where breech pregnancies were delivered without a c-section. I have also seen babies severely compromised in the process when the obstetrician is not skilled enough to do it.

Two issues present themselves in the world of medical liability:

1. Will mothers be completely informed and truly understand the risks their babies face? If a delivery goes very wrong during this period of attempting to reduce the c-section rate by any means possible, can the defence argue against years of evidence that planned c-section delivery is best for the baby's safety?

2. Thousands of women were not given the choice in the type of delivery. Does this mean they have grounds to question that lack of options should obstetricians return to vaginal delivery of term breech pregnancies?

Breech deliveries are high risk, even in the operating room babies can have a traumatic delivery, cases presenting themselves over the next few years will require specialized expertise to determine if every possible factor was considered before the method of delivery was determined.

Defective Implanted Defibrillator Leads

A common procedure for people with irregular or unusual heart rhythms often receive defibrillators implanted into their chest to provide a necessary shock to maintain a healthy heart rhythm whenever necessary. It was a big, and unwelcome, surprise when the manufacturer, Medtronic, announced last year that their Sprint Fidelis leads were malfunctioning at rates that were higher than other leads. These defective leads were pulled from the implant market but cannot be changed or removed without a real risk of harm to the patient. Numbers vary depending on the source, but in the range of 87.9% to 94.3% of the leads are still in place in patients.

In May of 2009, the Heart Rhythm Society, an American cardiac physicians’ group representing MDs who implant and extract defibrillators and their associated leads, issued policy statements calling for hospitals to better police the experience and training of the surgeons who extract defibrillator leads. This is especially important given the risk to the patient to remove or change these defective leads. HRS also issued a statement calling for companies that produce the leads to do be more accountable in the tracking the performance of their devices once they’re on the market.

A legal nurse consultant can provide information for a case where there may be a suspicion of a malfunctioning cardiac defibrillator, its leads or an injury that occurred while the leads were being removed. One of the questions that must be answered is the experience of the doctor who connected or extracted the leads. While the new guidelines have yet to be determined in Canada, the training and experience of the physician may be relevant to the injury. Legal nurse consultants for the defence may be able to raise the level of experience as an avenue of defence of the doctor. Legal nurse consultants for the plaintiff will question the lack of experience of the physician as evidence of negligence.

The incidence of medical device failure is a serious one. And is definitely the type of case requiring the expertise of a legal nurse consultant.

Economy and healthcare changes bring business to lawyers

This week saw glimmers of recovery in the Canadian economy. Mortgage rates, always tied to the bond market, have started to rise and this is a sign that the slump is beginning to come to an end.

However, the healthcare industry is not going to follow that trend. Layoffs and budget cuts have begun in major hospitals at a time of increasing patient loads. Nursing shortages that were the focus of news articles as recently as two weeks ago are suddenly announced "over" by politicians seeking to justify radical changes to the voting public. Clinical educators are slated for layoffs as well which directly impacts the continuing education for nurses and other professionals.

This has been good news for nursing and other health professional recruitment firms from other countries; they have begun actively seeking to recruit our experienced, well-educated registered nurses and they are succeeding. Offers are for positions with great wages and benefits in prime locations.

How does all this bring business to lawyers?

Patient care is coming under direct duress in the current work environment and this leads to mistakes.

Management is being shifted so that managers are in charge of units in which they have no clinical experience. Management of units is being consolidated under the supervision of one manager.

Education and training programs are being cut so staff will not maintain their skill levels at current standards. New staff, already coming in without the background of a registered nurse, will not receive a consistent orientation program so their care may not reflect policies and procedures.

Hiring freezes mean no replacements for maternity leaves of up to one year, no replacements for the retiring nurses, no replacements for nurses injured on the job and no coverage for absent staff. Nurses already have the highest absentee rate in Canada and this will only increase as staff become more overworked and stressed.

Less staff on the floor means current standard nurse-patient ratios will come under pressure to change. Areas where levels of care now dictate 1:1 nursing for the optimum patient outcome may see nurses caring for 2 or 3 patients and important information on the patient's condition will be missed or delayed in being seen resulting in compromised outcomes. Even layoffs in the clerical sector impacts patient care when nobody is at the desk to answer calls from the rooms while the nurses are busy with patient care in other areas of the unit.

There are implications for the mental health of all hospital staff during this period. Rumours and awareness of the impact of these changes have created an environment of high stress, lack of concentration and decreasing commitment to an employer who cuts jobs. Stressed hospital staff simply cannot perform at optimum levels.

Legal nurse consultants have the experience of hospital nursing to know the implications for patients and families during times of high stress and staff cutbacks. They can tell the legal team what to look for to see if the employer is at fault for the care that was or was not received during a hospital stay. Legal nurse consultants can pick up the subtle wording of other nurses that provides clues about the unit activity that affected your client. They can also give advice on questions for interviews that will demonstrate the environment during the event and its impact on your client.

Legal cases involving hospitals in Canada will see an increase as acuity, activity and populations rise while staff and budget levels decrease. Are you ready with your full legal team that will best represent your client?

