Interview/LNC: Cynthia Lacker
© 2008 The Medical-Legal News
Cynthia Lacker, RN, MS, CLNC, LNCC has more than 20 years experience as a registered nurse in the ICU, women’s health and geriatrics. She previously owned a Medicare-certified home healthcare agency and a durable medical supply company. She has been a healthcare consultant since 1997. She is a board member of the Philadelphia chapter of the AALNC. Lacker is the principle of two companies and is a faculty member of the University of Delaware, teaching in the legal nurse consultant certificate program. She has a wonderful husband, two lovely kids and two renegade cats, Leonard and Louise; email@example.com.
Cynthia Lacker on Medical Malpractice, Legal Nurse Consultant Certification & Personal Injury.
Q: How did you begin as a legal nurse consultant?
A: I wanted to pursue something more challenging than what I was doing at the time, which was working independently as a healthcare consultant. I worked primarily with home healthcare agencies creating compliance policies, billing procedures and developing organizational strategy.
Q: What professional titles do you hold?
A: I am the principle of Lacker & Associates, my legal nurse consulting firm, and have been for the last 11 years.
I am also the principle of Custom Medical Reports, Inc. (CMR), my litigation support services firm [See ad, Page 16]. In this role, I have conceptualized and developed CMR to provide a variety of litigation support services for those in the legal arena. My products include custom medical reports, ReportTipsRM, special medical reports like the Physician Finder ReportTM (a comprehensive 5-year prescription history and complete contact information for all prescribing physicians), templates, tele-conferencing and website development and hosting. It is really an exciting company, bundling all kinds of services. My goal is to bring high quality, high-technology services to small businesses at an affordable price.
Q: Do you testify as an expert in your clinical field of nursing specialty?
A: No, I do not. I consult full time and I am no longer clinically active.
Q: How many years have you been in LNC practice?
A: 11 years.
Q: What are your LNC specialty areas?
A: I like to say that I specialize in diversity. I do everything from medical malpractice and complex personal injury, to environmental torts, criminal defense, class action suits (pharmaceuticals, medical device, defective machinery) and special cluster cases.
Q: How did you become aware of legal nurse consulting as a specialty practice?
A: I happened upon the field while researching opportunities in the 1990s.
Q: Why did you go into LNC practice?
A: I already was a business owner and consultant. I wanted more challenge in my professional life. I thought I would be very good in this field because I already had strong writing skills, and I knew how to operate and run a business. I did my homework and then immersed myself in learning everything I could about legal nurse consulting.
Q: Describe your transition from clinical practice to LNC practice.
A: For me, the transition was very easy. As an independent healthcare consultant, I already had my business in place, and I simply changed my focus from the healthcare setting to the medical-legal environment. My biggest challenge was marketing and networking within the medical-legal environment. I did not know any attorneys when I began, and I had very few clinical contacts left, after having worked “solo” for many years. I had to reach out to different communities in order to develop a professional network to support my practice. I have since learned that networking is crucial to sustaining a viable practice.
Q: What barriers did you face?
A: None, really. I learned over time how to market and network efficiently. Honestly, I still learn something new every day. I am open to learning, so hurdles don’t seem like barriers, they are just challenges to overcome, and I keep moving forward.
Q: Did you obtain any formal training?
A: I obtained beginning instruction through the Medical Legal Consulting Institute. Through the years, I have sought out a variety of training opportunities in specialty areas. I obtained advanced certification in legal nurse consulting (Legal Nurse Consultant, Certified) through AALNC.
Q: Describe your first attorney interview.
A: I was incredibly lucky early on. One of my very first batches of cold calls connected me to an attorney who was a personal injury attorney. He had been working with a nurse for years — his wife. Two weeks before my call, his wife had obtained her real estate license and had left the legal business to pursue her own career in real estate. This attorney knew what a nurse meant in his practice, and he was desperate to find another nurse right away! Needless to say, it was not a hard sell. He also happened to be a past-president of the Colorado Trial Lawyers Association and was well connected in the legal arena. He was a great first client, and he taught me a lot over the years.
Q: Describe your first case.
A: My first case was an interesting workers’ compensation case, involving a nurse who had inhaled chemical fumes on the job. I had a quick introduction to workers’ compensation law, chemical exposure issues and a variety of other topics. It was interesting, too, to work on a case that involved a nurse.
Q: What is your most memorable case? Why?
A: My most memorable case involved a young woman injured in a motor vehicle accident. She was 16 at the time of the accident, and 19 when I reviewed the records. As I reviewed her case, provider by provider, it was apparent that the physicians and therapists who were treating her were focused only on their small part of her care — which is not uncommon in the healthcare industry. For example, the occupational therapist treating the upper extremity injury did not take into account the impact that her back injury had on the use of her upper extremities. The dentist treating her TMJ did not realize that visual deficiencies were causing some of the client’s headaches. The psychologist treating her for anxiety and depression did not realize that denial of her injuries was causing a delay in the improvement of her physical status.
This client’s injuries were severe and the treatment, although intense, failed to assess and treat this young woman as a “whole being.” It was one of the worst cases of fragmented care I had come across. As I put the pieces together, I was able to illustrate for the attorney the “big picture.” He had a client with severe deficits in many areas and, analyzing all of the injuries together, she was barely functioning on a daily basis. This “big picture” illustration helped him obtain for his client the care she needed, as well as a fair settlement from the insurance company. It was very rewarding.
Q: What was your most difficult case? Why?
A: When I first started out and received obstetrical cases, it was very stressful because I had never worked as an OB nurse. Luckily, I had mentors who really helped me through the steps of working these cases: locating appropriate nurses and other experts, obtaining authoritative literature and learning the clinical aspects of this area of consulting. Becoming involved in this area early in my career helped me realize how important networking in our field is and how, with the appropriate resources, tools and support, LNCs can be really involved in every area of consulting.
