FAQ

The simplest answer is to mitigate cost exposure. In cases where merit or economic benefit is not painfully obvious – nearly at the res ipsa level – your firm may incur substantial cost only to find the case is not sustainable. Additionally; courts, and most State Bars, take a dim view of attorney’s billing excessive costs or expenses to clients.

A Nurse Paralegal will efficiently review, categorize, and summarize medical records as bill to file expenses permitting more efficient use of more costly physician input where actually necessary. Nurse Paralegals provide these services with the added benefit to the firm of generating reports of relevant case law and statutes preliminarily formatted to meet the needs of the appropriate jurisdiction to reduce the time a firm’s Paralegal spends preparing documents for filing.

A well organized and annotated review of voluminous medical records can reduce testifying expert review time and client/firm expense by as much as 50%. Nurses have generated, worked with, and reviewed medical records throughout their careers. Professional Nurses bring extensive experience in myriad aspects of the medical/healthcare fields in addition to familiarity with health systems, particularly the Nursing care that occurs at the patient’s bedside. A preliminary Nursing review allows a physician reviewer/expert to focus her/his review on the most pertinent entries in a record, thereby saving them time and your client money. 

There are a number of companies providing these services “offshore” and some of those we have seen do good work. They use physicians frequently educated in the United States but who have returned to their home country and can afford to work at a reduced wage because of a lower cost of living.

MarGin believes these companies, when properly vetted for quality, can prove a valuable asset in a mix that includes MarGin. While these companies offer a quality service at a lower cost, their staff is not available to answer follow-up questions, provide ongoing advice, or make recommendations as the circumstances of your case change. While quality and cost may both likely beneficial to you or your firm, the service focus is necessarily narrow.

Have you ever found yourself needing a medical or science research article in 48 hours? Needed to clarify a point of medicine or science in your mind the day before a deposition or trial? That’s where MarGin excels. While it is easier for us to understand what you need if we’ve been involved from the intake, we strive to complete even the most arduous research for our clients in time to actually be of help.

A Paralegal’s experience with medical records likely parallels that of the supervising attorney. The depth of the knowledge base is astoundingly intimidating; from local court rules in several venues, recognizing the difference between controlling and persuasive authority, and the ability to differentiate between State and Federal Rules not only for applicability but relating to the advancement of a case.

Identifying meritorious cases in malpractice actions is very different from identifying issues of merit within a matter. Medical records frequently contain information that permits a healthcare-trained reviewer to recognize additional (missing) records pertinent to the matter that would not be obvious to persons without significant experience in the healthcare professions. An Attorney or Paralegal without specific education, training, or experience in healthcare or medicine may not recognize from a client’s intake, or even a preliminary review and organization of medical records alternative theories of tortious conduct.

An Attorney, Paralegal, or even a Physician expert reviewing a record may not recognize the discrete indicators of breaches by other practitioners; Nurses, respiratory care providers, ancillary personnel, or even hospital policy failures. Subtleties of language, recognition of intrinsic biases of caregivers, and other indicators are lost to reviewers not schooled in both the professional education in both the Paralegal and Nursing fields, When addressing medical malpractice the issue is specific and narrow while causation of the client’s result may be broad in scope. A Nurse Parlegal is the professional best placed by training and experience to examine this breadth of information to better focus the query.

Attorneys are well aware of the value brought to their practice by well-trained and broadly experienced Paralegals.

Without an education or experience set that includes health sciences however, Paralegals are handicapped when working to understand the minutiae of medical records. The LNC focuses on the nursing/medical and health care system issues using their Nursing education and experience.

A Nurse Paralegal, on the other hand, can bring together healthcare/medical perspective with the education and experience of a paralegal to conduct preliminary primary and secondary legal research relevant to the matter under consideration. Additionally, a Nurse Paralegal is better positioned to provide pre-drafted complaints/petitions; answers/responses; deposition/interrogatory questions; and motions/requests for production or admissions consistent with your jurisdiction’s Rules of Court.

Properly and effectively done, these documents will permit your experienced Paralegal to reduce the time required to produce these documents in the attorneys voice and spend more time on the research and client interactions that actually drive your practice..

With Paralegal training, a Nurse Paralegals are equipped to assist an attorney or firm with additional support in any matter. Through the application of their experience in Nursing, Nurse Paralegals can prove to be of particular value in matters related to:

• Professional Negligence;
• Personal Injury in matters not related to professional negligence;
• Workers Compensation;
• Family law issues where health or quality of care is in question;
• Medicare/SSI/SSDI benefit issues;
• Healthcare professional board disciplinary action investigation; or even
• Opposing Party testifying expert vetting reports.

The short answer is no.

The practice of medicine is outside the Scope of Practice of Nursing. Much like the Unauthorized Practice of Law by an experienced Paralegal. Nurses and Paralegals deal with records and their content as a core component of our jobs. Both bring to the attention of their supervising practitioner relevant information and opinions regarding the quality of the information available.

