When a personal injury or medical malpractice attorney is considering whether to take a medical case or accept a settlement in a case, the decision may hinge on what’s in the medical records. A legal nurse consultant can parse through thousands of pages of medical records to provide the guidance the attorney needs.
I have pulled a few cases out of my files as examples.
Anatomy Matters
Parents were concerned about the care their infant received from an anesthesiologist during a routine pediatric surgical procedure at an outpatient surgical center. It was documented in the chart as a traumatic intubation. The child required post-procedure hospitalization for treatment of stridor. Medical records showed that the anesthesiologist performed admirably while attempting to mitigate any damage.
When the parents checked in at the surgical center, they reported a healthy child with a history of reactive airway a few months earlier and a current runny nose. However, when the CRNA attempted intubation, he encountered copious secretions and an edematous and floppy airway that occluded the vocal cords with inspiration. He made two intubation attempts before calling the anesthesiologist. The anesthesiologist immediately took over, medically paralyzed the infant and intubated with a small ET tube on the first attempt. He proceeded to give the infant steroids and albuterol to combat airway edema and open the bronchioles.
In the following days at a children’s hospital, the child was diagnosed with Rhino-enterovirus (known to cause copious secretions and airway edema), enlarged tonsils with pharyngeal collapse, subglottic narrowing, and pharyngomalacia (floppiness of the laryngeal tissues above the vocal cords).
The anesthesiologist had taken a dangerous situation of a patient with extremely difficult anatomy and provided a stable and safe airway for the procedure. I advised the attorney not to take the case.
To Settle or Not to Settle
An attorney with a client who had preexisting conditions was offered a settlement but wanted input to weigh the likelihood of a greater settlement.
The client was standing in a parking lot when his left lateral knee was clipped by a slow-moving car. He was not knocked to the ground and didn’t require immediate medical care.
Two days later the client presented to his PCP with knee pain. There were no visible signs of trauma, and X-rays were normal. He was seen weeks later for mild knee pain and a worsening of pre-existing back pain. After a few months of unsuccessful PT (for his back), he required back surgery to repair a chronic spinal condition. PT, post-op, and follow-up PCP care made no mention of knee pain.
The patient had an established pain clinic relationship where frequent drug testing was performed with non-prescribed drugs occasionally found. The clinic’s notes were bereft of knee pain complaints.
A medical record review highlighted the functionality of pre-existing conditions, knee injury, documented changes, and areas of client compliance and non-compliance. Using this report the attorney recommended to the client that he accept the settlement offer.
Hospice
An elderly woman with a DNR in a nursing home had deteriorated and was transferred to hospice care. The hospice had a home-like environment, so no guardrails were put on the patient’s bed because she had never attempted to get out of bed unassisted.
The hospice nurse had visited daily and documented that she was in “terminal decline.” One day the patient fell out of bed and was found face down on the floor. She had 10/10 pain to her lower back. In the Emergency Department, an examination and CT scans were done and found she had a non-displaced comminuted right occipital condyle fracture (the bone at the base of her skull that connects the top of the spine). It only required stabilization with a cervical collar, however it was never placed. While waiting with EMS for transfer back to the facility, she became apneic and died peacefully. Due to her prior terminal condition, the attorney turned down the case.
