One City Built to Last
The news is in: On November 7, 2014, the justices announced they would decide on a lawsuit claiming that the language of the Affordable Care Act doesn’t allow the government to provide tax-credits to low-and-moderate-income health insurance consumers using federally funded Obamacare exchanges operating in more than 30 states. Indeed, there’s a medical quagmire. And there is a lack of communication between doctors, staffing and patients. For example, the Affordable Care Act isn’t just about insurance coverage. The legislation is also about transforming the way health care is provided. In fact, it has brought in new competitors, services and business practices, which are in turn producing substantial industry shifts that affect all players along health care’s value chain. Read Amy Armstrongs story on page 16. On page 21, our reporter Judy Magness, profiles companies all over the country making incredible advances. Take a look at Functional Medicine and the driving breakthroughs in breast cancer while The news is in: On November 7, 2014, the justices announced they would decide on a lawsuit claiming that the language of the Affordable Care Act doesn’t allow the government to provide tax-credits to low-and-moderate-income health insurance consumers using federally funded Obamacare exchanges operating in more than 30 states. Indeed, there’s a medical quagmire. And there is a lack of communication between doctors, staffing and patients. For example, the Affordable Care Act isn’t just about insurance coverage. The legislation is also about transforming the way health care is provided. In fact, it has brought in new competitors, services and business practices, which are in turn producing substantial industry shifts that affect all players along health care’s value chain. Read Amy Armstrongs story on page 16. On page 21, our reporter Judy Magness, profiles companies all over the country making incredible advances. Take a look at Functional Medicine and the driving breakthroughs in breast cancer while
y amy m. armstrong Expert Testimony From Registered Nurses An Emerging Career Field making an Impact Nurses are quickly joining the ranks of those doctors who have become medical legal consultants and expert witnesses. This comes as litigators are recognizing the value of insights provided by medical professionals, who spend much more time on the floor in close contact with patients, as accurate resources for expert testimony. For one California registered nurse with more than 30 years of patient care experience, this burgeoning need emanating from the legal community has also provided her with the opportunity to develop a unique and rapidly growing practice. Suzanne E. Arragg is the founder of SEA & Associates Medical Legal Consulting, Inc. based in Ventura, California. Nearly 15 years ago, she was asked by an attorney to review the medical records of a patient in a skilled nursing facility. It was a different type of request, but not one that threw her a curve ball. At that time, she was Director of Nursing in a skilled nursing facility and the inquiry from an attorney regarding the case captured her attention. The attorney wanted a primer regarding the workings of a skilled nursing facility. “My expertise was invaluable in terms of educating the attorney client about what a skilled nursing facility does, what type of staff is involved, the workings of the entire 24 hours of operation of this type of facility and what its obligations to its patients are,” Arragg recalls. “That is what got me started in this industry, since my nursing skills complimented the information they required Since then, Arragg went on to found SEA & Associates® and build a network of medical legal experts – primarily registered nurses – with expertise in various segments of the health care industry. Her team includes experts in long-term care, acute care, dependent adult care, regulatory compliance, drug and medical device , outpatient clinics , and managed care, plus much more. Through the national network she has developed, Arragg is able to locate a medical legal consultant for almost every specific medical niche. The bulk of these medical-legal nursing consultants are Certified Legal Nurse Consultants – a distinction Arragg also holds. The CLNC® designation is earned after completing an intensive educational program designed to teach registered nurses how to put their specialized medical knowledge to work in the courtroom. “It isn’t that nurses will completely replace doctors as expert witnesses rather nursing experts provide nursing standard of care testimony ” Arragg noted. “In legal terms, litigators still need the evaluation and the expertise of physicians. They look at all of the documents generated during the course of a patient’s case to determine how the clinical circumstance affects the patient – and they provide the diagnosis and medical causation argument,” Arragg said. “Yet, unlike nursing staff, the doctor is not in the medical facility or hospital 24 hours/7 days a week. They are not at the bedside in the constant fashion that nursing staff are. Nurses provide the clinical hands-on, hour-by-hour