Nurses, like Paralegals, are well schooled in identifying the Professional Rules of Conduct and Current Clinical Guidelines as well as the import of this information. While Nurses are not qualified by training to judge physician performance, identifying this information before engaging a consulting physician saves in physician time and firm expense. In fact, in the courts of the 5th Circuit, Legal Nurse Consultants and their opinion of medical causation has been specifically addressed.

MarGin offers Current Clinical Guideline reviews and causation evaluations within the parameters of Cleveland ex rel. Cleveland v. US, 457 F.3d 397 (5th Cir. 2006) which states in relevant part:

Wanda Poret (“Poret”), a [C]ertified [L]egal [N]urse [C]onsultant, was prepared to testify on Cleveland’s behalf that the BJACH employees deviated from the acceptable standard of care by neglecting to take a chest film and failing to diagnose congestive heart failure. In her report, she opined that had Samuel been treated for congestive heart failure on his initial visit, his subsequent deterioration could have been prevented. The United States objected to her admission as an expert witness, arguing that, as a Nurse, she was not qualified to testify as to the standard of care owed by physician assistant Eubanks. The district court excluded her testimony without a written memorandum of reasons for the ruling.

The court went on to rule:

Poret’s written report focused exclusively on the failure of the physician assistant at BJACH to meet the requisite standard of care. In her opposition to the United States’ motion to exclude Poret’s testimony, Cleveland attempted to argue that Poret was qualified to read and explicate the “chronology of care” Samuel received at BJACH, as Poret possesses a Bachelors Degree in Nursing and is a Certified Legal Nurse Consultant. However, this argument is inapposite given the content of her report. As a nurse, Poret is not qualified to testify as to a physician’s standard of care or the standard of care governing a physician assistant who stands in the place of the treating physician. See Broussard, 921 So.2d at 132 (stating the rule that only physicians qualified in a particular medical field may testify as to the standard of care owed by physicians in that specialty). The district court did not abuse its discretion in excluding Poret’s testimony as she was not qualified to testify as to the standard of care applicable to a physician assistant. Id. at 405.

MarGin Consulting, LLC has a better approach. We search for an expert for your case from scratch.

Because your case and client are unique to the fact pattern underlying your case, we conduct an independent search for each expert and each case, we have no subscribers, nor do we maintain an ongoing relationship with any experts. Our process is geared to discovery and vetting of matter matched experts with full transparency and discretion. And, since our experts are university professors in full-time clinical practice, or selected for their dual credentialing, our clients are assured of top-tier credentials from a true expert.

This, of course, depends on the volume and complexity of the records received and the scope of the review requested. MarGin will, upon request, provide a detailed cost estimate. This estimate is, in fact, a guaranteed maximum cost for the services requested.

This approach allows attorneys to reasonably determine the value of moving forward. MarGin will review available medical records as outlined in our schedule of services and then give the client a, generally, non-discoverable report that will also include recommendations and next steps. Those may include requests for additional records or creating a summary of the case’s strengths and weaknesses, with or without a detailed chronology of events.

The attorney/firm determines the scope and detail required of the work product before work begins to eliminate billing surprises. While delivering the highest possible quality service, MarGin works to accommodate firm budgets when possible without sacrificing quality.

Certainly.

• A review of Nursing care provided is subject to, firstly, fundamental Nursing practice and care provided in every setting. Wound care and prevention, infection control, patient education, medication review and administration.
• Nursing procedures and interventions, documentation of care and patient progress or level of compliance, and coordination of care across myriad professions and specialties are all core competencies in Nursing.
• We have specialty practice professionals on call to supplement this review to ensure that specialty standards we review are thoroughly considered. Additionally, we locate consulting and/or testifying Medical and Nursing expert witnesses who are well versed in the Current Clinical Guidelines for their particular specialty.

MarGin blends Nursing and Paralegal skills to offer a seamless integration of our work product to your practice needs.

• MarGin is fully ABA RPC Rule 1.5(a)(1) compliant by billing based upon the educational or skill level required for the work engaged. MarGin also eliminates collateral attack on our interactions with our attorney clients by not providing testimony in depositions or at trial.
• We assist in identifying and vetting appropriate experts for testimony and then step away from the process to maintain the applicability of the work product rule. MarGin provides licensure/sanction information, including reported criminal convictions for retained and opposing experts when requested.
• MarGin can coordinate record retrieval to reduce turnaround time with appropriate authorizations in place.
• All records are forwarded as received to the attorney or firm as initial work begins without delay.
• MarGin fully vets expert witnesses, both supporting and opposing and will, if so engaged, provide detailed information regarding the professional litigation history of experts with case details appended. We access documents and filings where available, including depositions, motions, testimony and rulings related to the expert. We are also available to provide a detailed background report on all experts upon request.