A Message from the President Message from the President by liaoqinmei


									                                                                                       March 2008

PHILADELPHIA CHAPTER OF THE                                          AALNC
    Please direct submissions to Cynthia Lacker at cynthia@medical-eyes.net

  Inside This Issue
     A Message from the President                                             1

     Case Study – Can You Guess the Verdict?                                  2
    A Message from the President
     Call for Contributors                                                    5
    By Michelle Cannon
     Board Member Spotlight                                                   6

     National AALNC News                                                      7

     Legal Nurse Consultant Resources                                         8

     Legal Nurse Consultant Tips                                              9

     Local Chapter News                                                       9

     Up-Coming Events                                                         10

    A Message from the President
    By Michelle Cannon, BSN, RN, CRNI


    Dear Members,

    Happy new year to all my fellow legal nurse consultants!

    As discussed in the last newsletter, our ongoing goals for this year included:

        •   Transition of our Web site √
        •   Expansion of our membership
        •   Increased participation of our current members
        •   Discussion of mentorship to attract and retain our newer members
        •   Participation in national AALNC and local chapter events to increase our
            exposure and recognition of our profession.

As the new president this year, I would like to share how privileged I am to work with
such an outstanding executive board. We had our first board meeting in February and
we have already accomplished one of our year end goals: Transition of our Web site. A
personal thank you goes to Lesley Slepner, Kathy Colfer and Sue Detweiler.

Although the key to our membership involvement and continued wealth of information
exchange comes through our updated and resourceful Web site, this will be an ongoing
project for the board this year. However, we are very excited to be able to expand and
develop this as we choose. We have formed a committee to assist in continuing to
shape its form and content since it is still in its infancy stage. Please note that the Web
site has changed domains from www.phillyaalnc.org to www.phillyaalnc.com.

Secondly, our first dinner meeting of the year on January 10th was a success. Thanks for
those who attended. As the new president, I presented Complex Litigation and all
comments and suggestions were appreciated. Thank you.

In summary, by meeting these goals this year, we will enhance legal nurse consulting as
well as our nursing profession. If you have any suggestions or comments to improve the
chapter, please let me know. It is always a “work in progress.”

I hope to see you at the national AALNC conference in Tampa, Florida this April.

Michelle Cannon, RN, BSN, CRNI
President Philadelphia Chapter AALNC

Case Study – Can You Guess the Verdict?
Read through this case study and see if you can guess the verdict – Defense Verdict or
Plaintiff Verdict and amount awarded. The verdict will be published in the next

Facts Case #1:
In February of 2003, plaintiff SJ, then 35, entered Medical Center for surgical removal of a
benign tumor from her uterus. The surgery lasted 2.5 hours, with no complications. Her
blood loss was 700 cc. After the surgery, at 5:15 p.m., Simpson was moved to the post-
anesthesia care unit (PACU), where she was noted to have an elevated pulse rate of 140.
The attending anesthesiologist diagnosed hypovolemia, and gave additional IV fluids and
Inderal to reduce her heart rate. After two hours, there was a change in anesthesia care,
and a second attending anesthesiologist also diagnosed hypovolemia and ordered a bolus
of 1,000 cc of lactated ringers and additional Inderal. Because SJ's heart rate remained
elevated, she was kept in the PACU.

The second attending anesthesiologist then left to administer anesthesia to another patient
in surgery, and a third attending anesthesiologist took over. This anesthesiologist ordered
a volume expander, Albumin 500 cc, to be given as a bolus with an additional 200 cc per
hour while SJ was still in the PACU. By 10:30 p.m., her heart rate dropped below 100 and
the anesthesiologist ordered her transferred to the floor.

Because no bed was available on the floor, SJ, her heart rate remaining below 100 with
normal blood pressure, did not leave the PACU until 11:40 p.m. and was admitted to the
floor at midnight, her vital signs now showing a blood pressure of 164/95, a pulse of 104,
respirations of 20 and oxygen saturations of 96%.

Although there was an order in her chart to notify the gynecological resident if the vital
signs were outside set parameters, the night floor nurse did not call the resident because
she assumed that the anesthesiologist was already aware of these finding, and the patient
looked stable. Meanwhile, the floor nurse did a complete assessment on the patient, and
determined that she was stable and there was no need for additional treatment.

At 2:45 a.m., the floor nurse gave SJ a bolus of 1,000 cc lactated ringers because an order
entered by the PACU nurse showed up on her computer, timed at 1:45 a.m. The night nurse
also continued to give the Albumin that was hanging as an IV when SJ arrived on the floor.
At the time of her arrival, 400 cc of Albumin remained in the IV.

At 4 a.m., SJ’s vital signs showed a blood pressure of 166/83 and a pulse rate of 119. Her
respiration remained at 20 and the oxygen saturations were 96%. The nurse's aide who
took these reported them to the floor nurse.

