Medical Legal Nurse Consultant and Life Care Planner – Interview

© 2009 The Medical-Legal News

Donna Hunter (Adkins) is the President of Medical Claims Analysis & Management Services. She is credentialed as a life care planner, legal nurse consultant and medical case manager. She has served as an expert and fact witness in state and federal venues. Donna has mentored many nurses during her career. You may reach her at 1405 Yosemite Circle, Lexington, KY 40517 or (859) 333-0358.

Donna Hunter on Life Care Planning, Product Liability & Medical Claims.

Q: How did you get started as a legal nurse consultant?
A: I consulted on my first case more than 30 years ago when I was assisting on a case involving a death of a child due to “huffing.” I became seriously interested in becoming involved in legal cases involving medical and nursing issues when my son was critically injured in a motor vehicle accident and I stood watching a neurosurgeon make a grievous error. I was able to intervene and transfer my son who had an eventual good recovery. I decided I would like to assist others who are trying to determine the facts and issues of cases involving alleged medical or nursing malpractice or negligence. I am an educator at heart and love to educate the jury, judge and attorneys regarding standard of care issues; this has been a good fit for me.

Q: What degrees and professional titles do you hold?
A: I have a Bachelor of Science in nursing and have taken 160 hours in training in rehabilitation from the University of Florida. I have had many more hours of training in various areas, including forensic nursing, case management, death investigation, etc. I am nationally credentialed in life care planning, advanced catastrophic case management and legal nurse consulting. I am in the process of renewing certifications in emergency nursing and rehabilitation nursing.

Q: Do you testify as an expert in your clinical field of nursing specialty?
A. Yes.

Q: Are you presently working clinically?
A: I work in my nursing specialties — consulting and case management. Although I am not an employee of a facility, I do consult with various facilities and continue to do bedside assessments in my line of work.

Q: How many years have you been in LNC practice?
A: More than 20 years.

Q: What are your LNC specialty areas?
A: Life care planning, personal injury, medical and nursing malpractice and negligence, product liability, criminal cases, case management, worker’s compensation and Social Security disability issues.

Q: How did you become aware of legal nurse consulting as a specialty practice?
A: I was an LNC long before the ANA gave approval for certifications and recognition of legal consulting as a nursing specialty. I will say that I welcomed this approval and the standards and accountability that come with it.

Q: Why did you go into LNC practice?
A: I saw a real need to assist the legal profession and others with understanding the medical issues in the cases they were working. I think it is a miscarriage of justice if any attorney attempts to litigate any case without the right experts or consultants on board.

Q: Describe your transition from clinical practice to LNC practice.
A: My transition was easy and smooth as I have long been consulting and educating many professionals, including nurses, PAs, doctors, attorneys, judges and lay people. LNC practice is suited to those who like to research and educate, and those who like to write!

Q: How hard was it for you to get started in LNC practice?
A: Not hard at all. I would say the hardest thing for me was deciding to hang out my shingle. Once I did that, in 1993, there was no looking back. Oh, I forgot, the hardest thing was deciding what to name my company. I followed some sage advice and named my company for the services I provided: Medical Claims Analysis and Management Services.

Q: What barriers did you face?
A: No real barriers, only those self-imposed, such as fear of failure, etc.

Q: Did you obtain any formal training? If so, where?
A: No formal training. My experience as a nurse in multiple arenas served me well. I would have to say now, though, that it would have been helpful if I had some business principles and marketing courses.

Q: Describe your first attorney interview.
A: It has been too long ago for me to remember the specifics. However, in general, I can remember being intimidated the same way the doctors used to intimidate me. Now, I realize that attorneys are just like the rest of us, with their own strengths, failures, etc. I also realize that nurses are likely as educated, just differently, than attorneys and should not be intimidated by a law degree. Nurses do not practice law and attorneys should not practice nursing or medicine. The professions should be equally respected. Sorry for the long answer here, but I frequently hear nurses verbalize their fear of interviewing with an attorney. Just imagine the attorneys in your exam room with only the little gown on to hide their dignity. That should balance out the scales.

Q: Describe your first case.
A: My first case involved the death of a child who was playing with paint cans behind an apartment complex. Several other children also became brain injured. The case still lingers in my mind as being so senseless and preventable.

