Making Their Case Two Nurses Launch Business Providing Medical-legal Research for Lawyers

Amie Cashman, RN, was looking for something different.Her work as a nurse was rewarding, but the hours and the stress were starting to take their toll — physically and emotionally. What’s more, the work had started to become routine in many ways. “I thought I wasn’t using my brain anymore,” she recalled. “I was seeing the same types of things over and over again. I was ready for a new challenge.”

She’s found one in the emerging profession of ‘legal nurse consultant,’ an individual who provides consultative services to lawyers weighing medical malpractice cases and other legal work involving the medical profession. She and partner Denise Neal, also an RN, have formed Legal Nurse Consultants of New England.

Their small but growing venture provides a wide variety of services to law firms of all sizes across the Pioneer Valley and well beyond. Their case list continues to grow through word-of-mouth referrals, and, while they don’t have a business plan in place yet, they have high expectations for their enterprise.

In Neal’s words, the partners have traded one form of stress for another. They still work long hours — most weeks, anyway — but the hours are of their own choosing. Meanwhile, the work brings high levels of variety and excitement: a combination of law, medicine, and old-fashioned detective work.

“Each day is different, and each case is different — there’s a lot of learning going on,” said Cashman. “You don’t know what’s going to come across your desk every day — that’s the fun part.”

The Healthcare News looks this month at this emerging specialty, and how Neal and Cashman are stating their case in the local market.

Case in Point

When asked what they can bring to the table for their clients, Cashman and Neal said it is the ability to see what those not in the medical profession might not see when weighing a medical malpractice case or other type of health care-related matter.

“We can read between the lines,” said Neal, who told The Healthcare News that, while a simple medical chart can be hard enough for a layman to read, it’s what is not on the chart that is often more important in deciding whether a particular case has merit.

“It’s what’s between the lines that most attorneys or paralegals wouldn’t see,” said Neal. “We look at what’s there, and we ask, ‘what’s missing?’ And, because we’re nurses, we know what’s really going on when there’s a patient emergency or when a patient’s not doing well.”

Medical professionals serving as consultants to those in the legal community is certainly nothing new. Doctors, nurses, and other medical professionals have been hired by lawyers to help screen cases and serve as expert witnesses for decades now.

But with the growing litigiousness of society — and also due to increasing amounts of stress endured by those in medicine — consulting work is becoming an increasingly attractive career option, said Cashman, who notes that there are now more than 4,500 certified legal nurse consultants across the country.

And she predicts that, if little is done to alleviate the current high levels of stress on nursing or to combat the sky-high malpractice insurance rates in this state and many others, more nurses and doctors may look to the legal consulting field in the future.

For now, Cashman and Neal don’t have too much competition in a field they’ve been in together for roughly a year now.

As nurses at Baystate Medical Center, they knew each other, although they worked in different departments, and concluded at about the same time that the mounting stress and long hours were not what they bargained for when they joined the nursing profession.

“I had been in nursing for nearly 11 years and found that it was starting to take its toll,” said Cashman, who had moved back to her native Western Mass. after living for many years in Washington state. “The pay wasn’t great, and there wasn’t much flexibility, so I started looking at other options.”

She came across some literature on legal nurse consulting, and became intrigued enough to attend the Medical Legal Consulting Institute in Houston and gain certification in that specialty. In mid-2001, she set up shop in her home.

Neal, who started in nursing in 1990, followed a similar course. “At the time I started looking at some alternatives, there was a lot of stress going on at Baystate, and all hospitals,” she said. “Nurses were being asked to work more hours and handle more patients. It’s better now, but at the time, it was pretty stressful.”

She considered law school, but didn’t want to get out of nursing altogether. Legal nurse consulting allowed her to bridge both the legal and medical fields. She attended the institute in Florida and, after helping Cashman start a newsletter on legal consulting, started working on cases together with her in May 2002.

Becoming a legal nurse consultant offers one a chance to stay in health care — although it’s not exactly on the front lines — and the work can be much more lucrative, said Neal, noting that, while most nurses top out at $30 per hour, consultants to lawyers can make $75 to $100 per hour and choose their caseload and schedule.

Healthy Alternative

Cashman and Neal say their work takes a number of forms and includes everything from reviewing patient records to preparing written reports and chronological timelines, locating expert witnesses to identifying missing records, writing deposition questions to interviewing witnesses.

The bulk of their day-to-day work involves helping lawyers (and therefore the insurance companies and individuals they represent) determine if a medical malpractice, workers’ compensation, or other type of medical case has merit.

In the case of medical malpractice, this is a process that involves review of the treatment provided to a patient — what was done and, in many cases, not done — and measuring it against the industry’s accepted standards of care.

And while they don’t have any hard numbers, Neal and Cashman say that only a small percentage of the cases they review — perhaps only one in 10 — do have merit.

That’s because there’s a big difference between a bad outcome and negligence, said Neal, who said the latter has a specific definition and is simply not as subjective as many might think. That is especially true in the area of obstetrics, where many of the more high-profile malpractice cases originate.

“In many cases, we find that it wasn’t something that happened during delivery that led to a bad outcome, but something that happened much earlier,” said Neal. “And often, these are things that are hereditary or genetic, that the obstetrician had no control over.”

And because their research keeps a number of meritless cases from going to trial, Cashman and Neal believe that they are part of the solution, not part of the problem, when it comes to the larger issue of medical malpractice and the costs that must be borne by the medical profession.

“Our work keeps a lot of cases out of the courts,” said Neal. “We save the attorney a lot of time and a lot of grief, but we also help bring down costs for the insurance companies and their clients.”

While experienced as nurses, Cashman and Neal are not well-versed in the many aspects of running their own business, and they told The Healthcare News that the learning curve is extensive.

While growing their caseload, the two are also getting on-the-job training in finances, marketing, and other aspects of entrepreneurship. They say their business plan is a work in progress, one slowed by their current volume of cases.

They have begun to more aggressively market their business, an exercise they say could fall more under the heading of education for lawyers about what they do and how they can save people time and money.

“Some attorneys still don’t know what legal nurse consultants are or how they can help them, so they try to do this work themselves,” said Cashman. “And while they may be good attorneys, they’re not doctors or nurses, so they might miss things that we can find.”

The Verdict Is In

Given the chance to think about it, Cashman said her comment about not using her brain in nursing was a bit of an exaggeration and not entirely accurate. Like Neal, she does a few shifts a week at Baystate, and still finds the work enjoyable.

However, she’s using her brain more, and in many different ways, at what she now considers her day job — being a legal nurse consultant.

She and Neal still have stress, and they still work long hours — but now they’re working for themselves, and that makes all the difference in the world.
“There are a lot of days when it just doesn’t feel like work,” said Neal. “You don’t get that feeling in nursing.”