FAQ

Why should I hire a LNC or Paralegal Nurse Consultant when I have a physician reviewing my cases?
The simplest answer is to mitigate cost exposure. In cases where merit or economic benefit is not painfully obvious – nearly at the res ipsa level – your firm may incur substantial cost only to find the case is not sustainable. Additionally; courts, and most State Bars, take a dim view of attorney’s billing excessive costs or expenses to clients. A Paralegal Nurse Consultant will efficiently review, categorize, and summarize medical records as bill to file expenses permitting more efficient use of more costly physician input where actually necessary. A well organized and annotated review of voluminous medical records can reduce testifying expert review time and client/firm expense by as much as 50%. Nurses have generated, worked with, and reviewed medical records throughout their careers. Professional nurses bring extensive experience in myriad aspects of the medical/healthcare fields in addition to familiarity with health systems, particularly the nursing care that occurs at the patient’s bedside. A preliminary nursing review allows a physician reviewer/expert to focus her/his review on the most pertinent entries in a record, thereby saving them time and your client money. Paralegal Nurse Consultants provide these services with the added benefit to the firm of generating reports of relevant case law and statutes preliminarily formatted to meet the needs of the appropriate jurisdiction to reduce the time a firm’s paralegal spends preparing documents for filing.
I ‘Offshore’ my medical record services and that company provides quality service at a low cost for my firm and my clients; Why choose MarGin?
There are a number of companies providing these services “offshore” and those we have seen do good work. They use physicians frequently educated in the United States but who have returned to their home country and can afford to work at a reduced wage because of a lower cost of living. MarGin believes these companies can prove a valuable asset in a mix that includes MarGin. While these companies offer a quality service at a lower cost, their staff is not available to answer follow-up questions or ongoing advice or recommendations as the circumstances of your case change. While quality and cost are both likely beneficial to you or your firm, the service focus is necessarily narrow. Have you ever found yourself needing a medical or science research article in 48 hours? Needed to clarify a point of medicine or science in your mind the day before a deposition or trial? That’s where MarGin excels. While it is easier for us to understand what you need if we’ve been involved from the intake, we strive to complete even the most arduous research for our clients in time to actually be of help.
My paralegal has reviewed and organized hundreds of medical records and does a great job, why hire MarGin?
A paralegal’s experience with medical records likely parallels that of the supervising attorney. Identifying meritorious cases in malpractice actions is very different from identifying issues of merit within a matter. Medical records frequently contain information that permits a trained reviewer to recognize additional (missing) records pertinent to the matter that would not be obvious to persons without significant experience in healthcare. An attorney or paralegal without specific education, training, or experience in healthcare or medicine may not recognize from a client’s intake alternative theories of tortious conduct. An attorney, paralegal, or even a physician expert reviewing a record may not recognize the discrete indicators of breaches by other practitioners; nurses, respiratory care providers, ancillary personnel, or even hospital policy failures. When addressing medical malpractice the issue is specific and narrow while causation of the client’s result may be broad in scope. A paralegal nurse consultant is the professional best placed by training and experience to examine this breadth of information to better focus the query.
What is the difference between a Paralegal, a Legal Nurse Consultant (LNC), and a Paralegal Nurse Consultant?
Attorneys are well aware of the value brought to their practice by well-trained and broadly experienced paralegals. Without an education or experience set that includes health sciences; however, paralegals are handicapped when working to understand the minutiae of medical records. The LNC focuses on the nursing/medical and health care system issues, while a Paralegal Nurse Consultant can bring together healthcare/medical perspective with the education and experience of a paralegal to conduct preliminary primary law research relevant to the matter under consideration. Additionally, a Paralegal Nurse Consultant is better positioned to provide pre-drafted complaints/petitions; answers/responses; deposition/interrogatory questions; and motions/requests for production or admissions consistent with your jurisdiction’s Rules of Court. Properly and effectively done, these documents may permit your experienced paralegal to reduce the time required to produce these documents and spend more time on the research and client interactions that actually drive your practice..
On what types of cases can Paralegal Nurse Consultants provide assistance to attorneys?
With paralegal training, a Paralegal Nurse Consultant can assist an attorney or firm with additional support in any matter. Through the application of their experience in nursing, Paralegal Nurse Consultants can prove to be of particular value in matters related to:

