Urine Trouble: A Story of How Nurses Can Help PI Attorneys to Filter Pre-Existing Conditions to Prove Causation and to Increase the Value of a Case

In this podcast episode, we have a special guest, Laurie Morgan, who shares her extensive clinical background as a nurse and her role as a legal nurse consultant. Our host, Elisa, explores how nurses can assist attorneys in personal injury cases, shedding light on the value they bring to the legal profession. Laurie discusses a specific personal injury case involving an older gentleman who experienced various injuries over the years, including an elevator accident that led to a neurogenic bladder condition. They delve into the importance of differentiating between pre-existing conditions and injuries caused by accidents, the role of nurses in analyzing medical records, and the financial impact of such injuries. Laurie's expertise in reviewing expert reports and providing valuable insights adds significant value to the case. Join us for this intriguing episode as we unravel the complexities of personal injury cases and the crucial role of nurses in the legal field.

Transcript

Elisa: 0:17

This is episode 18 Of your MedMal podcast, discovering the needle nurse consultants help you discover what you didn't know that you didn't know about how to win your medical malpractice case. If you're new to our podcast, welcome, you can learn more about how behind the scenes legal nurse consulting can improve your firm's win rates and profitability. By following us on LinkedIn or visiting our website@wwwdotnplegalconsultants.com. It's time to discover the nurse consultant advantage. Let's get started.

Elisa Collins: 0:50

Today our guest is Laurie Morgan. Welcome to the show. Laurie. Thank you for having me, Elisa. Tell us about your clinical background, and we'll go from there. Well, I've been a nurse for

Laurie Morgan: 1:00

a really long time. I started as a nursing assistant when I was in high school, and I've worked my way through medical surgical, I've done labor and delivery, I've been a school nurse. I actually did dabble as a clinical instructor also. I've worked on floors with my students in telemetry as well as Geri-Psychiatric, so that kind of got me into a lot of the different hospitals in different areas. I've worked in large teaching hospitals. I've worked in home care where we had a lot of wounds at that time. I work with adults with developmental disabilities right now, and all of their psychiatric needs. So that's just a few of the things that I've

Elisa Collins: 1:37

done. This has come up so many times on the podcast. As nurses, we're really blessed to have the ability to jump from one area of nursing to another without having to go through additional training or formal education. So it's a real blessing over the span of a career that we can do that. It sounds like you've taken advantage of that in your career.

Laurie Morgan: 1:58

Absolutely A lot of the times I did end up choosing jobs and positions that would work with my family. That is something that we can do as a nurse. So I do feel

Elisa Collins: 2:06

blessed to be able to do that. Legal nurse consulting is a really good way for nurses to use their skills and knowledge from home, and that helps with their life work balance. I can see that's of a common denominator in some of the choices that you have made in your nursing career. All of those things have in common you are intensely familiar with standards of care. Working in a teaching hospital, working in academia you have to be on your game when it comes to knowing the actual standards of care. So I, I'm sure that helps you in your legal nurse consulting.

Laurie Morgan: 2:36

Absolutely, because that's definitely something to focus on when you're working with students is teaching them that standard of care.

Elisa Collins: 2:42

There's, what the standard of care is and should be and then there's reality sometimes And what we're held to from a legal standpoint is the true standard of care what we learned in nursing school.

Laurie Morgan: 2:52

Exactly. Sometimes there's that line where, the standard of care versus reality, and that can be an important lesson when you're with students.

Elisa Collins: 3:00

As a clinical instructor, it may be difficult, because you have to educate them on,"Okay, this is how this should be done." But then their actual preceptor-- which is the person that they follow around or shadow on the actual floor-- they may tell them something different. Yeah. That's an awesome clinical background to offer your services as a consultant to the legal profession as an LNC. And I understand you do a fair bit of personal injury work at times for your clientele. Yeah. I've been fortunate to do

Laurie Morgan: 3:29

Med mal cases as well as personal injury.

Elisa Collins: 3:33

Laurie can be reached for consulting services at her website at lawlegalnurseconsulting.com. I'm excited because today's episode is a little bit different because so far we've had medical malpractice plaintiff's stories primarily as the focus of our episodes, and today I just thought we could have a special episode and share a different way that nurses can help attorneys. A lot of attorneys that take medical malpractice cases for the plaintiff also do a lot of personal injury, so I thought this would be a great special episode to bring Laurie on and talk about a personal injury case where a nurse was needed to help sort out the things in the case. Laurie, when would a nurse be necessary in a personal injury case, like when would that be helpful? Cause we're not looking at standards of care in personal injury. Exactly.