Another difficult case involved pharmaceutical billing errors — it was tedious, and every contact with the pharmaceutical company led to the discovery of more errors. I thought it would never end!
Both of these cases taught me that I could handle any case that came my way as long as I researched clinical and regulatory standards, applied analytical thought and had perseverance.
Q: Do you use or are you interested in subcontracting?
A: I do. It is one of the more challenging aspects of my work. However, using subcontractors has helped me improve my work product tremendously. When I read a report from a subcontractor, and have questions, it makes me think about how the attorney client perceives my own work. Sometimes, after thoroughly reviewing the medical records, information that is clear to us, as nurses, is not translated well in the written report. Reviewing others’ work without the benefit of having read the medical records has made me very aware of the technical aspects of report writing. Working with subcontractors created the inspiration for the development of Custom Medical Reports, Inc.
Q: What are the top three things you like most about being an LNC?
A: Diversity, diversity and diversity.
Q: How often do you market?
A: Continually. Every business owner markets continually in some way. If you are smart, you learn to be proactive, and you create positive marketing connections with clients and potential clients. While a lot of marketing is word-of-mouth from clients to potential clients, I do advertise my businesses in our trade journal, and via my websites, which work for me 24/7!
Q: What is your biggest marketing challenge?
A: For me, the biggest challenge is thinking outside the box, and creating opportunities that go beyond what is currently available in our field. I view my services as “litigation support services.” To me, this means any service that would help anyone involved in the legal arena. Report writing is a passion of mine, and teaching legal nurse consultants, paralegals and attorneys how to write good, high-quality medical reports is one of my goals. I also strive to bring many other support services to people in our field like affordable teleconferencing and specialty medical reports like our “Physician Finder ReportTM.” My challenge has been getting the word out to a lot of different sub-communities simultaneously and making sure I am connecting with people from many different professional communities.
Q: What marketing tools do you use?
A: I use web-based marketing and print marketing. My websites, www.medical-eyes.net and www.CustomMedicalReports.com contain a lot of information on my products and services. I use a permission-based service for email marketing. I also do print advertisement, currently with the Journal of Legal Nurse Consulting. I speak at a variety of professional groups, too.
Q: What do you think is the biggest reason you continue to receive cases?
A: It is simple — the quality of my work. I put out a quality product at an affordable price. That is the real reason I have repeat business. However, I do use other incentives, too. I am always available for my clients. I will fit in rush cases for existing clients at no extra charge. Existing clients also merit free priority shipping anywhere in the nation. I have a toll free number for my clients to use. I have a dedicated site where clients can upload records and download reports securely. All of these little extras add up to great service.
Q: Have you written any articles? Any chapters or books? How many and on what topics?
A: I have written many articles for LNCs. Some of them are posted on my websites. Many articles were published in LNCResource. I am currently writing a chapter for the new Legal Nurse Consultants Principles and Practices textbook, due out in 2009. I have written a demonstrative evidence module for an LNC certificate course through the University of Delaware. Finally, I am putting together an eight-hour seminar on nursing documentation and malpractice issues.
Q: Have you given any presentations?
A: I presented a pharmaceutical litigation seminar at the NACLNC conference in 2007.
Q: Give three areas of interest other than legal nurse consulting.
A: My children, writing and step aerobics.
Q: Where do you see yourself as an LNC in five years?
A: I am excited about the future! I hope to pursue several areas. A piece of my business development strategy is to continue with the production of standardized report formats for other LNCs. I will continue to develop templates to share with other LNCs in order to facilitate high quality work-product development.
I am computer savvy, and I would like to train others on medical-legal software. I envision being able to train LNCs and provide custom templates for cases based on case type: personal injury templates, medical malpractice templates, class action, etc. I am working with attorneys to develop legal-issue-based templates in a variety of areas. Basic templates, which are easily customizable, would be helpful to LNCs entering our field.
I am also investigating the role of technology in the courtroom and its impact on the delivery of LNC services. I believe that LNCs who are able to embrace technology and master litigation software will be able to offer valuable services. If an LNC can read and interpret the medical data, enter the data into a computer program and then manipulate that data for the attorney in the courtroom, I believe she would be an indispensable asset to the litigation team.
I will continue to write on a variety of topics in our field.
Q: Where do you see the specialty of legal nurse consulting going in the next five years?
A: The biggest trend I see in legal nurse consulting is in technology. In order to provide professional and cost-effective solutions to attorneys, legal nurse consultants must master technology. Growing your business today means interacting with attorneys on their platform, so learning about some of the litigation software packages and integrating your work product with this software can instantly increase your client base. It is also important to be aware of cost-benefit ratios in our field. What does it cost to provide our services? How do we save litigators money? Nurses need to understand these questions and need to be able to convey their worth to potential clients.
Q: What recommendations would you make to a new LNC about the challenges of our specialty?
A: My recommendations would include thorough research and investigation into the field before investing in training programs. One piece of the research has to be research into business development strategies. Many new LNCs don’t realize that this venture is really about starting your own business. You have to be prepared. You have to have seed money. You have to have a plan. You have to build your business through persistence and perseverance.
Have a business plan before entering the field. Be ready to learn on the job. Find a mentor to coach you in the beginning. Do a paid or unpaid internship at a law firm. Many new LNCs think they will start by landing subcontracted work. It is not easy. Don’t be fooled, do your homework.
Find the best tools available to help you build a quality business. Never compromise on quality. If you don’t know the answer, it is OK. Research and find the answer. Learn from your attorneys and teach them what you know. It is a give and take, and a nice partnership.
Have fun and do great work!