Q: What is your most memorable case?
A: My most memorable case was a class action involving thousands of people who had been exposed to PCBs from an industrial plant. Several generations of families had been affected. I was hired as the life care planner to determine the apportionment to be awarded to each plaintiff.

Q: Why was it memorable?
A: In addition to being the largest case I have had, it was gratifying to work with an attorney who I felt had the utmost compassion and respect for his clients. It was also very gratifying to know that I had some small part in truly assisting someone to overcome problems and have a better future.

Q: What was your most difficult case? Why?
A: The most difficult case I ever had was one in which the attorney sat on the steps of the courthouse and cried after losing a summary judgment and having the case thrown out on a rule involving sovereign immunity. The case involved a juvenile who sustained brain injury following an attempted suicide at a jail. The child was catastrophically and permanently injured. The family was suffering greatly. Causation and liability were clear. The attorney had worked hard to gain justice for his clients. I sat on the steps with that attorney and watched him agonize over a decision that was totally out of his control.That image will stay with me always, as will the respect I have for the attorney.

Q: Do you use or are you interested in subcontracting?
A: Yes, I occasionally use subcontractors, primarily for research. I have sometimes contracted with case managers when my load is particularly heavy.

Q: What are the top three things you like most about being an LNC?
A: Independence, accountability and making a difference in someone’s life.

Q: How often do you market?
A: Often, every time I consult or generate a report. No ads or banners — my work product is my advertising.

Q: What is your biggest marketing challenge?
A: Meeting deadlines that rapidly change.

Q: What marketing tools do you use?
A: My brain and past experiences.

Q: What do you think is the biggest reason you continue to receive cases?
A: My reputation for integrity, honesty and a good work product. I keep myself current by subscribing and reading the appropriate journals and attending professional seminars.

Q: Have you written any articles? Any chapters or books? How many and on what topics?
A: I have written many articles over the years, most recently for the AALNC journal. I co-authored a chapter on emergency nursing in a nursing malpractice book (edited by Pat Iyer, past president of AALNC).

Q: Have you given any presentations?
A: Over the years I have given many presentations to many groups, medical and professional. The topics have included emergency care, forensics, disaster and triage, criminal aspects of nursing care, case management and rehabilitation issues, life care planning, standards of care in nursing, advanced life support and basic and advanced trauma care. I also have taught many first aid and CPR classes to the general public. While serving as an officer in the Navy, I taught the Corpmen ACLS and disaster scene management as well as basic and advanced first aid.

Q: Give three areas of interest other than legal nurse consulting:
A: 1) Compassionate care of the elderly, animals and children, 2) having a nice fruity, cold drink with my friends on a cruise ship and 3) watching my children lead productive, moral lives as adults.

Q: Where do you see yourself as an LNC in five years?
A: Continuing to work. I wish to write and teach more.

Q: Where do you see the specialty of LNC going in the next five years?
A: I think our specialty will continue to evolve with nurses entering who are very committed to this practice area.We have come a long way from the early days of attorneys not knowing about this practice area as a specialty of nursing. A long time ago I can remember attorneys telling me that they thought LNCs were paralegals or scribes. Now attorneys tell me they can’t believe they ever practiced in the medical arena without a nurse! I think in five years we will see more and more attorneys have nurses as part of their professional staff.

Q: What recommendations would you make to a new LNC about the challenges of our specialty?
A: In my opinion, the following are crucial:
1) Find a good mentor and hang with her or him on good and bad days. Ask questions and do your homework. Don’t be too proud to do any task. Don’t ask for rest time if the mentor doesn’t rest. Don’t ask to eat if the mentor doesn’t eat. This is the real world of legal nurse consulting.
2) Invest in a good “go to meeting” outfit. Include shoes, a nice leather purse and briefcase. Always polish your shoes and manicure your nails. Nurses don’t always do these things. We have to be taught this stuff.
3) Don’t be lazy. Dress for work every day if you have to in order to keep yourself motivated.
4) Join national and local professional associations. Soak up the knowledge and friendships and support. Don’t just attend the meetings; be involved.
5) Be prepared to be shocked at the number of hours you will work. Be prepared to have to work to earn your money.
6) You will be respected when you earn it. Not before. You cannot rest on your credentials or titles.
7) Treat everyone with respect. You just never know when that next referral is coming, or from whom.

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