At 6 a.m., the gynecological intern examined SJ and noted the earlier elevated blood
pressure and pulse. The intern rechecked the pulse herself and recorded a pulse of 105,
but did not recheck the blood pressure. The intern noted the fluid intake and output since
the start of surgery, and recorded that the patient was five liters fluid positive, but that she
had urinated over 2,600 cc in the last six hours. At 6:45 a.m., a fourth-year gynecological
resident also examined SJ and found her lungs clear with no evidence of any symptoms or
problems other than mild tachycardia. Meanwhile, the intern ordered that the patient be
given a full liquid breakfast because she was hungry. The 6 a.m. lab works were still
pending, and both the intern and the fourth-year resident then went to a teaching
conference at 7 a.m., and were going to return to rounds on the patients with the attending
physicians after 9 a.m.

At the nursing shift change at 7 a.m., a report was exchanged between the departing and
oncoming nurses. At 8 a.m., the day nurse entered SJ’s room, introduced herself and spoke
with the patient. She noted that SJ was not in distress and helped set up her breakfast in

bed. The day nurse also testified that at approximately 8:25 a.m., she walked past SJ’s
room and noted her to be sitting up, in no distress, eating her breakfast. At 8:30 a.m., a
nurse's aide walked into SJ’s room to check her vital signs and found her to be
unresponsive. She pushed the Code Blue button and awaited the medical staff's arrival to
start resuscitation. At 8:37 a.m., an emergency room resident intubated SJ and Lasix 40 mg
IV was given at 8:45 a.m. SJ responded and, at 10 a.m., she was transferred to the ICU. At 1
p.m., a Swan-Ganz catheter was inserted, which showed some elevated pressures. An
echocardiogram was normal and a chest CT scan showed asymmetric infiltrates.

The next day, SJ was extubated and, on Feb. 9, was moved from the ICU to the floor. On
Feb. 12, an MRI was taken of her brain, which showed hypoxic-ischemic injury to the basal
ganglia. On Feb. 19, she was discharged and admitted to a skilled nursing facility.

In April, SJ had a feeding gastrostomy tube placed.

Eighteen months later, in December 2004, she was moved to an acute rehabilitation facility
where she was able to regain the ability to eat orally.

SJ sued Medical Center for medical malpractice, contending that its nursing employees
negligently administered excess fluids and that the fluid overload caused her to develop
pulmonary edema. Her counsel argued that when she lost consciousness, she aspirated
fluid from her stomach or the liquids she was eating, which caused a secondary aspiration

The defense contended that there was no fluid overload, nor did excess fluid result in
pulmonary edema. Instead, the defense maintained, SJ experienced a sudden unpredictable
aspiration that caused a respiratory arrest and, secondary to that, a pulmonary edema. The
defendant argued that SJ had no signs or symptoms of pulmonary edema preceding the
respiratory arrest, and that her post-arrest condition was more consistent with an
aspiration than pulmonary edema.

Defense radiologist testified that the findings on the post-code radiographic studies were
inconsistent with cardiogenic pulmonary edema (edema caused by fluid overload). Instead,
the CT scan showed alveolar consolidation, a finding consistent with aspiration, he
asserted. He also testified that most of the consolidation was found in the right lung base,
which would be primarily affected by an aspiration event.

Defense cardiologist testified that SJ aspirated, supported by the sudden onset of the
catastrophic event in a patient with normal cardiac systolic and diastolic function, and
normal renal function. Her post-code echo revealed a normal ejection fraction and her
cardiac left ventricular dimensions were normal. He also opined that a progressive clinical
deterioration noted with fluid overload/pulmonary edema did not occur in this otherwise

healthy patient.

Defense pulmonologist testified that SJ was not in fluid overload and that she aspirated. He
testified that pulmonary edema developed instantaneously at the time of the aspiration,
and that the aspiration was sufficient to cause the frothy pink sputum seen at the time of
the code. In his opinion, aspiration was unavoidable.

SJ suffered an injury to her brain as a result of lack of oxygen, which resulted in motor
difficulties including bradykinesia (extreme slowness in movements) of all four extremities
and dysarthria (disturbance of articulation due to emotional stress, paralysis, in
coordination or spasticity of muscles). She has regained normal mental status with some
ability to use a computer but she is unable to work. Her condition has recently improved
with intensive therapy and she will have additional life expectancy of 35 to 40 years.

SJ also claimed that, although she had no actual work history, she had recently returned to
community college to take art and computer graphics courses, and wanted to work in
computer illustration. She claimed past medical specials of $134,073, future medical care
expenses of $6.43 million (present cash value) and future loss of earning capacity of
between $646,000 and $800,000, as well as loss of household services and general

    1. Defense Verdict? or
    2. Plaintiff Verdict and estimated amount?

Send your best guess to cynthia@medical-eyes.net. Answers to follow in the next issue!