Laurie Morgan: 4:20

Typically personal injury attorneys are very good at dealing with basic injuries. It's when there's multiple injuries over years that it gets complicated for the attorneys. So in this case, this older gentleman had falls in the past. He had motor vehicle injuries in the past, he actually already had some fusion surgery in his back, where they fused the vertebrae together where

Elisa Collins: 4:44

they actually used

Laurie Morgan: 4:45

metal pieces to enclose his vertebra so that they were not causing pressure on his spinal cord. So this client already had all of these injuries prior, and then he ended up having another injury. He had an elevator accident where he damaged his spine further. And this time he actually started to have problems with urination. He had a condition called

Elisa Collins: 5:09

neurogenic bladder. Can you explain for our listeners what a neurogenic bladder is?

Laurie Morgan: 5:13

So when we urinate the signal comes from our brain and it goes down our central nervous system and down to the bladder. So if there's any interruption along that pathway, it will interrupt the ability to urinate and that's called"urgency". And those were the symptoms that were found in this person's case after his accident.

Elisa Collins: 5:36

An elevator accident that's seriously one of my worst nightmares. It doesn't stop me from getting in an elevator, but taking an elevator accident case, that would make my phobia just a little bit worse. Yeah, that's intense. I can't even imagine. Yeah,

Laurie Morgan: 5:51

Make you think twice about going on the elevator and taking the stairs instead?

Elisa Collins: 5:55

Yeah, I don't know if... depending on the building-- I don't know if that's necessarily what I'll start doing. But yeah, that's that's crazy. So what you have to look at is trying to tease apart what w as caused by the incident versus what was preexisting? What kind of pushback do you get from the defense on cases like that when you're working a plaintiff case?

Laurie Morgan: 6:17

So in this kind of case, obviously the defense is going to really harp upon the past injuries and that the new injury is an aggravation, but it would not have been as severe if this gentleman didn't already have all of this damage to his spine and his spinal cord.

Elisa Collins: 6:33

My understanding with personal injury is that even if they do have preexisting conditions a clear exacerbation of that condition that is caused by the injury is enough to justify some compensation for that plaintiff. Exactly. I mean, You don't have to necessarily show that the patient had absolutely no prior injuries.

Laurie Morgan: 6:53

Exactly. And in this case, he actually had very different symptoms after the accident. He did have some difficulties with urination prior to this injury, but after this accident, the symptoms were completely different.

Elisa Collins: 7:06

And as a nurse it's easier for you to think outside the box in terms of the different body systems that can contribute to that outward manifestation of urinary problems. So for example, you talked about frequency and urgency. Certainly, as a provider looking at that kind of presentation would have things like prostate problems on the differential as well as there's all sorts of body systems that get involved, kidneys, bladder, ureters, urethra, that kind of thing.

Laurie Morgan: 7:37

The urinary system is pretty complicated and injury in the spinal system can cause--p otentially-- urinary problems. So in this gentleman, after the accident, he was having lots of incontinence, which is not getting to the bathroom in time. He was having lots of urgency, and usually that would end up in an accident. In addition to that, he was also going to the bathroom during the day, every hour. Sometimes he would not be able to empty at all. And then he was also getting up five to seven times a night. So this is

Elisa Collins: 8:06

all post accident. All post

Laurie Morgan: 8:09

accident prior to the accident-- which was in his records-- he did have some obstructive problems. That can be related to prostate problems, as men age. But it was very clear in his records that this was very stable prior to the accident.

Elisa Collins: 8:24

So one thing you were able to do for that attorney was to take a look at the records and really compare and contrast the difference between how he was presenting in terms of his urinary symptoms before versus after the accident.

Laurie Morgan: 8:37

Yes, exactly. And that was really important to differentiate the two symptoms. And even the treatment afterwards, because he needed extensive treatment to try to help his symptoms. Unfortunately, he was not able to be treated with just PO medications. He ended up having to have some Botox treatments to his bladder and still was having some symptoms.

