Nurses at Law

When a hospital patient dies due to complications from falling out of bed, the cause might seem clear to the plaintiff’s attorney — hospital protocol was breached when the bed’s side rails were left down improperly, for example.

But for Meghan D’Angelo, a certified legal nurse consultant, digging into medical records and hospital policies frequently yields a wealth of contributing factors. In one such case, the patient had twice been given the wrong dose of a medication with sedating side effects, and the nursing staff had skimped on patient assessments.

“There was a lot going on,” D’Angelo said. “It illuminated all kinds of other issues.”

Throughout almost two decades working as a clinical nurse and in hospital administrative roles, D’Angelo said she’s tried to demystify health care information for those without a medical background — typically patients, friends and family members trying to understand medical terminology or weigh treatment options.

Now, she’s expanded her repertoire to translating medical records and other documents to support attorneys working on personal injury, medical malpractice and other cases with a medical angle.

After earning her legal nurse consulting certification, D’Angelo launched Chesapeake Legal Consulting Group LLC in Pikesville last September.

She juggles part-time work at her fledgling company with a job as assistant nurse manager of pediatric outpatient clinics at Johns Hopkins Hospital. She worked her way up from a staff nurse at Hopkins to her current position, but D’Angelo said once her client base becomes large enough, she plans to transition to full-time work at the consulting firm.

“I knew that I wanted to own my own company,” she said. “I have clinical expertise and administrative experience, and I felt like putting all of that together and helping people in a different way.”

From a medical perspective

As a consultant to attorneys, D’Angelo’s role goes deeper than that of an expert witness called to the stand at trial. She often comes in at the earliest stages of a potential claim to weigh whether or not the case has merit, then works on everything from evaluating a patient’s pre-existing conditions to determining whether standards of care were met.

Her work might involve a thorough examination of the medical records, hospital protocol, scope of nursing practice and applicable research, at a rate ranging from $150 to $250 an hour, she said.

“We’re looking from a high level down to a detailed level,” D’Angelo said. “I’ll say, ‘look, let’s not only focus on what happened at the bedside, but also, were the hospital policies and procedures followed?’”

In the patient-fall case, for example, D’Angelo was originally called in simply to verify that the bed rails were left down. But she found a host of other issues at play and worked on the case for two months.

As a practitioner with a background in both hands-on care and administration, D’Angelo said, she’s able to work on the side of the plaintiff’s attorney or with the health care provider’s legal team.

No matter the attorney’s position, D’Angelo said, she approaches the case from a health care perspective — as someone with first-hand experience caring for patients and overseeing hospital staff.

“It’s no different than when you’re taking a history from a patient,” she said. “You find out what it is the attorney needs, what is their position on the case. They’re the ones that are being the persuaders. My job is to find what they need to support that.”

However, D’Angelo said, her allegiance is to the facts — and when they support the other side, it’s her job to help the attorney prepare for opposing counsel’s argument.

‘Filling in the blanks’

Not all certified legal nurses are consultants like D’Angelo. At Silverman, Thompson, Slutkin & White LLC, in-house legal nurse Ruth Stein assists in some capacity with all the medical malpractice and catastrophic injury cases the firm handles, said senior partner Andrew G. Slutkin.

At any particular time, Stein said she’s usually in the discovery stage on about 15 cases and has another 15 or so in litigation or in some type of claims process. These might vary from a slip-and-fall to a delay in diagnosing cancer to chemical burns from surgery.

“She’s our investigator,” Slutkin said. “As medical malpractice lawyers, and lawyers who do catastrophic-injury cases, we are very adept at reviewing medical records — we have to be — but we’re not doctors and nurses.”

In one case against a surgeon who removed the wrong ovary from a patient, Stein found that the defendant doctor had altered the patient’s medical records, creating a second set of records with different notes in order to cover her tracks in the eventual lawsuit.

“We used it at trial, and it was beautiful to put up these two versions and show that what the doctor was saying was only in one set,” Slutkin said. “It was a great way to prove the case.”

Although the challenges a nursing professional faces in the legal field differ from those of a clinical nurse working 12-hour shifts at a hospital, there is some overlap, Stein said.

“You’re evaluating more than just nursing care; you’re evaluating the care of medical specialists. You have to have the knowledge to be able to understand the medical and legal issues together,” Stein said. “I’ve learned so much — every case is a puzzle.”

For D’Angelo, making sense of what went wrong in a malpractice or negligence case is one of the most satisfying aspects of the job.

“Looking at something the attorney or paralegal is struggling with as far as content is very clear for me,” she said. “It’s obviously not at the bedside, working with nursing staff, but it’s really filling in the blanks and realizing what’s missing and what’s needed to strengthen the attorney’s case.”