Call for Contributors
By Cynthia Lacker, RN, MS, LNCC

Greetings Members!

In February, the Board Members discussed sending the Chapter Newsletter to
approximately 25 legal firms each mailing. This will begin with the March 2008 issue.
This is another great reason to consider contributing an article, a tip, a resource, or to
complete and submit the Member Spotlight form.

I have received feedback from 2 chapter members, and I am grateful for the wonderful
information they have provided to share via our newsletter. I would love to have
members write a piece discussing the medical malpractice case; the personal injury

case; the pharmaceutical case; and the criminal case. If you have worked in any of these
fields and would like to contribute, please email me!

Board Member Spotlight
Thank you to our first board member, Tracy Patrick-Panchelli, to respond to the Board
Member Spotlight form. Please consider filling out the form so that we can continue to
highlight one member in each newsletter. Send your completed forms to
cynthia@medical-eyes.net. Contact me if you need another form either via email
[above] or via telephone 610-696-1763.

  Name: Tracy Patrick-Panchelli, BSN, RN-BC, CPN
  Title: Independent Legal Nurse Consultant
  Company Name: Panchelli Medical-Legal
  Consulting LLC
  Specialty Area/Setting: Pediatrics

   1. How long have you worked as a LNC? 6 years.

   2. What type of cases do you work on? Medical malpractice – plaintiff and defense.

   3. What do you like best about being a LNC? The ability to use my nursing
       knowledge in an analytical, autonomous way and the ability to work from home.

   4. What do you like least? The unpredictable, unsteady nature of the work.

   5. What is your major goal for this year? To learn the role of president of the
       Philadelphia Chapter of AALNC now that I have been named president-elect. I
       would also like to do more teaching and writing for publication.

   6. What would you like our group to know about you and/or your practice?
       I have been a nurse for 15 years, 13 of those years in pediatrics. I hold national
       certification in pediatric nursing. In addition to my consulting practice, I also
       work as a clinical nurse educator on a pediatric inpatient surgical unit as well as
       a staff nurse on the Pediatric Transport Team at Nemours/Alfred I. DuPont
       Hospital for Children in Wilmington, Delaware. As a legal nurse consultant, I
       have been deposed as an expert witness multiple times and I have authored
       numerous expert reports. I enjoy all aspects of my work and am always learning
       something new!

   7. How could our group help and support you as a LNC? Marketing tips are always
       helpful, particularly those that could be employed when work volume slows

National AALNC News
2008 Conference Planning: Using some of the discussion points from our board
meeting, we are excited about agenda for the upcoming Chapter Leader Forum at this
year's National Educational Conference. This year's session is scheduled for Wednesday,
April 9 1:00pm - 5:00pm. Chapters are encouraged to send 1 or 2 representatives. In
addition, as Chapter leaders, we hope you will consider participation in the 4th annual
Chapter Night. The event is scheduled for Thursday, April 10 at 6:30pm and the theme
is Florida Fun in the Sun Beach Party. Early Bird Registration for the conference is $520
through March 5, 2008. USAirways has recently had RT tickets from Philadelphia to
Tampa for $149! We’re hoping for a strong Philadelphia Chapter presence – and we
hope to see you there!

2009 Conference Update: We are pleased to announce that the AALNC 20th National
Educational Conference will take place April 22-25, 2009 in Phoenix at the Renaissance
Glendale Hotel & Spa. The board is excited to return to our first conference city to
celebrate our 20th anniversary. This will be officially launched in Tampa.

Nominations/Elections: The election materials have been finalized from the Nominating
Committee and were reviewed during the meeting. Recognizing the importance of going
green, AALNC is moving to electronic voting. Stay tuned as the materials will be routed
to all active members in the coming weeks.

2008 Plan of Work: During the board meeting, the Board of Directors reviewed the 2008
Plan of Work. We're excited about the initiatives to be tackled including increasing
awareness among the legal community.

3rd Edition of Principles & Practices: Under the stewardship of Ann Peterson and Lynda
Kopishke, the 3rd edition of our core curriculum is moving as planned. This is an
extensive process which will take 18-24 months. A call of authors was recently sent to
the membership. As chapter leaders, you have your pulse on the membership. We ask
you to encourage your chapter membership to submit required materials to be
considered as an author.

2007 Year-end: Finally, the board used this time to review 2007 goals and
accomplishments. Overall, it will be a strong financial year for AALNC. Our change in
membership dues process has been successful and the online course continues to do

well. We took our first steps in a global attorney awareness effort at the end of the year.
We will provide a full update at the Annual Business meeting.