Elisa Collins: 8:57

I'm curious to know how you would present those sorts of findings to your attorney client. What strategies did you use in your work product?

Laurie Morgan: 9:04

So I went over what medications he was using prior to the accident and then all the additional medications that he needed afterwards. I did a future cost projection because he needed continued treatment: medial branch block. He was already being treated with quite a few medications, and the medications he was getting were pretty expensive. So his future cost projection was definitely an important part of the case.

Elisa Collins: 9:29

Is that something that the attorney asked you to do or is that something that you, after taking a look at the nature of the situation you suggested to the attorney that you could do to help?

Laurie Morgan: 9:40

Usually if it's just a basic-- like orthopedic injury-- that person will have already gone through treatment and they're at a medical maximum improvement place in their treatment. Whereas, in this case, it was very important because the patient was still undergoing treatment, and these treatments were only

Elisa Collins: 9:56

temporary. And I love that because as a nurse you can suggest a service that you can do to radically increase the value of the case-- or that actual compensation number of that case-- because, if you didn't have that number then you'd be working with a lot lower settlement. Exactly. A lot of times attorneys will think of services offered by a legal nurse consultant in terms of that hourly rate and kind of be like,"Oh, a nurse costs this much per hour." When in reality, when you're looking at it as paying for someone to come in and increase the value of your case and just turn that dial up. You can't-- I wanna say"you can't put a number on that"; I guess technically you can, but it's an investment that can turn around and have huge ROI for the attorney to just have someone who knows what they're talking about, come in and turn up that, dial on the value of the case.

Laurie Morgan: 10:51

And especially for a patient like this that's gonna need continued treatment

Elisa Collins: 10:55

in the future. Yeah. I mean, You look at something like urinary problems, it's a little bit of a pain, but compared to other types of injuries, I can see where the average attorney without a medical background wouldn't necessarily see... the"dollar signs" or the dollar amount attached to that. Because it is a symptom that is very disruptive to one's quality of life, certainly. Absolutely. But, unless you're experiencing that and your pocketbook is experiencing what difference that makes in your life, it's hard to put that economic damages on it. You know what I mean? Yeah. It's easy to overlook the economic damages of something that is... so clearly emotionally distressing and clearly, life disruptive. Nobody can argue that urinary problems are n ot a disruption in your life.

Laurie Morgan: 11:46

Especially for this gentleman where it was impacting his daily life as well as his sleep. And if you're not sleeping well, then it can affect your day as well. In addition to all the appointments that he needed for medications and follow up, and Botox. It does add up, for sure.

Elisa Collins: 12:01

Financially does a cost projection like that, do you get into the non-economic damages or is it strictly the economic damages?

Laurie Morgan: 12:10

This was just basically for settlement purposes. Give him some more information because he was worried that the defense was not gonna take his case seriously. Because neurogenic bladder is definitely something that can be difficult to prove.

Elisa Collins: 12:23

Yeah. And in this case he had bladder issues and urinary tract issues, which is anatomically--quite frankly-- a distinct problem. It may present itself with similar symptoms, but it is a distinct pathophysiology that was going. You come in and you're able to demonstrate through a clear chronology of symptoms a clear uptick in the symptoms shortly after the elevator?

Laurie Morgan: 12:51

Absolutely. And in this case it was interesting because the patient did have the prior urology problems, so he already had a urologist. So he saw the urologist less than a month after the accident.

Elisa Collins: 13:02

Yeah. And that's good in this case because yeah, it might be hard sometimes to get into a specialist that quickly, and when there's a huge gap between the time of the accident and the presentation of the symptoms on paper, then it can be really hard to make that case for causation. So that sounds like identifying that chronology really helped to increase the value of the case as well.

Laurie Morgan: 13:21

Yep, exactly. One other thing that I was asked to do for this case was to actually review the orthopedic experts report. In his report he conveniently left out some causation statements that were noted by the doctor. So I was able to point those out to the attorney as well.

Elisa Collins: 13:38

okay. So in his report he weaved in elements of the treating physician's opinions. But what was left out--if you look at their original records--is that those treating physicians actually opined on the causation. Yes, exactly. It can be tempting to read a report by a opposing counsel's expert and say"Well, this sure sounds legit. This sure sounds like it makes sense," but to dig into those records and to see the original records of the treating providers, and see what they have to say... that's critical. Not to just rely on the experts-- and especially not to rely on simply the reports of the experts of opposing counsel. So your attorney also hired an expert to counter what was being said by the expert of the opposing counsel...?

