Nurses Market Medical Skills in Legal Realm : Advisers summarize medical histories for lawyers, advise in jury selection, sit in on depositions, do research.

18 y/o Ma S/P TC 8 mo. ago.

Medical personnel can read that sentence, but most of us don’t have a clue to its meaning. It describes an 18-year-old man who was in a traffic accident eight months ago.

The abbreviations are standard argot for a medical chart. But they befuddle most lawyers and insurance claims representatives who deal with medical malpractice, personal injury and medical products liability cases.

In the past, lawyers and insurance companies have hired doctors to read the charts and testify as experts--at a cost of $300 to $500 an hour. Today, nurses are marketing themselves as legal nurse consultants with some success at the much lower hourly rate of $75 to $150.

Karen McLachlan, president of the 45-member Orange County chapter of the American Assn. of Legal Nurse Consultants, wears a beeper just about everywhere she goes. It went off twice during a recent Friday breakfast.

McLachlan believes she is the busiest independent legal nurse consultant in Orange County, with 30 clients. “There are a couple in L.A. who are busier,” said McLachlan, who serves Orange County clients from her home office in Long Beach. She moved there recently after living in Anaheim.

Her job consists of reading charts and summarizing the history of medical care for lawyers. She also attends jury selections as an adviser, sits in on depositions and researches the likely cost of care for an injured patient throughout his or her lifetime.

What McLachlan likes best, though, is sifting through the charts. Recently, she investigated a case of a 2-year-old girl who is severely retarded because of alleged medical mishandling. Lawyers believed the baby was damaged during delivery. But McLachlan discovered that the delivery was fine and that negligent postpartum nursing care probably caused the child’s brain damage.

“The attorneys could have wasted their time going after the obstetrician,” said McLachlan, who still works one day a week as a nurse at St. Mary’s Hospital in Long Beach. “It’s like being a detective. You want to find the missing link that caused the problem.”

She said she has some misgivings about criticizing the work of other nurses. But she reminds herself that her role is as a patient advocate.

The profession of legal nurse is about five years old and grew most rapidly in Arizona because state law there requires a nurse’s review of cases charging negligence by a nurse. Many Arizona law firms employ nurse consultants on staff. The year-old national association is based in Phoenix.

In Southern California, most legal nurses work as independent consultants, but about seven Orange County law firms employ in-house nurse experts, according to McLachlan.

Mark Plummer, a lawyer in the Law Offices of Herbert Hafif in Newport Beach, said legal nurses have trouble convincing lawyers to use their services rather than a doctor’s.

“It’s hard to depend on somebody so much,” he said. “If she were to miss something that caused me to undervalue a case . . . in a sense, I’m in the business of insuring my opinion.”

He said he began working with McLachlan after hearing from others that she is reliable.

Also, legal nurses often are not chosen as substitutes for a doctor on the witness stand, because lawyers think a doctor holds more sway with a jury.

“Many lawyers say that when they go to court, they have to have a doctor for credibility,” said Pat Fyler, who runs a legal nurse referral service in Brea. “But as a physician friend told me: ‘We both know the nurses are the ones who really know what’s going on.’ ”

Fyler Associates is just over a year old and has a list of 40 nurses who can be called on to consult, depending on the specialty needed. She expects there will be great demand for expert testimony from cosmetic surgery nurses soon, for cases about silicone breast implants.

Fyler netted $22,000 during her first year in her legal consulting business, and she continues to work full time in the emergency room at St. Jude Medical Center in Fullerton. She stepped down as manager of the emergency department to start her referral service.

Fyler coaches her nurses, some of whom are just getting a start as consultants. One of the most difficult things, she said, is getting the nurses to speak directly about the errors they see in patient care.

“One of the skills nurses learn is how to tell doctors what to do without appearing to tell them what to do,” Fyler said. “I tell them now they can come out and say what they’re thinking.”