Certified Legal Nurse Consultants never want to look foolish or say the wrong thing to an attorney-client. But what if it’s not you, but the attorney who requires redirection? The attorney has hired you for your nursing expertise, not to simply agree with everything they say. In this blog I’ve asked 8 CLNC® Pros to share how they respond when the attorney is wrong. Here’s what they say:
If the attorney is focusing on one nurse or one discipline within the hospital, and their focus is too narrow, I explain why another healthcare provider had greater responsibility for the patient and clarify that provider’s job responsibilities. Sometimes an attorney focuses on the provider who saw the patient after a problem occurred and assumes that person was responsible for addressing it. They might not understand the actual role each healthcare provider played. My job is to give the attorney insight into the responsibilities of each healthcare provider and to explain how the care provided relates to the issues in the case.
– Yolanda Anderson, RN, BSN, CEN, CPEN, CLNC
When an attorney-client is wrong or heading in a direction that could weaken the case, my tone is respectful, evidence-based and solution-oriented. This approach preserves the relationship while protecting the integrity of the case. When an attorney is pursuing a theory of liability that is not well supported by the medical documentation, I respectfully redirect the discussion toward alternative, better-supported theories. For example, rather than concentrating solely on the medical diagnoses, I may suggest focusing on the adverse procedural outcome and offer to provide the documentation and analysis that more clearly support that approach. If the attorney resists my redirection, I acknowledge the proposed strategy while professionally expressing my concerns. I explain how opposing counsel may leverage pre-existing medical history or other vulnerabilities, and I offer to outline those risks in detail so they can be fully considered before moving forward.
– Suzanne E. Arragg, RN, BSN, CDONA/LTC, CLNC
When the attorney is wrong or is pursuing the wrong angle, I explain my opinion professionally and clearly from a medical and nursing point of view. I also share redacted chronologies and reports I have prepared for other attorneys and explain how they benefited those cases. The attorneys are usually very interested in the reports and appreciate the information.
– Dale Barnes, RN, MSN, PHN, CLNC
I had an attorney-client whose emergency physician expert thought an acute infective endocarditis case was strong. I disagreed because there was more than one possible cause of the patient’s infective endocarditis. The timing was much closer to food the patient had ingested the week before symptom onset than to an electrolyte infusion the client had received more than eight weeks prior to symptoms. I shared the evidence-based research about the disease process which supported my opinion that causation would be difficult to prove.
I reviewed a different case as a potential testifying expert. The patient had extremely low blood pressure for an extended period before the nurse contacted a physician. The order clearly stated to “Call if the mean arterial pressure is below 60.” The mean arterial blood pressure had been below 60 for more than 45 minutes before the nurse took action. I first explained what the nurse did well in closely monitoring the patient. Then I informed the defense attorney that I could not support the case because the nurse’s actions were not consistent with the standards of care. I further explained that a deposition would likely go poorly for the defense if I was the testifying expert. I stood by my opinion and supported it in several ways. As a Certified Legal Nurse Consultant, I have to tell “the good, the bad and the ugly” as I was taught by LegalNurse.com. The sooner an attorney knows their case has problems, the better for everyone involved.
– Marcia Bell, RN, BSN, CAPA, CLNC
When an attorney is wrong, my approach is to educate. I use authoritative texts that support the correct information, and then I provide an example that reinforces that point. Most of the time, the attorney appreciates learning the correct information. I have only had one instance in which an attorney would not listen, and I had to terminate the relationship. I could not support the attorney’s viewpoint because it was incorrect, and I could not support the opinion he wanted me to give.
– Carol Fridal, MS, RN, CEN, CLNC
I was working with an attorney who had a clear lack of medical knowledge and frequently mispronounced complex medical terms such as spondylolisthesis and radiculopathy. Rather than reacting negatively, I professionally corrected the pronunciation and explained the terms. This approach helped the attorney improve his understanding while avoiding embarrassment. Accurate use of medical terminology is essential because misstatements can undermine credibility before a judge or jury.
– Dorene Goldstein, RNC, BSN, CLNC
When interacting with an attorney who is wrong or requires redirection, I remain professional and present the facts, standards and authoritative references. Attorneys are usually very receptive to this approach. I recently reviewed a case involving a resident in a long-term care facility who had significant weight loss, dehydration and pressure injuries. Certain aspects of the case required clarification. I explained the standards of care for significant weight loss and pressure injuries per CMS standards, as well as how those standards related to the healthcare facility’s deviations. The attorney expressed gratitude for the information and was able to strengthen his case development as a result. It is also important for the Certified Legal Nurse Consultant to respect the attorney’s expertise and to serve as an unbiased professional asset.
– Shequita Moore, MSN, RN, LNFA, CLNC
I approach attorneys with respect and professionalism while articulating my professional nursing opinion on medical-related cases. I focus on strengthening the attorney’s credibility rather than correcting them in a way that feels confrontational. I always take the opportunity to educate the attorney because education is part of the CLNC consultant’s role. The approach is everything. I clearly explain how I can strengthen their case or address potential issues. I also discuss standards of care without highlighting gaps in the attorney’s knowledge, and I avoid phrases such as “You’re wrong.” I remain firm in my opinion even if the attorney continues to disagree. A good attorney will respect that. This approach ultimately builds credibility and loyalty.
– Michelle Neal, RN, BSN, CLNC
When the attorney is wrong, it pays to provide the valuable service they pay you for, i.e., your opinion. By analyzing, clarifying and educating, you strengthen the attorney’s understanding of the healthcare issues and protect the integrity of the nursing analysis.
Thanks to Yolanda Anderson, RN, BSN, CEN, CPEN, CLNC, Suzanne E. Arragg, RN, BSN, CDONA/LTC, CLNC, Dale Barnes, RN, MSN, PHN, CLNC, Marcia Bell, RN, BSN, CAPA, CLNC, Carol Fridal, MS, RN, CEN, CLNC, Dorene Goldstein, RNC, BSN, CLNC, Shequita Moore, MSN, RN, LNFA, CLNC and Michelle Neal, RN, BSN, CLNC for sharing how to respond when the attorney is wrong.
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