Laurie Morgan: 14:28

He did not. He had me review the expert report because that was actually very late in the case. I reviewed that probably a month before settlement.

Elisa Collins: 14:38

Did you get involved early on in the case or did he bring you in later?

Laurie Morgan: 14:42

I was working on the case for a good nine months because the patient, was getting additional treatments. So I got started in the case six months into his treatment, and then he continued to need treatments for his back pain as well. But he also was having the urology difficulties with urinary incontinence, frequency, and he was on medications, and then he would go back three months later and the medications were not effective, so then there would be another treatment offered to the patient. And he finally just realized he wasn't happy with the PO medications, and he opted for the Botox treatment.

Elisa Collins: 15:15

It sounds like there's a lot of different layers to the injuries here. Did you get involved also in the back pain aspects of it as well?

Laurie Morgan: 15:23

That--Yep. That was included also. That was another part of the case that was a little bit difficult because of all his past injuries, he was already taking quite a few pain medications prior to this injury. But there again, he also needed additional medication to manage his pain after. So That was another place where I showed what the patient was taking prior and what he was taking after.

Elisa Collins: 15:45

So your cost projection covered both the cost projection for the urinary symptoms and the cost projection for the back issues? Pain management. Yep. Yeah, and that's also one benefit of having someone behind the scenes generate something like that, because typically when you have a testifying expert, they're very narrow in their focus, and it's gonna be very difficult to find a testifying expert who is able, qualified, and willing to testify to both the cost projections for the urinary issues and the cost projections for the back issues. So to have a behind-the-scenes person come along and do that... behind the scenes we're a lot more liberal, I guess whereas a testifying expert is expected to stay very tightly in their lane, a behind-the-scenes consultant can wander around all over the medical spectrum to pick up the red flags in any and all areas, and then help that attorney to identify which aspects of the case require a testifying expert, and then also to locate that testifying expert. So you may have one behind the scenes person that is overall consultant on the case, and then that person points you to all the different testifying experts that would be needed to solidify your findings. Essentially by looking at what you looked at, coming to the same conclusion.

Laurie Morgan: 17:09

And I actually did locate some urology experts for this attorney. But he did end up not using any of them because they did go to settlement and he was pretty happy with what the settlement

Elisa Collins: 17:19

was. And really, that's the best of all worlds: to come to a settlement that both parties can be happy with. If we can bring all the facts out in the open and get this thing to. All the better because once a case goes to trial, the chances that it's gonna be a defense verdict are a lot higher. But if it's a plaintiff verdict, it's a lot more expensive for the defense. For the defense, yeah. To me, it feels like that, the reason for that is because the only two types of cases that make it to trial are those cases that the defense just firmly believes that they did nothing wrong and they will not budge because they just know that they can defend themselves to a jury. Or on the opposite extreme, it's those cases where the errors were so egregious that the plaintiff's counsel is certain that they'll get a jury verdict and therefore they don't accept the low ball offers of the defense, and eventually the defense runs out of time. To offer something that is acceptable and then they wind up in court simply because they ran out of time to continue to make these higher and higher offers to try and get themselves out of this situation. So what that winds up looking like, I would imagine, is that the cases that wind up in trial are either clearly for the defense or clearly for the plaintiff, right? That's why so many of them settle. And when you can help your case settle, especially in those iffy cases, to get it to settle...

Laurie Morgan: 18:52

My attorney said,"I hate this diagnosis. Is there any way that we can prove this?" so he was definitely happy that it went the way it did.

Elisa Collins: 18:59

Excellent. It sounds like you did a really fantastic job in using your nursing skills and your understanding of human anatomy and physiology. Stepping outside that box of what can cause these urinary symptoms. And, that natural propensity to think, okay well, he already had bladder problems. He already had, in this case prostate problems, but you can have those symptoms aggravated by multiple contributing physiology. One of the beauties of working with legal nurse consultants behind the scenes is it's a network really. And when you tap into that through a legal nurse consultant that you hire directly, you have access now to h er network-- in a indirect, roundabout way-- if there's something she doesn't know, the chances are she knows someone who does. Exactly. And she can either subcontract that out or just, tap into her network in some way. you used this tool that you were recommended to use by a certified life care planner to establish that this individual was likely to live how long? 20.2 years. And so that number plays into all of your number crunching for all the different things. The daily medications; in this case, I imagine the patient needed attends or some kind of adult diaper

Laurie Morgan: 20:12

yes, that would be one cost that the client would incur over the future years of his life. In addition to other treatments. So if we look at just his pre-injury medications for the year, it wasn't really expensive. His pre-injury medication cost was$350 for the. And then if we look at his post-injury medications, it was 8,500 for the year.