perspective on the continuum of care the patient received, as well as those who interfacing with interdisciplinary team members that may be involved with a specific patient . The perspective a nurse brings is invaluable because it represents what is happening to that patient throughout the case.” While her medical-legal consulting is available for the myriad of medical issues, her specialty and abiding interest is in elder care. She admits it is a highly complicated issue. There are so many different types of elder care available: skilled nursing facilities, in-home care, residential care in an assisted living home where the presence of a licensed nurse is not always required,– and the list goes on. “Attorneys struggle with which standards to apply as they attempt to assist frustrated family members, who also do not know what the legal ramifications are in the setting where their loved one lives,” Arragg explained. “In California, the components of the law and the loopholes that exist in elder care require litigators prove that elder THE SUIT MAGAZINE - NOV 2014
abuse did occur,” Arragg said. “It really is an art that litigators have to master.” “In medical malpractice, lawsuits hinge on four elements: the duty of the medical professional, a breach of that duty, causation and damages These elements only provide the basis for an elder abuse case. To prove elder abuse, a plaintiff must be able to prove reckless neglect and abandonment of the patient,” Arragg said. That’s tough and it is also why a larger percentage of elder abuse claims are being settled in favor of the defendant. “The defendant can prove that they gave medication or provided treatment at the appropriate times. They can easily prove that 24-hour care was given and that the patient saw the doctor,” Arragg said. Much of the challenge surrounding elder abuse is represented in the unrealistic expectations of family members. Skilled nursing facilities are not required to provide the one-on-one care that is desired by family members. Yet, because these often become “home” for so many elder patients, the desire for more attention often conflicts with the financial realities governing these facilities. Many elderly patients come in with Medicaid as their only source for payment. In California, dependent upon the size of the skilled nursing facility, that averages $180 per day to cover medication, 24-hour nursing care, meals and a room. It represents a significant disconnect that Arragg sees reaching a crisis point, not only is our population living longer, but also as more and more baby boomers enter retirement and begin to experience the medical complications that often accompany aging. “That is pretty low reimbursement for a facility to employ a registered nurse that costs $40 an hour,” she said. “Can these facilities afford to provide one-on-one care? Absolutely not. It is a sad struggle, but the reality is that there simply is not enough time, not enough money, not enough resources.” This is the reason she focuses on her out-of-court consulting services aimed at helping long-term care facilities, assisted living homes and skilled nursing facilities do more with the resources they have and to stay ahead of regulatory changes. She is also a huge proponent of training registered nurses to specialize in long-term care. Arragg knows there is more work to do. Yet, in the 15 years since she consulted on that first case, she has consulted on thousands of cases across the nation that have had great effectiveness, by helping to clarify whether or nor elder abuse had occurred. “I feel as if my greatest success has been my ability to educate attorneys about the continuum of health care and how this impacts legal matters – particularly in the unique setting of long-term care,” Arragg emphasized. SEA & Associates Medical Legal Consulting P.O. Box 3222 Ventura, CA 93006-3222 www.sealegalnurse.com THE SUIT MAGAZINE p.83
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- Page 33 and 34: y peter suciu Compliance is Key for
- Page 35: their needs are, but still require
- Page 38 and 39: y enid burns HELPING SMALL LENDERS
- Page 40 and 41: y amy m. armstrong Employee non-Com
- Page 42 and 43: y g. levin Health Agent says Everyo
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- Page 48 and 49: EARLY IDENTIFICATION OF LD AND ADHD
- Page 50 and 51: y rodric j. bradford Commitment to
- Page 52 and 53: y enid burns THE CORNERSTONES OF Ho
- Page 54 and 55: y mary minor davis Offsetting the T
- Page 57 and 58: y gerald h. levin Shifting Markets
- Page 59 and 60: the economic downturn of 2008-09. D
- Page 62 and 63: y dan harvey Thinking the UNTHINKAB
- Page 64 and 65: y judy scinyamagness EXPERT witness
- Page 66 and 67: y felix badea Familial Advice at An
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- Page 71 and 72: y peter suciu GUIDING PEOPLE THROUG
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y amy m. armstrong<br />
Expert Testimony From Registered Nurses<br />
An Emerging Career Field making an Impact<br />
Nurses are quickly<br />
joining the ranks<br />
of those doc<strong>to</strong>rs who<br />
have become medical<br />
