Category Archives: Uncategorized

The Changing Face of Body Language

As the daughter of an Army Drill Sergeant, I grew up around Fort Jackson, SC. We shopped at the PX, attended the Roman Catholic church on base, bought 29 cent gasoline and went to the movies for a …

Source: The Changing Face of Body Language

Authenticity

I believe the greatest barrier/challenge that faces a new LNC is the ability to manage anxiety in new situations, meetings, presentations or interviews with attorneys.

These are the same problems faced by attorneys in preparing a closing argument.

When I began meeting new attorneys, I know that I did not project self-confidence. I will always be grateful for the ones who hired me despite this shortcoming. I was not convinced of my worth or that I could provide what they needed. I knew the lingo and had read the bullet list of 30 benefits of hiring a legal nurse, but I had not yet delivered those benefits.

I grappled for words that would communicate my competence in case analysis, but I was relying upon the success of others to give me courage.

Amy Cuddy is a social psychologist with a fascinating story (find her on TED talks and read her book, “Presence”). She combines multiple philosophies and her own experience to describe that hard-to-capture essence of convincing others that you are worthy.

Convincing others of your worth begins with conviction that you have the qualities you wish to impart. When you truly believe in what you do and who you are, others will also believe. I know after ten years and many hundreds of cases from all sides of the law that I am who I say I am.

True authenticity is not memorized or rehearsed; it comes from the heart.

Mediating with a Full Deck

It’s no secret that most civil cases never go to trial, or that insurers would be happy to settle workers comp cases rather than periodically increase their reserves. Unfortunately, it is also true that plaintiffs have no way of knowing how to value their claim or accept their attorney’s recommendation for a reasonable settlement. They drink the Kool-Aid of TV commercials, uninformed friends, and the back-end advice of their city bus.
More importantly, attorneys  have a difficult time knowing how to place a proper value on their client’s claim for future medical costs. Looking at past costs and lost wages is a cut and dried process. Asking colleagues for a ballpark figure on surgery, or going to a source like Healthbook, never takes into account the individual needs of client. And the client (patient) lives for the future.
Since mediation is often the final chance to intervene in an injured person’s life, make sure the potential costs are known, and presented in a professional format that facilitates acceptance at the table. Using the proper CPT codes, basing the cost on the State workers compensation fee schedules or the 75th percentile of UCR, including recent office visits, diagnoses and current life expectancies, creates a powerful tool for settlement.
Medical Cost Projections should be based upon the recommendations of the treating physician for potential surgery and medical care; annual costs of physical therapy, psychological care, x-rays, lab work, office visits, medications, DME equipment, bath and kitchen aids, yard and home maintenance if this will be an issue, and other costs that might occur with catastrophic injuries.
Big or small, every settlement matters to the patient whose life continues after both sides of the table go home, or on to the next case.

Stroke and CHI – Key Concepts for Legal Professionals

Stroke and CHI – Key Concepts for Legal Professionals.

Stroke and CHI – Key Concepts for Legal Professionals

Head injuries or brain damage can occur anywhere – in the workplace, in an MVA, in medical malpractice, toxic torts, a domestic fall, and environmental exposures.

Litigated head injuries generally arise from two sources:

1. Accidents
a. blunt trauma (fall, violent blow or MVA)
b. penetrating trauma (gunshot)

2. Medical causation (stroke)
a. ischemic (a clot blocking blood flow to a major artery)
b. hemorrhagic (rupture of a major artery causes damage to the brain)
c. TIA or Transient Ischemic Attack (symptoms resolve within 24 hrs)

In all instances, brain injury is affected by blood: either blocked flow (ischemia) or bleeding that puts pressure on another area, damaging tissue. The location of the injury is the most important determinant of the severity and likelihood of recovery.