Elisa Collins: 20:37

Wow. When you multiply that by the 20 years, you can get some really high numbers really quickly, and it can really help in a case like this where the attorney was worried that it"might not be taken seriously". You know, you can start to really take those numbers seriously. And this is with just medications, let alone the incontinence supplies that I imagine were a part of the story, which those those run, cents a piece. And when you add those up, we're talking about a couple of dollars a day, but in 20 years that's a substantial amount. Absolutely.

Laurie Morgan: 21:09

Even to have a botox treatment in this case, between the anesthesia costs and the hospital costs and the doctor costs, et cetera. Each treatment was over$3,000.

Elisa Collins: 21:20

Yeah. And I think with a simple cost projection-- for the purpose of settling, most legal nurse consultants can figure their way through that. It's almost like... I think of it like a warning:"Don't make me go hire a life care planner!" Do you know what I mean? like, Look at this simple cost projection that my nurse did. Don't make me go hire a certified life care planner to spend 10 hours squeezing every last bit of value out of this. Because even with this cost projection, we're in the hundreds of thousands of dollars. Are you taking me seriously? because this is

Laurie Morgan: 21:51

the minimum case scenario. Sure. Because if you do the full numbers, it's going to

Elisa Collins: 21:55

be a lot higher. The more you look into it, the more. Come out of it. And you can literally spend even just an hour brainstorming and that hour brainstorming can squeeze an additional 10 or$20,000 out of a cost projection depending on the injuries and the types of case we're looking at. Very easily

Laurie Morgan: 22:13

the

Elisa Collins: 22:13

numbers start to add up for sure. Yeah, absolutely. I can absolutely see the value of that. Thank you for bringing that to our attention as a cost projection is one way that a legal nurse consultant can prime a, a case in advance of a life care planner or somebody else coming in to be able to testify to that. The real value there is that you were able to get this case to settle and this sounds like a case that would've probably gone all the way to trial, and if the attorney didn't have your help, they would've had a really hard. Or settled for much less. Really? Yeah. If it settled, it probably would've settled for a couple of grand, just throw a couple bucks at the guy, but really, I never would've imagined that it would cost,$8,000 a year for medications and then an additional eight to 10,000 a year for incontinence supplies times the 20 years. For something like that, we're not talking about someone in a wheelchair. We're not talking about someone who needs modifications to their home now, or a wheelchair van. We're just talking about someone who's has this very frustrating inconvenience of incontinence for the rest of their life,

Laurie Morgan: 23:12

rest of their lives. Yeah. And they're gonna need ongoing treatment for the rest of their life.

Elisa Collins: 23:15

Yeah. Thank you so much for bringing this story. It was a great example of how nurses can help in other types of cases besides medical malpractice and also how we can help with those cost projections. And on the damages side of things, in addition to what we normally talk about on the call, which is more standards of care and causation. But here you've brought some light to how nurses can help with the causation. Personal injury, teasing out preexisting conditions and providing a narrative for direct causation as well as speaking to damages. That's really insightful. Thank you so much. Thank you for having me, Elisa. All right,

Elisa: 23:51

You've been listening to discovering the needle nurse consultants help you discover what you didn't know that you didn't know about how to win your medical malpractice case. This podcast is a production of discovery, NP legal consultants. Discovery is the largest unified growing force of specialty nurse practitioners offering consulting services to medical malpractice attorneys who take cases for the plaintiff

Heidi: 24:14

To request a consultation or to be featured as a legal nurse consultant on our podcast, you may reach us on our website@ourwebsiteatwwwdotnplegalconsultants.com. Or by calling 2 0 8 7 7 9 1 9 9 0. That's 2 0 8 7 7 9 1 9 9 0.