The Expert Witness Route into the Field of Legal Nurse Consulting
Patricia Iyer, MSN, RN, LNCC
By Patricia Iyer
In the spring of 1987, I sat in a conference room listening to a nurse talk about career alternatives for nurses. I was employed as a nursing quality assurance coordinator, and enjoyed the analysis of trends and development of plans to improve care. But I was traveling 1.25 hours one way on the most heavily trafficked roads in New Jersey, and was getting burned out from the trip. At that point, I had been out of nursing school for about 20 years, and in that time had been a staff nurse, diploma school educator, nursing staff development director, and nursing quality assurance coordinator.
The seminar leader presented information about a number of non-traditional nursing roles. She explained that nurses went to court to testify about standards of care. That sounded very interesting. I had a master’s degree in nursing, had coauthored a book about the nursing process, had experience teaching staff nurses and department managers, and liked to write. I had years of staff nurse experience in medical surgical nursing, and maintained clinical involvement while I directed the hospital’s staff development department.
The next day when I returned to work, I called the attorney who ran the hospital’s risk management department. I asked him how I could get into nursing expert witness work. He explained about my state’s jury verdict analysis publication and Martindale Hubbell. My life changed forever when I walked into the country courthouse’s library, which was 20 minutes from my house. I used the jury verdict analysis issues in the library to determine which attorneys were doing nursing or medical malpractice cases. I copied down information from the volumes of Martindale Hubbell, which was not online at that time, to get the attorney’s contact information. When I had a list of about 20 attorneys, I sent out an introduction letter that explained that I was available to review medical surgical cases as a nursing expert witness, enclosed my CV and sat back.
What I did not realize when I sent out those letters was that medical surgical units were (and are) frequently the targets of suits. Attorneys needed experts, and lots of them. Immediately I got the attention of two defense attorneys. The second attorney who contacted me sent me a case, and within a month, called me up to discuss scheduling for trial. I remember being floored, and calling a friend in panic. “I wanted to be an expert witness but I never thought I’d have to testify on the second case I reviewed!” I think I could have gotten to the courthouse on sheer adrenaline on the day of trial, without needing my car. That initial batch of twenty letters continued to bring me work, repeat business, word of mouth referrals and my expert witness case load grew.
One day in 1989, a plaintiff attorney asked me to review an emergency department nursing case. “I’m not an ER nurse”, I told him, “but I know a masters prepared clinical specialist who would be great.” I connected the two of them, sat back, and the light bulb went off. I had done both of them a favor without any financial compensation. I began to learn more about the process of subcontracting cases to other expert witnesses.
Using the relationships I had built up over the years, I began to recruit nurses to review cases for me. In the beginning, I was casual about training them, until one day one of my clients called to complain about the semi-literate report he’d received from one of my experts. I was horrified when I saw what she had put together. After that, I insisted the experts send the reports to me for proofreading. I picked up issues that needed to be resolved before the report could be presented to the attorney and developed resources for training the experts.
I reviewed cases as a testifying liability expert for 20 years and enjoyed just about every aspect of the role (except cross examination). Shortly after I started reviewing cases as an expert, one of my clients asked me to summarize records of a man who had a botched laparoscopic cholecystectomy. He developed a fistula and was literally digested from the inside out. There were no nursing liability issues involved; my client wanted me to explain to the jury what this deceased patient went through. I remember testifying by sharing poignant quotes from the record and looking over to see tears pouring down his wife’s face.
There was no name for this role when I first began performing it and it was uncommon in our state until a judge endorsed it. The role is now variously called pain and suffering expert, expert fact witness or expert witness. I continue to provide this type of testimony. It draws upon my verbal and written communication skills, and the ability to synthesize volumes of data and determine how to display it.
Legal nurse consultants are nurses who bridge the practices of medicine and nursing with law. They work with attorneys who handle cases with medical issues, which can include medical or nursing malpractice, personal injury, products liability, criminal, matrimonial, or exposure to toxic chemicals. LNCs may enter the field through a wide variety of routes, including self-learning or going through a course taught at a college, online, or by a seminar company. There is no one right way to enter the field.
Be prepared to sacrifice, to work long hours and to continuously learn. Entrepreneurship gets into your blood as you begin to experience the joys of being your own boss. Legal nurse consulting opens many doors not available to other nurses. And it can be hugely satisfying.
Patricia Iyer MSN RN LNCC has been president of Med League Support Services, Inc. since 1989. She has coauthored, edited or written over 130 books, articles, chapters, online courses and case studies. She was the chief editor of the second edition of Principles and Practices of Legal Nurse Consulting, the core curriculum of the field. Her most recent texts was coedited with Alice Adams: The Path to Legal Nurse Consulting: Collective Wisdom of Successful LNCs. Pat offers a starter package to help nurses get launched in this rewarding field.
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