What happens when entire health care portfolios are gone?

Recent administrative changes to Alberta Health Services are bringing changes to the organization. Within the Calgary area, for example, Women’s Health Services no longer exist. And the word is that this may be slated to happen province-wide.

The immediate effects are seen in the absence of top level management positions to advocate for health care services geared toward women’s health care. At a time of record numbers of maternity cases, maternity units in dire need of renovation and updating and increasing demand for gynecology services, there is no leadership with a specific interest in this specialty. There has also been a hiring freeze placed on nursing staff and support staff in these areas despite clear indications that there are understaffing issues and pending retirements.

What does this mean for medical liability attorneys? It means there are going to be cases emerging as a direct result of insufficient resources to provide the standard of care expected in Canadian hospitals. The staff will not available to maintain the current standard of nurse-patient ratios. Less qualified and experienced staff will be hired as a cost-cutting bridging measure which puts patients at risk. The equipment necessary to monitor patients for their safety and best outcome will either not be available or will be outdated and not meet current standards. The physical environment of the hospital patient will deteriorate—even to the point of being dangerous from an infectious disease standpoint with such things as cracks in the floors under delivery beds and beds unable to be cleaned to acceptable standards because they are need of replacement after years of use and breakdowns.

Nurses are aware of the shortfalls of working within a hospital environment during times of economic downturns while patient populations and acuity rise. Having that experience and perspective will assist you in evaluating and building your next case involving women’s health gone wrong.

Nurses are active in risk management

I am about to begin an interesting new task on the busy obstetrical unit at the hospital. My task will be to audit medical charts of patients recently cared for within the unit-- and they need a nurse to do it.

I am excited by this opportunity because it is another demonstration of the important role nurses play within the medical industry. This is not a blame game. The risk management team for the health authority recognizes that nurses are uniquely qualified to evaluate the documentation of patient care. Not only do audits check to see if policies and procedures are being followed but also if a complete course of care can be tracked for, in this case, multiple patients under one system (mother and baby or babies).

We all learn from doing and sometimes a gentle reminder of what was missed or a congratulatory note of a task well done may lead to improved documentation that assists the legal team in a case up to twenty years down the road. On that note, what were the charting practices ten or twenty years ago? Is your team prepared to deal with "exception charting" or "SOAP" charting that were common directives then?

A legal nurse consultant cannot be a recent graduate of a school of nursing because policies, procedures, knowledge, equipment and, yes, even charting were not the same even five years ago. This is a specialty area of nursing where experience is the rule not the exception and it is an exciting opportunity for these senior nurses to use their background in a whole new way!

What role could a nurse have in a law firm?

Canadian nurses have discovered a new area of specialty-- legal nurse consulting. It can be the best of both worlds for an experienced RN. She can use her established knowledge and skills in a whole new way. She can explore employment options outside of shiftwork. She can remain an important member of a professional team that can make a difference.

Here is how a nurse works within the team:

*Strategizes with the legal professional for successful resolutions between parties involved in health care-related litigation or other medical-legal or health care-legal matters;
*Educate attorneys and/or others involved in the legal process regarding the healthcare facts and issues of a case or claim;
*Research and integrate healthcare and nursing literature as it relates to the healthcare facts and issues of a case or a claim:
*Review, summarize, and analyze medical records and other pertinent healthcare and legal documents and comparing and correlating them to the allegations;
*Assess issues of damages and causation relative to liability within the legal process;
*Identify, locate, evaluate, and confer with expert witnesses;
*Interview witnesses and parties pertinent to the healthcare issues in collaboration with legal professionals;
*Draft legal documents in medically related cases under the supervision of an attorney;
*Develop collaborative case strategies with those practicing within the legal system;
*Provide support during discovery, depositions, trial, and other legal proceedings;
*Support the process of adjudication of legal claims.

Source: AALNC

Critical Flaw Costs Lawyer Thousands

A critical flaw was discovered by a defending attorney after the plaintiff’s attorney had spent thousands of dollars bringing the case to discovery.

a. 25 yr old woman in third pregnancy with one living child; first pregnancy had a compromised outcome
b. Premature rupture of membranes at 34 weeks of pregnancy; stabilized and transferred to antepartum unit to wait for pregnancy to reach 36 weeks, a common practice at this time
c. Sudden onset of bleeding and pain at 35 ½ weeks; fetal monitoring shows fetal distress; to OR and baby delivered within 8 minutes of primary nurse entering patient’s room
d. Mother had significant blood loss but fully recovered; baby needed extensive resuscitation but died two days later
e. Claim was made against the primary physician, admitting physician, and primary care nurse. Basis of the claim was that the patient’s call for help was not answered for twenty minutes by primary care nurse. This was substantiated by the patient’s husband watching the clock on the wall of the room.

