July 16, 2018

BLJ: Nurse paralegals read between the lines

BLJ: Nurse paralegals read between the lines

Mary Versterling has been a nurse for eight years, starting at Roswell Park Comprehensive Cancer Center and later in the health insurance field. 

“I spent that time really developing hands-on nursing skills,” she said. “I’ve always been fortunate enough to be an advocate for patients and their families.”

Last year, while considering a change in her career, she found out about an opening at Hurwitz & Fine P.C. for a nurse paralegal. 

“I was excited to take on a role like this because it would allow me to not only be able to advocate for patients and their families like I did before but also represent physicians, nurses, nursing assistants and nursing homes and hospitals,” she said. “I can be their voice, because I do think there are two sides to every story. I’ve seen that throughout my nursing career.”

The job requires her to be objective at all times.

“I wanted to be able to represent nurses and physicians,” she said. 

Nurse paralegals serve as liaisons between the medical and legal worlds, according to Versterling. Much of what she does involves poring over medical records.

“I keep in the back of my mind what is being claimed as I’m going through the medical records,” she said. “I’m thinking with a critical eye, looking for any discrepancies or gaps so we can really see the full picture.”

Nurse paralegals keep an eye out for a “deviation from standard of care” as they examine the records, she said.

“A lot of times, that’s why these cases are brought forward,” she said. 

She also searches for such things as time gaps between when an emergency call was made and when an ambulance arrives at a patient’s home or when a patient arrived at the emergency room. She said she goes through documents with a “fine-tooth comb,” looking for any and all details that could be used in a case. 

“That could make or break a case,” Vesterling said. “A nurse paralegal is able to read between the lines and know what to look for in the specific details.”

Patrick Curran, a member at Hurwitz & Fine who handles medical malpractice cases, describes nurse paralegals as “indispensable.”

“It’s extremely important, either as a plaintiff’s lawyer or a defense lawyer handling medical malpractice cases, to have competent, motivated nurse paralegals to help analyze a case,” he said. 

There’s a difference between an attorney’s point of view and that of a nurse paralegal, according to Curran. While an attorney serves as a client advocate, a nurse paralegal looks at the case objectively.

“They need to tell me if they see something I don’t,” he said. “They can help me understand the nursing process and medical process. Fairly often, we have a good-hearted debate about whether this was a deviation malpractice or not. We learn from each other.”

What impresses Curran is how a nurse can take a medical record, look at the medication list and often be able to tell lawyers something about the patient that they didn’t know before.

“It’s a constant learning experience,” he said. “We’re bouncing thoughts and sometimes arguments or theories back and forth.”

While more cases are settled before they go to trial, having a nurse paralegal as part of the trial team is something that must be considered on a case-by-case basis, Curran said. They are available at the law firm while a case is at trial. 

The role of a nurse paralegal may be different in mediation or arbitration.

“A mediation or arbitration may be much quicker – a day or a few days – as opposed to a trial that may go on for a week or weeks,” he said. “Again, most of the work done by a nurse paralegal on a case that ends up in arbitration or mediation is done beforehand.”

There’s a learning curve for nurse paralegals who lack experience in the legal profession, Curran added.

“It’s a challenge to apply what they know, in terms of medical issues and injuries, to the world of litigation,” he said. “Most of the nurse paralegals I’ve worked with in 35 years didn’t have previous training in the law or as a paralegal. You pick up what you need as you go along.”

He said Hurwitz & Fine finds that the health professionals’ time is best spent focusing on medical issues as opposed to the other duties a paralegal takes on. They may handle research in medical literature, for example, or strive to get a handle on the needed expertise a case requires. 

Indeed, the job requires a “forensic viewpoint,” according to Curran.

“You’re not just taking the facts as you find them, you’re trying to prove one side or the other,” he said. “It takes time for a nurse paralegal to see how that comes into play while they go through the facts.”

They also help the legal team to develop timelines and other methods to analyze information that’s needed for trial. 

Versterling said every nurse develops his or her own way to review records. She prefers to handle it in increments to combat eye fatigue and ensure that no detail is overlooked. 

“You also have to have significant nursing experience to pick up on little details and read between the lines. That’s a lot of what helps me be efficient while going through medical records,” she said.

“They’re looking at what it means in terms of care for that patient,” he said, “whether or not it was good care or questionable care.”

Nurse paralegals are a critical part of the legal team, according to Curran. 

 
 

“That idea of some hierarchy doesn’t exist,” he said. “A good plaintiff or defense attorney will listen to nurse paralegals.”

While the job is different from her previous nursing experience, Versterling said the challenges keep her on her toes.

“I really enjoy it, especially from the aspect of being able to not only advocate for the patients and their families but to make sure that someone is hearing the voices of the nurses or the physicians or the nursing aids,” she said.