Legal Nurse Consultant & Deposition Expert – Interview

Interview/LNC: Sarah Kaminski, independent

© 2008 The Medical-Legal News

Sarah Kaminski, RN, BSN, LNC, has more than 20 years of experience as a registered nurse with cardiac surgery patients, and as an assistant nurse manager and nursing supervisor. She has been the owner of Carolina Medical-Legal Consulting in Greenville, S.C., for five years and specializes in screening cases, chronological summaries, expert witness location and deposition preparation. She serves as a director-at-large for the newly revived South Carolina chapter of AALNC, and she has been a mentor to the state’s LNCs;

Sarah Kaminski on Expert Witnesses & Deposition Preparation.

Q: How did you begin as a legal nurse consultant?
A: My first exposure to legal nurse consulting was an ad I read in a nursing magazine. When I read the description of what LNCs do, it seemed to fit me like a glove and it was very appealing because I knew I would enjoy the many facets of LNC work. I had no doubt I wanted to become a LNC, but I also did not want to rush into something new that would take me completely away from my comfort zone of hospital bedside nursing. I tucked the idea away for a couple of years and then became pregnant with my third daughter. After Cammie was born, I took two years off of nursing altogether to stay home with my three girls.
When my husband’s company was sold, I needed to go back to work full time until he found comparable employment. I loved being at the bedside, but not the stress, or having someone set my schedule for me and controlling the way I worked. During those long 12-hour nights, my thoughts returned to the idea of becoming an LNC and I made up my mind to pursue this new direction in my nursing career. I took a course that helped prepare me for understanding some of the broader concepts of legal nurse consulting and then I began marketing my services right away. I received my first case in a week, and then I was fortunate to become acquainted with an experienced medical malpractice attorney who gave me several cases over a long period of time. He was also very gracious to teach me patiently when it came to the legal intricacies of his cases. He is still giving me cases and teaching me today.

Q: What professional titles do you hold?

Q: Do you testify as an expert in your clinical field of nursing specialty?
A: I testified on one case when I was a new consultant and still working clinically.

Q: Are you presently working clinically?
A: I have not worked clinically for four years.

Q: How many years have you been in LNC practice?
A: Five years.

Q: What are your LNC specialty areas?
A: Screening cases to help decide merit, chronological summaries, expert witness location and assisting attorneys with deposition preparation.

Q: How did you become aware of legal nurse consulting as a specialty practice?
A: Initially, I saw ads for LNC courses. Once my interest was piqued, I began talking with some in-house LNCs and researching LNC work on my own. I also called several attorneys, most of whom told me to contact them after I had completed my course. I also came across the American Association of Legal Nurse Consultants’ website, and read the helpful information posted there.

Q: Why did you go into LNC practice?
A: I had several reasons. I guess the primary reason was that the type of work LNCs do appealed to me. As a bedside nurse, I was frustrated because there was very little time to read patient charts and piece together the big picture of what was going on with them medically. Because of staffing issues, and limited resources, it ended up being very task oriented, and I wanted more than that when it came to being able to understand and analyze health issues. I also wanted more autonomy about how and when I performed my work. I work very well independently, so was not afraid to leave the hospital and try something new. Now that I have been consulting for more than five years, I have grown to appreciate the independence even more, in addition to the respect and professionalism my attorneys have shown me.

Q: Describe your transition from clinical practice to LNC practice.
A: I began marketing as soon as I finished my course, and fortunately, received my first case within a week and additional cases within just a few weeks. I continued to work clinically for nine months after I became an LNC and then made the decision to stop working clinically due to time and conflict of interest issues. The transition was a welcome one for me. As soon as I began working on cases, I knew I had made the right decision because I loved LNC work, and believed I had the skill set to do it well.

Q: How hard was it for you to start in the LNC practice?
A: I was fortunate because my husband was able to put together my marketing materials for me, which gave me a very professional product at a great savings. He was also my computer assistant, which made the technology learning curve much easier. We were able to buy computer equipment for me at no cost when his company bought all new equipment. All of these “helps” allowed me to have very little overhead, and to begin earning money right away.