Legal Nurse Consultant Resources
Thanks to Tracy Patrick-Panchelli, BSN, RN-BC, CPN President, Panchelli Medical-Legal
Consulting LLC, and President Elect, Philadelphia Chapter of the AALNC, for providing
this useful resource:

One of my favorite resources in my legal consulting practice is eFax. This is a Web-
based faxing system that I've used for about the last five years. The best thing about it
is that it eliminates the need for a physical fax machine that clutters up my office and
always has the potential to malfunction. With eFax, I pay an annual subscription fee and
have unlimited ability to send and receive faxes. I utilize my scanner if I have a physical
document that needs to be faxed. Otherwise, any documents I have saved in my
computer can be faxed by use of the print function within the file. eFax appears in the
drop-down list of printers and, when selected, instantly converts my document to a fax,
to which I can attach a cover sheet and apply a stamp such as "Draft". I receive email
confirmation that my faxes went through successfully within minutes of sending them,
which allows me to track what I sent and when without having additional paperwork.
When I receive faxes, they arrive in the form of an email, which I save in a number of
folders, printing only when absolutely necessary. I really dislike clutter, so eFax helps
me keep my office organized!

From Cynthia Lacker, RN, MS, LNCC:

One of the best investments I have made in my business is the purchase and
implementation of QuickBooks Pro. This “professional” version of QuickBooks allows me
to do some very valuable tasks. My favorite one is invoicing via email. But let me back-
track and quickly walk you through the business functions as they relate to Legal Nurse

First, you can set-up your customers [clients; attorneys] and list and connect them to
specific jobs [cases]. Then, once the case arrives at your door, you can use the time
tracking function to record all time spent on the case. It is simply a check-box to turn
the timer on and off, and so it is very easy to keep accurate time records for every case,
and easy to pause for those sometimes numerous home-office interruptions [phone
calls, doorbells, child wails and animal emergencies]. Moving on, once you have
completed the case, a click of the mouse sends all billable time directly to your invoice.
And finally, back to my favorite valuable task, simply send your client the invoice via

Of course, QuickBooks Pro has all the standard report features that let you track
everything from income, to receivables, to delinquent accounts, and it also has contact
management capabilities, too. With every new release, I find more functionality that
boosts my office management capabilities. Version, 8, which I have not yet purchased,
has built-in integration with Outlook, so I am very excited to see how that piece works!

Legal Nurse Consultant Tips
Thanks to Tracy Patrick-Panchelli, BSN, RN-BC, CPN President, Panchelli Medical-Legal
Consulting LLC, and President Elect, Philadelphia Chapter of the AALNC, for providing
this tip:

To facilitate billing my clients, I take advantage of the Forms Designer functionality in
the Quicken Home & Business software. This allows me to create invoices and
statements that I can print right onto my company letterhead, giving them a
professional look. Once the template is created, there is minimal data entry involved for
me. I can easily track my accounts receivable by looking at "client invoices" which
appears as its own account in the account list. I also use Quicken to track the status of
my cases by pulling up a project/job list in which I can sort by "closed,” "in progress,” or
"pending" status.

And a marketing tip from Cynthia Lacker, RN, MS, LNCC:
Be persistent without becoming a pest. It’s vital to connect with both new and existing
clients. Attorneys are very busy, and if your first phone call isn’t returned, don’t stop
trying to make a connection. Remember, though, connecting with attorneys is easier if
you have something of value for them. Take the time to create a one page article that
will catch their eye and give them something of value. You could create a “top-ten” list
of hospital errors for medical malpractice attorneys or a simple list of chiropractic tests
and their significance for personal injury attorneys. Demonstrate your knowledge and
provide a tangible benefit for the client or potential client, instead of writing or calling
simply to attempt to make an appointment to discuss your services. End the article with
a handwritten note inviting the attorney to call you on his or her next medical case.
Chances are good that you will be the firm they call on when the next challenging case
comes across their desk.

Local Chapter News
We’d like to announce that Beth Ridgley, former Philadelphia Chapter President, will be
on the National ballot running for a Director at Large position. Congratulations Beth!

Tracy Patrick-Panchelli has been chosen as an Associate Editor for the next edition of
the Legal Nurse Consulting Principles and Practices textbook. Congratulations Tracy!

Please make a note of the new Philadelphia Chapter website, and bookmark it for future
reference: www.PhillyAALNC.com

Upcoming Events
Please join the Chapter on March 13, 2008 for our second meeting of the year. We will
be holding a panel discussion regarding advertising – what works, and what doesn’t.
Meetings are held at the Doubletree Hotel in Plymouth Meeting, at 640 W. Germantown
Pike, Plymouth Meeting, PA 19462, Tele: (610) 834-8300. For directions, please
navigate to www.doubletree.com. The meeting, with dinner, begins at 6:00 PM. We
hope to see you there!


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