Can MarGin do everything that my testifying physician experts can?
The short answer is no. The practice of medicine is outside the scope of practice of nursing. Much like the unauthorized practice of law by an experienced paralegal. Nurses and paralegals deal with records and their content as a core component of our jobs. Both bring to the attention of their supervising practitioner relevant information and opinions regarding the quality of the information available. Nurses, like paralegals, are well schooled in identifying standards of practice and care as well as the import of this information. While nurses are not qualified by training to judge physician performance, identifying this information before engaging a consulting physician saves in physician time and firm expense. In fact, in the courts of the 5th Circuit, Legal Nurse Consultants and their opinion of medical causation has been specifically addressed.

MarGin offers Standard of Care reviews and causation evaluations within the parameters of Cleveland ex rel. Cleveland v. US, 457 F.3d 397 (5th Cir. 2006) which states in relevant part:

Wanda Poret (“Poret”), a [C]ertified [L]egal [N]urse [C]onsultant, was prepared to testify on Cleveland’s behalf that the BJACH employees deviated from the acceptable standard of care by neglecting to take a chest film and failing to diagnose congestive heart failure. In her report, she opined that had Samuel been treated for congestive heart failure on his initial visit, his subsequent deterioration could have been prevented. The United States objected to her admission as an expert witness, arguing that, as a nurse, she was not qualified to testify as to the standard of care owed by physician assistant Eubanks. The district court excluded her testimony without a written memorandum of reasons for the ruling.

The court went on to rule:

Poret’s written report focused exclusively on the failure of the physician assistant at BJACH to meet the requisite standard of care. In her opposition to the United States’ motion to exclude Poret’s testimony, Cleveland attempted to argue that Poret was qualified to read and explicate the “chronology of care” Samuel received at BJACH, as Poret possesses a Bachelors Degree in Nursing and is a Certified Legal Nurse Consultant. However, this argument is inapposite given the content of her report. As a nurse, Poret is not qualified to testify as to a physician’s standard of care or the standard of care governing a physician assistant who stands in the place of the treating physician.See Broussard, 921 So.2d at 132 (stating the rule that only physicians qualified in a particular medical field may testify as to the standard of care owed by physicians in that specialty). The district court did not abuse its discretion in excluding Poret’s testimony as she was not qualified to testify as to the standard of care applicable to a physician assistant. Id. at 405.

What do you mean when you talk about the MarGin Advantage in Expert Witness Location?

MarGin Consulting, LLC has a better approach. We search for an expert for your case from scratch. We conduct an independent search for each expert and each case, we have no subscribers, and we do not maintain an ongoing relationship with any experts. Our process is geared to discovery and vetting of matter matched experts with full transparency and discretion. And, since our experts are university professors in full-time clinical practice, or selected for their dual credentialing, our clients are assured of top-tier credentials from a true expert.

There are any number of nurse consultants and self-proclaimed expert “referral services” who refer attorneys to experts in their database. It is MarGin’s contention that these databases are flawed for several reasons. To begin with; these databases are limited to experts with whom the referring nurse or service has an ongoing relationship. This reduces the likelihood that a recommended expert is actually chosen for her/his expertise in addressing your fact pattern. Additionally; many of these providers simply request the aide of others with such a database if they haven’t an expert in the field identified by the attorney. Further still; calling MarGin will result in our asking for the fact pattern and allegations to ensure that the appropriate field(s) of expertise are identified. By way of example, some topic are basic to a broad field and do not, per the Rules of Evidence, require multiple sub-specialty certifications. Abandonment of a home-bound ventilator dependent pediatric patient does not require a nursing expert in the same specialty. Abandonment is the issue and that is a constituent of fundamental nursing practice and licensure. The opinion expert is actually a fact expert. Though the court may wish an opinion or Special Matters affidavit or certification, the burden is not an identically matched provider. It is, in fact, a qualified provider. Remember that “experts” in searcher databases sometimes pay a listing fee in exchange for the referral, while in other cases the referring agent bills a surcharge over the expert’s actual fee in order to monetize the process. All this while the referral service builds a list of experts ready to opine on any case. Additionally; these experts chosen from databases are often not vetted for their ability to withstand a challenge based upon your fact pattern or allegation(s). In some cases, owing to only minimal familiarity with statutory and appellate law, conflicts are not adequately investigated or identified.