Q: What barriers did you face?
A: The biggest barrier was my lack of experience working in the legal realm. I struggled with the best way to tell attorneys I could do LNC work when I had not actually done any. I wanted to be truthful, yet convince them to hire me. In addition, I had to come out of my comfort zone, and market myself when I had never needed to do that before in order to get a job. So, I guess I would have to say that the barriers I faced were more on a personal level than anything else. Of course, it took many hours of hard work to build up an attorney-client base, but I viewed that as more of a challenge than a barrier.

Q: Did you obtain any formal training? If so, where?
A: I did not obtain any formal training through a university setting or LNC internship. I took Vickie Milazzo’s course in Texas in 2003, in addition to spending several hours talking with experienced in-house legal nurse consultants and learning from them. One of the first attorneys who gave me cases was wonderful to educate me regarding legal issues and the legal framework within which he needed to work to litigate his cases. My advice to nurses interested in becoming LNCs is that in addition to taking a course, it is extremely helpful to take some sort of hands-on internship, or find an experienced LNC to mentor you.

Q: Describe your first attorney interview.
A: My first attorney interview was with a friend I had known for several years, so it was more like chatting with a good friend. He was very gracious to give me a small case, and I was sure he was just trying to help me out, but I determined to do a great job! The encouragement of getting a case on my first interview gave me the confidence to keep marketing and work hard to get additional cases.
My second attorney interview was very relaxing because it was on a Friday and the attorney was dressed down and in a casual mood because he was moving his baseball business that day. His mother had been an RN and he was already sold on the idea of using nurse consultants, partly because he grew up with a nurse, and also because he had already used nurse consultants in his practice. He gave me cases right away.

Q: Describe your first case.
A: My first case was about a man who had been involved in a motor vehicle collision and it had already been established that he was going to need future knee replacement surgery. The attorney wanted me to put together the costs of the surgery in a formal document so he could include the amount in his demand for the case. I assimilated the costs involved, and, using Excel, put them together in a spreadsheet format that the attorney was able to use to make his demand.

Q: What is your most memorable case? Why?
A: This is an easy question to answer. My most memorable case is about missed hypovolemic shock in a 5-year-old girl. If she had been properly diagnosed in a timely manner, it is highly likely she would still be alive today, and her family spared much grief. This case really tugged at my heart to the point that I visited her grave. There is a book called Mommy Please Don’t Cry written by a mother whose baby daughter died. It is written and illustrated very sweetly from the perspective of the child who died and is in heaven looking down and talking to her mother. Through the attorney, I was able to give the mother a copy of this book. She later told the attorney that the book really helped her with her grief. She took the book to her daughter’s grave and read it several times and cried and grieved. I realize this is not a typical thing an LNC would do in a case, but the circumstances were right, and the attorney thought it was a good idea to do this for the mother. Without affecting my objectivity in analyzing this case, it was rewarding to be able to reach out to try to help comfort this mother.

Q: What was your most difficult case? Why?
A: Though I have reviewed several complex cases, I cannot think of a most difficult one. The most complex cases I have reviewed were two baby cases where there were many issues involved and the causation was very difficult to sort out. In both cases, they were sent to an expert physician for review, and the attorney decided not to pursue them.

Q: Do you use or are you interested in subcontracting?
A: No to both questions at this time. At some point I realize I may need to hire subcontractors to grow my business better, but it is a huge undertaking that I take very seriously and I am not ready to do that just yet.

Q: What are the top three things you like most about being an LNC?
A: I love the nature of LNC work, the professionalism involved and my autonomy as an independent LNC.

Q: How often do you market?
A: At least every six months I send out letters to attorneys I have not contacted previously. I follow up those letters with a phone call or two. If I do not receive a response, I make an additional contact via email. My goal is always to land a face-to-face meeting with the attorney.

Q: What is your biggest marketing challenge?
A: Right now it is making time to do the marketing, but I believe it is something I have to do, so I work hard to continue my marketing efforts.

