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Medical detectives for legal professionals

Medical: Local entrepreneur offers help to those who need claims investigated

Posted: November 23, 2010 10:09 p.m.
Updated: November 24, 2010 4:55 a.m.

Local entrepreneur Andrea Smith is like the Sherlock Holmes of the medical and legal worlds — she investigates issues on behalf of attorneys representing clients with medical claims.

Smith owns a company called Nutris, a certified legal nurse-consulting firm in Valencia that reviews medical records at a fraction of the cost to hire a doctor for the same service.

“We take the professional side of nursing and mesh it with the legal field,” Smith said.

The firm does not replace the need for a doctor to review a case or take the witness stand, but Nutris conducts an exhaustive preparatory review of medical records to pinpoint the causes of a medical problem.

Origin of error
Nutris pores over medical records to see if they can be used in medical lawsuits, or to prove a lawsuit has no merit.

When there is a valid case, Smith said that her firm performs an exhaustive review of a patient’s care. A problem often occurs before a doctor enters the picture, which causes the doctor to make an error or compound a medical problem, she said.

For example, Smith said a labor and delivery nurse is responsible for watching the fetal monitoring strip. But if the nurse does not note a problem and alert a doctor that a Cesarean section is needed, it creates complications before the doctor even shows up at the hospital for delivery. If the doctor is then sued, Smith’s job is to discover the nurse’s misstep.

The company creates a timeline to document a patient’s care, reviewing everything from treatment to discharge.

Standards of care
In reviewing records, the local firm looks for any deviations from standard practices of care and evidence of medical-record tampering.

Determining if standardized care practices were followed at a hospital can be tricky.

Each hospital should at least be following national standards of care, Smith said. But each hospital also has its own policies and procedures.

Smith added that each health specialty has its own guidelines for standard care.

All of these policies and procedures need to be amassed before records are reviewed.

If required, Nutris also attends and reports on independent medical examinations.

Record tampering
Smith said there is a protocol for taking notes on a patient.

Nurses write one sentence per line and never scratch out any notes, Smith said. Because notes are written on the fly as the medical practitioner is monitoring and assessing a patient, the notes are brief.

“We look for evidence of record tampering.” Smith said.

If the medical records reflect sentences that are too complete and methodical, in a way that the reporting flows too smoothly, that’s a red flag Smith said. If it appears additional words were squeezed in at a later time, the additional notes may reflect a cover up.

Right-hand adviser
In preparing for a case, Nutris can assist with discovery by preparing case questions and requests for medical records.

The company can also prepare questions for deposition or trial examination. The legal nursing consultants will prepare an attorney so that the lawyer is familiar with the medical jargon that will be involved, and can properly frame questions or interpret responses.

Likewise, the company can interview and prepare clients, key witnesses and experts for hearings or trials.

Nutris also locates medical specialists and experts in a given field, who can assist an attorney with building the credibility of a case.

The company will research and apply the authoritative medical and nursing literature as it applies to a case, and also help develop exhibits or other evidence.

For hire by case

Smith said that Nutris is the only service of its kind in the immediate area, but there are only about 11 such firms total in Southern California.

The firm is a member of National Alliance of Certified Legal Nurse Consultants, which has access to 6,000 medical legal consultants across the U.S.

Nutris only uses certified legal nurse consultants. The consultants complete a 180-hour course and take a rigorous exam to become certified. Each consultant needs to maintain his or her certification through ongoing education and annual renewals.

Smith herself is a registered nurse and lives in Valencia with her husband and children.

“Some firms hire medical legal consultants on a full-time basis, such as an insurance company or legal firm,” Smith said.

“We fill those needs for firms that only need assistance on a case-by-case basis.”


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