Medical Legal Consulting News, Winter 2013
IN THIS ISSUE:
- Case Study: A Classical Example
- Vocabulary Quiz: Got Your Back
Welcome to the 2013 Winter issue of Medical Legal Consulting News from MLCS, Inc. I hope that this New Year is off to a bright and successful start and that you are having an opportunity to enjoy some winter wonderland.
We suggest avoiding injuries with good reading material and good music. On that “note,” let us introduce our newsletter theme for the year 2013: MLCS’ Greatest Hits, featuring case studies of MLCS medical record reviews and analysis that uncovered pivotal details which significantly impacted outcomes.
We welcome your feedback and appreciate any suggestions for case studies. Look for our “Rock and Roll” article in the Spring 2013 issue.
Linda Luedtke, RN, MSN
President and Director of Consulting Services
Case Study: A Classical Example
Claimant changes tune on relevancy of fall to his spinal injury when MLCS decodes the medical records.
MLCS nurse consultants work from the philosophy that the best defense and offense is the truth revealed in the medical records. We find that reviewing the medical records and bills and creating a record summary in chronological order allows the truth of the records to come to the top… in other words, there is a melody line.
This melody line tells the story of the injury and treatment and reflects natural history, the expected course for recovery. “Dissonance” or a wrong chord in the melody line can be hard to spot, but is typically obvious to the “trained ear” of the MLCS nurse consultant. When something does not fit the melody, we “listen” for alternative explanations, pertinent missing records, and relevant pre-existing conditions.
MLCS nurses have completed thousands of medical record reviews involving spinal injuries since 1990. We consider these reviews our classical pieces. It often takes a well-trained ear to quickly spot the dissonance. “Listen” to this one, which resulted in the claimant changing his tune from a demand of $500,000 to a settlement of $35,000. MLCS received an assignment to review voluminous medical records of an active 80-year- old gentleman who was alleging multiple injuries as a result of a fall in a parking lot. The primary injury was aggravation of a pre-existing spinal condition requiring surgery at less than four months after the fall.
Prior to MLCS involvement, the demand was $500,000. When we reviewed the records, what did we hear? The fall was not a change in tempo or even a key change, but very consistent with the pre-accident melody line, which included a predisposition for falls because of a history of vertigo, lumbar spinal stenosis, decreased vision, knee surgery and the aging process. What did this suggest? The fall most likely did not cause the condition that required surgery.
Missing records provide clues
Despite the volume of records provided by the plaintiff, pertinent records from the year prior to the fall were not provided. The available records suggested that the claimant was treated in multiple states (including VA facilities); this gentleman had winter and summer residences. The incomplete post-accident records revealed different accounts of the fall.
There were several normal neurological exams within the first two months post-injury, which would support that a significant acute injury was not present. There were also several records in which there was no mention of the spinal or radiating extremity complaints.
MRI scanning and the operative report supported that a degenerative process rather than acute injury was the primary reason for surgery. The MLCS nurse found that symptoms worsened several weeks to months post-accident, which would not support that the fall was the cause. Also, there was evidence of a likely motor vehicle accident in another state — a clue to more missing records.
MLCS report + negotiation = dropped demand, then settlement
The MLCS nurse consultant organized the medical record facts as to why the lumbar surgery did not appear reasonably related to the minor fall, and compiled a detailed missing record list for pre- and post-accident records. The defense attorney used the information in negotiation.
The demand dropped from $500,000 to $90,000. Requests were made for additional records. Prior to the MLCS nurse reviewing the complete records, the case settled for $35,000. How’s that for changing the tune?!
For more information regarding this record review, or if you have an outcome to share, please contact us at 630-357-4040 or click here.
Start off evaluating back injury claims on the right note! Understanding terminology is a major key.