Q: What marketing tools do you use?
A: I primarily use letters and phone calls. I am going to be exhibiting for the first time at the South Carolina Trial Lawyers convention in Hilton Head. Many of my attorneys have encouraged me to begin exhibiting. A friend of mine who is a life care planner asked me to exhibit with her, and split the cost, so I decided to take the plunge. I have put a lot of effort into the content of my display and materials, and hope it will pay off.
For several months I placed an inexpensive ad in the Greenville County Bar Association’s monthly newsletter. Though I didn’t have any direct business from those ads, I think it was good for name recognition because the majority of local attorneys read the newsletters.
I guess I would say that the best marketing tools I have are current attorney-clients who are happy with the quality of my work. I have received many referrals this way.

Q: What do you think is the biggest reason you continue to receive cases?
A: My service-oriented attitude in dealing with my attorney-clients. I try to put my very best effort into every case for each of my attorneys no matter how big or small the case. I believe they are satisfied with the quality of my work, or they would not continue to give me their cases. I also believe that because I have made a concerted effort to learn the legal aspects of litigating medically-related cases, it puts me in a strong position to anticipate the needs of each case and tailor my work to the unique needs of each case. If my attorneys can see I “get it,” they are comfortable trusting me with their cases.

Q: Have you written any articles? Any chapters or books? How many and on what topics?
A: I am currently working on an article for the next issue of JLNC. It is for the Working World section, and is about missed hypovolemic shock in a pediatric patient (my most memorable case).

Q: Have you given any presentations?
A: I have given presentations to senior nursing students on legal issues in nursing, and also on legal nurse consulting as an alternative career for experienced nurses. One of my future goals is to be able to present at an LNC conference.

Q: Give three areas of interest other than legal nurse consulting.
A: My daughters’ activities, which include swim team, their friends and sports. I love to travel, and in the summer of 1985 a friend and I backpacked in Europe for five weeks. It’s time to go again! I am very interested in the culture of the Gullah people who live primarily in the Low Country of South Carolina and Georgia.

Q: Where do you see yourself as an LNC in five years?
A: I see myself possibly with either a business partner or subcontractors. I see myself as being known as the LNC in South Carolina who is the best for plaintiff attorneys to call for screening cases, locating experts and assisting with deposition preparation. I also see myself as being able to be a member of the South Carolina Bar if I choose. I am also interested in doing more writing, and speaking at LNC conferences, and being involved in influencing the direction of the LNC profession.

Q: Where do you see the specialty of legal nurse consulting going in the next five years?
A: My hope is that we will be more firmly established in the minds of attorneys as a credible profession, and that the use of LNCs will become standard for attorneys who handle medically-related cases, both defense and plaintiff. I also believe that experienced LNCs need to continue to establish standards of practice for our profession, and that includes LNC education, internships and mentoring, and credentialing.

Q: What recommendations would you make to a new LNC about the challenges of our specialty?
A: I guess right off the bat I would encourage those considering becoming an LNC to do lots of research and to think long and hard before making a significant time and money investment in a course. I have met many nurses who have been sold on the “dream” of being an LNC, but who may not really be cut out for LNC work or who may not understand the reality of what is involved as far as marketing and building a business from the ground up. It is not a profession that involves sitting at a desk all day in your pajamas and billing $150/hour for your work. There are many LNC programs out there that have very appealing ads that draw nurses in, yet many of those nurses end up never getting a case or having much success in the LNC field. With that said, I think the first challenge is deciding if LNC work is a good match for the individual nurse. Once that decision is made, a good decision needs to be made regarding the best way for each nurse to become educated and experienced regarding LNC work. There are many options available, and making a wise and fiscally sound decision involves thorough research and receiving counsel from experienced LNCs.
Other challenges involve deciding whether to work independently or in-house, for an insurance company or in one of the many other available venues for an LNC.
I think marketing and getting cases is always a challenge that does not involve magic as much as it involves strategy, hard work and determination.
The biggest challenge is to produce a quality work product that is beneficial to your attorney-clients as they litigate and defend their medically-related cases.

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