Key Concepts

• Rate and degree of recovery after brain injury is quite variable

• The most common form of traumatic brain injury is the subdural hematoma (SDH), with a mortality rate ranging from 50 – 90%. A significant percentage of these deaths result from the pressure on the brain that develops in the days after injury. Treatment of the SDH depends upon the location and age of the lesion. Because bleeding is not static, “Early and sometimes repeated CT scanning may be required in cases of clinical or neurologic deterioration, especially in the first 72 hours after head injury, to detect delayed hematoma, hypoxic-ischemic lesions, or cerebral edema.”

• Approximately 20-30% of patients will recover full or partial brain function. However, post-operative seizures are relatively common in these patients.

• Although recovery from TIA (transient ischemic attack) occurs within 24 hours, these patients may be at a high risk for falls if they may regain mobility before being aware of their surroundings.

• Strokes arising from blood clots usually require anticoagulation therapy to prevent further clotting, but improper medication management can result in a fatal hemorrhage

• Because patients can “go bad” quickly, frequent monitoring of vital signs, ICP (intracranial pressure) measurements, lab values, pupil checks and level of awareness is crucial.

• A critical part of assessment includes changes, even by one point, in the Glasgow Coma Scale

The Glasgow Coma Scale (GCS) numerically represents the level of consciousness and is based upon a 15-point scale for estimating and categorizing the outcomes of brain injury. The patient who is unable to respond verbally or follow commands can nonetheless have a reflexive response to painful stimuli. Families do not appreciate this form of assessment, but the patient’s physical response tells a great deal about how the brain is processing this noxious stimulus. The following signs are associated with a poor prognosis:

• A Glasgow Coma Scale less than 8 in the field
• A Glasgow Coma Scale less than 5 in the ER
• Unequal/changing pupil size
• Motorcycle accident (direct head impact and no airbag)
• Problems with ventilation, further depriving the brain of oxygen

A patient with an acute and severe brain injury may be placed into a medically induced coma to protect and allow the brain to rest by slowing metabolism. Mechanical ventilation controls oxygen and carbon dioxide levels that can aid in reduction of swelling, and sedation allows an override of the patient’s breathing, which is often labored and dysfunctional.

Pain should be managed effectively because it can lead to a rise in intracranial pressure. An intubated patient is treated with short acting sedation and analgesia until time for weaning.

Claims for pain and suffering in the unconscious patient should consider:

• The victim’s awareness of impending danger prior to the head injury (an assertion of this awareness has been successfully argued even with death cases)

• Successfully communicating to a jury the difference between purposeful movements and reflex, and

• Evaluation of post-injury residuals established by Medical Cost Projection or Life Care Plan.

Putting post-injury impairment into perspective, it is very important to know the level of prior intellectual and emotional functioning. This information is sought by defense counsel in quantifying financial responsibility, and is equally important to plaintiff’s counsel in supporting a reasonable demand.

____________________________________________

Alice Adams is a veteran RN who has cared for many acute head injury patients. She has been a legal nurse consultant since 2006 and lives in Atlanta, GA. She evaluated the injury cases in the 2007 Bluffton University Baseball team’s tragic accident and fatalities, and is very active compiling Medical Cost Projections and providing medical analysis for >40 attorneys and law firm.

http://www.aliceMadams.com nurseatlanta@gmail.com 404.771.5155

Questions from Jurors are GOOD, Period.

Really loved this blog.

Not allowing jurors to ask questions is akin to not allowing patients to ask questions of their doctors. We always encourage patients to write down their thoughts before their appointment, lest they forget something critically important.

And honestly, twelve pairs of fresh eyes and ears are bound to think of something that a team of attorneys may have overlooked after months or years of honing in on a theme.

Thank you for allowing a repost.
Alice

Juryology: Art & Science of Jury Persuasion

Pulp Cover_Juror QuestionsThere’s a story in the July 21 online edition of the Boston Globe about a trial in which jurors have asked 281 questions, and in my opinion, the piece skews rather negatively about the whole practice of allowing jurors to ask written questions during trials. That’s wrong: Juror questions are a good thing for you, Counsel, and you should be enabling them in every one of your trials.

View original post 2,037 more words