legal consultants and<br />
expert witnesses. This<br />
comes as litiga<strong>to</strong>rs are<br />
recognizing the value<br />
of insights provided by medical<br />
professionals, who spend much more<br />
time on the floor in close contact with<br />
patients, as accurate resources for expert<br />
testimony.<br />
For one California registered nurse<br />
with more than 30 years of patient<br />
care experience, this burgeoning need<br />
emanating from the legal community<br />
has also provided her with the opportunity<br />
<strong>to</strong> develop a unique and rapidly<br />
growing practice.<br />
Suzanne E. Arragg is the founder<br />
of SEA & Associates Medical Legal<br />
Consulting, Inc. based in Ventura,<br />
California. Nearly 15 years ago, she<br />
was asked by an at<strong>to</strong>rney <strong>to</strong> review<br />
the medical records of a patient in a<br />
skilled nursing facility. It was a different<br />
type of request, but not one<br />
that threw her a curve ball. At that<br />
time, she was Direc<strong>to</strong>r of Nursing in<br />
a skilled nursing facility and the inquiry<br />
from an at<strong>to</strong>rney regarding the<br />
case captured her attention. The at<strong>to</strong>rney<br />
wanted a primer regarding the<br />
workings of a skilled nursing facility.<br />
“My expertise was invaluable in<br />
terms of educating the at<strong>to</strong>rney client<br />
about what a skilled nursing facility<br />
does, what type of staff is involved,<br />
the workings of the entire 24 hours of<br />
operation of this type of facility and<br />
what its obligations <strong>to</strong> its patients<br />
are,” Arragg recalls. “That is what got<br />
me started in this industry, since my<br />
nursing skills complimented the information<br />
they required<br />
Since then, Arragg went on <strong>to</strong><br />
found SEA & Associates® and build<br />
a network of medical legal experts –<br />
primarily registered nurses – with<br />
expertise in various segments of the<br />
health care industry. Her team includes<br />
experts in long-term care,<br />
acute care, dependent adult care,<br />
regula<strong>to</strong>ry compliance, drug and<br />
medical device , outpatient clinics ,<br />
and managed care, plus much more.<br />
Through the national network she<br />
has developed, Arragg is able <strong>to</strong> locate<br />
a medical legal consultant for almost<br />
every specific medical niche.<br />
The bulk of these medical-legal<br />
nursing consultants are Certified Legal<br />
Nurse Consultants – a distinction<br />
Arragg also holds. The CLNC® designation<br />
is earned after completing<br />
an intensive educational program<br />
designed <strong>to</strong> teach registered nurses<br />
how <strong>to</strong> put their specialized medical<br />
knowledge <strong>to</strong> work in the courtroom.<br />
“It isn’t that nurses will completely<br />
replace doc<strong>to</strong>rs as expert witnesses<br />
rather nursing experts provide nursing<br />
standard of care testimony ” Arragg<br />
noted.<br />
“In legal terms, litiga<strong>to</strong>rs still need<br />
the evaluation and the expertise of<br />
physicians. They look at all of the<br />
documents generated during the<br />
course of a patient’s case <strong>to</strong> determine<br />
how the clinical circumstance<br />
affects the patient – and they provide<br />
the diagnosis and medical causation<br />
argument,” Arragg said. “Yet, unlike<br />
nursing staff, the doc<strong>to</strong>r is not in the<br />
medical facility or hospital 24 hours/7<br />
days a week. They are not at the<br />
bedside in the constant fashion that<br />
nursing staff are. Nurses provide the<br />
clinical hands-on, hour-by-hour perspective<br />
on the continuum of care the<br />
patient received, as well as those who<br />
interfacing with interdisciplinary<br />
team members that may be involved<br />
with a specific patient . The perspective<br />
a nurse brings is invaluable because<br />
it represents what is happening<br />
<strong>to</strong> that patient throughout the case.”<br />
While her medical-legal consulting<br />
is available for the myriad of medical<br />
issues, her specialty and abiding interest<br />
is in elder care. She admits it is a highly<br />
complicated issue. There are so many<br />
different types of elder care available:<br />
skilled nursing facilities, in-home care,<br />
residential care in an assisted living<br />
home where the presence of a licensed<br />
nurse is not always required,– and the<br />
list goes on.<br />
“At<strong>to</strong>rneys struggle with which standards<br />
<strong>to</strong> apply as they attempt <strong>to</strong> assist<br />
frustrated family members, who also do<br />
not know what the legal ramifications<br />
are in the setting where their loved one<br />
lives,” Arragg explained.<br />
“In California, the components of the<br />
law and the loopholes that exist in elder<br />
care require litiga<strong>to</strong>rs prove that elder<br />
THE SUIT MAGAZINE - NOV 2014
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