Two vital errors were made by the plaintiff’s attorney that could have been identified by a legal nurse consultant:

1. He did not ask the primary care nurse what her patient load was at the time of the incident. There had been layoffs on the unit at this time. The incident also occurred during a time of night when nurses commonly take a one hour break and patient loads can be heavy. On this night, the primary care nurse was caring for six triage patients, an early labour patient and two antepartum patients which she had told the nurse in charge was too heavy for patient safety. However, the primary care nurse was never obliged to give him this information during discovery.

2. He did not confirm the actual presence of a clock on the wall of the patient’s room for her husband to time the response time. This unfamiliarity with hospital layout and the custom of clocks on the walls of rooms in other parts of the maternity unit cost the plaintiff their claim against the primary care nurse and wasted the attorney’s resources in preparing the case as well as three hours in discovery with the primary care nurse.

Nursing shortage is important to lawyers

A report issued by the Canadian Nurses Association shows that the shortage of registered nurses is expected to grow to 60 000 by 2022. The current absentee rate for RNs is twice as high as any other profession with an average of 14 days per year. Workload, short-staffed units, lack of basic equipment and large numbers of less qualified and less experienced staff are taking a huge toll on the skilled work force in Canadian hospitals.

"It gets to a point where you have nurses so tired that when one of their colleagues calls in sick, they just say: 'Give me a warm body' - regardless if he or she has the education." Personal care workers are heavily relied on in some regions. "We need (them), don't get me wrong," Linda Silas, President of the Canadian Federation of Nurses Unions said. "But for patient safety and quality care, you need the nurses around and we shouldn't jeopardize this because of the shortage."

There is also a noticeable shortage of doctors, pharmacists, and physiotherapists.

Why should this matter to a lawyer? Because when your client comes to you with their story of what happened to them in the healthcare system, you need to be aware of the dynamics of the environment in which the event(s) took place. What were the staffing levels at that moment? What were the qualifications and experience of the direct care givers as well as their supervisors? Was the care being given by a worker outside of their scope of practice? Was fatigue or illness a factor in the level of care being provided at that moment?

Legal nurse consultants are registered nurses who have hands-on experience with the healthcare environment. They know first hand how the level of care is affected by the dynamics of the unit and the people in it. Let their expertise and insight bring to light nuances of the case that could so easily be missed.

Top 5 Reasons to Have Legal Nurses of Canada on Your Team

Because of the legal nurse consultant’s expertise in healthcare-related issues, he or she can bring the following benefits to the litigation team:

1. Cost-effectiveness: The LNC critically analyzes the healthcare facts of a case and
helps the attorney select and manage cases. Many cases can be either rejected or
settled quickly by using the resources and knowledge of an LNC.
2. Resourcefulness: The LNC has access to a national network of healthcare and
professional resources and contacts. The LNC is well versed in the use of medical
libraries, medical equipment, and other resources.
3. Knowledge: The LNC has a thorough understanding of healthcare issues and trends
related to the entire litigation process. The LNC “speaks the language” of
physicians, healthcare providers, and patients.
4. Experience: The LNC has a background of clinical experience, which includes the
ability to interpret medical records, documents, and health science literature.
5. Advantage: The LNC is a relatively new area of expertise which means adding one to your legal team is an advantage during the legal process.

Another Diet Pill Recall Alert

According to a May 1, 2009 news release by attorneys at Morgan & Morgan, the Food & Drug Administration (FDA) issued a warning to consumers to immediately stop using Hydroxycut products. Hydroxycut products, dietary supplements manufactured by Iovate Health Sciences, Inc., have been linked to serious liver injuries and at least one death. The products were sold in Canada as well.

This recent example in the product liability field is within the expertise of the legal nurse consultant as part of the legal team. Legal nurse consultants are not hired to know the law but rather to understand the injury, what caused it, its extent and how it could have been prevented. Once the free legal consultation has been completed, the legal nurse consultant can piece together vital pieces of information to assist the attorneys in evaluating the merit of each case.

Nurses have specialized knowledge and resources to assess the risks and benefits of a product, whether it was regulated and for what particular use, identify common off label uses of a product, explore the history of the product and the side effects that have been reported as well as personal patient histories which might have affected the outcome with this product. Then they can assist in the preparation of cases for legal teams faced with a large scale recall within the healthcare-related industry.

What is a legal nurse consultant?

The legal nurse consultant is a licensed registered nurse who performs a critical
analysis of healthcare facts and issues and their outcomes for the legal profession,
healthcare profession, and others, as appropriate. With a strong educational and
experiential background, the legal nurse consultant is qualified to assess adherence to standards of healthcare practice as it applies to the nursing and healthcare professions.
There is a diversity of practice settings and services performed by legal nurse
consultants nationwide.

The legal nurse consultant practices the art and science of this nursing
specialty in a variety of settings, including law firms, government offices, insurance
companies, hospital risk management departments, and as self-employed practitioners.
The legal nurse consultant is a liaison between the legal and healthcare communities and
provides consultation and education to legal, healthcare, and appropriate other
professionals in areas such as personal injury, product liability, medical malpractice,
workers’ compensation, toxic torts, risk management, medical professional licensure
investigation, and criminal law.