The one case I will always remember is the case with the largest volume of medical records I have ever reviewed – more than 70,000 pages. It is also the first case in which I testified at trial. Venturing into the courtroom is one of the experiences that has made me most proud to be a Certified Legal Nurse Consultant.
The case involved a patient who remained in a hospital intensive care unit for approximately 13 months following nonemergent cholecystectomy. The patient had multiple preexisting comorbidities, including hypertension, diabetes, kidney disease and morbid obesity. After the initial surgery, she developed multiple postoperative complications, including a severe, life-threatening infection that necessitated several additional surgeries and consideration for transfer to a tertiary hospital. She was never transferred despite multiple opportunities. The patient ultimately died from complications of the surgical infection and renal failure.
Following her death, the family filed a lawsuit against the surgeon and the hospital. The causes of action included medical negligence and elder abuse. Deviations from the standards of care included:
- Failure to document and communicate a significant change in condition.
- Failure to develop and follow an appropriate nursing care plan.
- Failure to implement physician orders timely and appropriately.
- Failure to adhere to hospital policies and procedures.
Although I had previously been retained as an expert witness in several cases, none had proceeded to trial. I understood that the case would likely go to trial and had to give considerable thought to accepting a testifying expert role. I had worked successfully as a consulting expert for many years. Testifying in a courtroom was different. Could I present complex information clearly under the pressure of testifying? After careful consideration, I decided to go for it.
I was retained by the plaintiff’s attorney and testified for three days. My role was to educate the jury about the standards of care applicable to ICU nursing. My testimony addressed, among other subjects, hemodynamic monitoring values, appropriate nursing interventions and the ICU nurse’s responsibility to notify the physician of significant changes in the patient’s condition. Explaining these concepts to the jury was more difficult than I had anticipated. By the time I was called to testify the jurors were tired. They had already heard from several other testifying experts, including a wound care nurse and a physician.
My testimony represented only one component of the plaintiff’s broader legal strategy. For example, there were issues related to staffing and hospital expansion that were outside the scope of my testimony and beyond my area of expertise.
The trial resulted in a defense verdict. Despite that fact, the attorney told me that I had presented complex information to the jury clearly and performed well. He commented that I was impartial, confident and consistent in my opinions. Most importantly, he shared that the plaintiff’s family appreciated my testimony.
One thing I would have done differently is request all relevant deposition transcripts. During cross-examination the opposing attorney asked if I had reviewed the deposition transcripts of one of the surgeons and understood his rationale for not transferring the patient to the tertiary hospital during a critical period. The plaintiff attorney had not provided that particular transcript, and I had not thought to request it. While I was embarrassed, my opinion remained unchanged.
Even though testifying at a trial was new for me, my clinical expertise gave me a confidence that opposing counsel could not diminish. Trusting my nursing education, clinical experience and CLNC® training was all I needed to do a good job. Part of being a CLNC consultant is recognizing one’s professional worth and the value one brings to attorneys. Testifying was not at the top of my professional to-do list. This case required me to leave my comfort zone. I did more than meet the challenge. I learned from it. Participating in trial gave me first-hand knowledge of courtroom proceedings that I could never have gained solely through the consulting expert role. I entered the courtroom wondering whether I was ready. I left knowing that I was capable. I am profoundly grateful for the experience.
Guest Blogger Profile
Laura Tippit, MSN, RN, GERO-BC, CLNC, owner of Legal Health Partners, has more than 28 years’ nursing experience in critical care, telemetry, gerontology, and travel nursing. Laura consults on medical-related cases for both plaintiff and defense attorneys.
