AALNC highlights: expert precedent, JCAHO does strokes, metadata dangers

by • May 1, 2007 • UncategorizedComments Off on AALNC highlights: expert precedent, JCAHO does strokes, metadata dangers1706

© The Medical-Legal News 2007

The American Association of Legal Nurse Consultants (AALNC.org) held its annual seminar in Austin in April. Here are highlights of each session. 

• Keynote: The opening speaker was attorney Matthew Arnold, who presented the Sullivan v. Edward Hospital case. Arnold argued the case before the Illinois Supreme Court and won, setting a precedent that medical doctors can no longer testify to nursing standards of care. Expert witnesses and those who locate them must be aware of this case.

• Corporate compliance: Legal nurse consultants have opportunities in this field. With tort reform adversely affecting LNCs in some states, corporate compliance may be a career alternative.

• Missed trauma: Emergency department healthcare providers must have a high index of suspicion in order to identify injuries potentially missed. It is the missed injuries that are clinically significant.

• Strokes: Rapid detection and treatment is essential to functional survival. JCAHO now certifies stroke centers, and the more significant medical-legal cases will be where appropriate care was available with the proper systems in place, but was withheld.

• Pap smears: Five out of 100 abnormal pap smears will be read as normal. The work of a cytotechnologist was described as “reading 100 novels a day and looking for the occasional misspelled word.” Cytotechnologists review between 90-100 slides per day — about five minutes per slide. In bad pap smear cases, defendants have a favorable outcome 67-75 percent of the time.

• Nursing home surveys: Survey documents are used to assist the attorney in determining validity in nursing home cases. The importance of the new QIS mandatory system for skilled facilities was not discussed.

• Toxic tort litigation: Medical records contribute to the differential diagnosis and how to find causation when a patient is exposed to a toxic agent.

• Defending long-term care cases: Some difficulties of these cases — discrepancies in flow sheets, documentation issues, lack of federal regulations as to care standards, regulations are not care standards, complexity of pre-incident medical conditions.

• Computer forensics: The central theme was that “deleted does not mean gone” — important to discovery.

• Minimum Data Sets: The gist of the presentation was using the MDS as a tool for creating timelines and finding keys to assessing documentation.

• Patient confidentiality in cyberspace:The most stunning information was that the metadata of electronic health records shows what was edited in a document and is found under “properties,” and that every change to a document is sent along with the document when it is copied or transferred. Therefore, unintentional release of medical information may raise liability issues if patient confidentiality is compromised.

• Posttraumatic cervical dystonia: PCD can result from motor vehicle accidents and is frequently missed by medical providers and attorneys.

• Closing keynote: “Navigating Today’s Business Challenges” highlighted how LNCs should use technology to manage and eliminate paper records, use remote reviewers, remotely access medical records, educate attorneys and produce quality, fast work products. •

— Reported by Donna Adkins, RN, BSN, CS, LNCC, CCM, CLCP, Rose Clifford, RN LNCC, Nancy Dion, RN, LNHA, Pam Hollsten, RN BSN, LNCC, Susan Mellott, PhD, RN, CPHQ, FNAHQ, Frances W. (Billie) Sills, RN, MSN, ARNP and Connie Taylor, RN, BSN.

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