What do you do that will bullet-proof the experts you find for my firm?

MarGin Consulting, LLC uses a proprietary 10 point questionnaire developed based upon discussions with and research by attorneys from across the United States. MarGin has distilled the approach to substantive challenges to experts to these questions and instructs each expert selected by our clients on how to prepare for these challenges.

Much is made of Daubert, and rightly so, however; Daubert progeny in Kumho and Joiner cannot be dismissed. Additionally, each jurisdiction has its own appellate rulings regarding experts and their opinions and testimony. We respectfully ask you to inquire about the “gatekeeper” rulings and statutes in your jurisdiction when investigating an expert location service. The answers may surprise you.

As a part of our expert vetting process MarGin screens more than 200,000 published and unpublished appellate decisions in just one investigative database to identify successful substantive challenges. This, in addition to our significant investigative capabilities will help assure that your MarGin recommended expert witnesses will be available throughout your case’s life.

What is the cost to prepare medical records for a case?
This, of course, depends on the volume and complexity to the records received and the scope of the review requested. MarGin will, upon request, provide a detailed cost estimate. This estimate is, in fact, a guaranteed maximum cost for the services requested. This approach allows attorneys to reasonably determine the value of moving forward. MarGin will review available medical records as outlined in our schedule of services and then give the client a, generally, non-discoverable report that will also include recommendations and next steps. Those may include requests for additional records or creating a summary of the case’s strengths and weaknesses, with or without a detailed chronology of events. The attorney/firm determines the scope and detail required of the work product before work begins to eliminate billing surprises. While delivering the highest possible quality service, MarGin works to accommodate firm budgets when possible without sacrificing quality.
Can you help provide assistance with a nursing home case even though your specialty areas are critical care, oncology, hospice and home care nursing?
Certainly. A review of nursing care provided is subject to, firstly, fundamental nursing practice and care provided in every setting. Wound care and prevention, infection control, patient education, medication review and administration, nursing procedures and interventions, documentation of care and patient progress or level of compliance, and coordination of care across myriad professions and specialties are all core competencies in nursing. We have specialty practice professionals on call to supplement this review to ensure that specialty standards we review are thoroughly considered. Additionally, we locate consulting and/or testifying medical and nursing expert witnesses who are well versed in the Standards of Care for their particular specialty.
What does MarGin Consulting offer that other nurse consultants do not?
MarGin blends nursing and paralegal skills to offer a seamless integration of our work product to your practice needs. MarGin is fully ABA RPC Rule 1.5(a)(1) compliant by billing based upon the educational or skill level required for the work engaged. MarGin also eliminates collateral attack on our interactions with our attorney clients by not providing testimony in depositions or at trial. We assist in identifying and vetting appropriate experts for testimony and then step away from the process to maintain the applicability of the work product rule. MarGin provides licensure/sanction information, including reported criminal convictions for retained and opposing experts when requested. MarGin can coordinate record retrieval to reduce turnaround time with appropriate authorizations in place. All records are forwarded as received to the attorney or firm as initial work begins without delay. MarGin fully vets expert witnesses, both supporting and opposing and will, if so engaged, provide detailed information regarding the professional litigation history of experts with case details appended. We access documents and filings where available, including depositions, motions, testimony and rulings related to the expert. We are also available to provide a detailed background report on all experts upon request.