Hamilton Herald Masthead


Front Page - Friday, March 17, 2023

Finding what’s hidden in medical records

Nurses serve as expert witnesses in variety of cases

Elena Melnik and Cerissa Bryson are registered nurses who provide expertise to attorneys working on cases that involve medical issues. - Photo by David Laprad | Hamilton County Herald

Medical expert witnesses have traditionally included physicians, surgeons and other practitioners whose skills and experience qualify them to testify in cases centered on a particular medical issue. For example, attorneys often use such witnesses in the discovery and trial stages of personal injury or medical malpractice lawsuits.

Today, more and more registered nurses are also lending their knowledge to attorneys who are representing clients in cases involving medical issues.

Among them are Elena Melnik and Cerissa Bryson, two legal nurse consultants based in Chattanooga. Together, Bryson says, they help the lawyers for whom they work better help their clients.

“We bring our understanding of health care to cases that touch medical records,” Bryson explains. “We work with estate planning attorneys on competency disputes, conservatorships and guardianships. We help family law attorneys on domestic violence cases. And I have a colleague who worked on a major trafficking case involving multiple victims and their injuries. There’s a place for us in many specialties.”

Much like there’s an informal legal language known as “legalese,” Bryson says, the medical field has its own language. Legal nurses translate this unique dialect into a format the attorney working on a case can understand and apply to their line of attack.

“If an attorney’s client was injured in a car accident, we’ll look through the records, list the diagnoses and make sure the attorney understands the extent of the injuries and the pain and suffering their client endured,” Bryson says. “If we find information that’s applicable to the injury or the consequences of the injury, we can improve the compensation their client receives.”

Bryson can specifically provide a pain and suffering analysis, a report that focuses not on a patient’s treatment but their experience with pain and its consequences, she notes.

“A pain and suffering report can help an attorney quantify and qualify the noneconomic damages in a case.”

Bryson is careful to note that legal nurse consultants do not comment on physician standards of care; rather, they identify areas of potential liability.

“We can tell by looking at the records if something was done inappropriately because there are protocols and procedures for every illness and disease. Caring for a stroke requires a specific protocol. Using that protocol, we’ll know if something was a breach of duty.”

As Bryson and Melnik scour medical records, they can weed out frivolous cases, build a timeline of events and even provide an audit trail of the records.

Bryson says she’s worked on a number of cases during which she was able to sniff out compromises in the integrity of the data the attorney received from the health care facility.

“It’s obvious when someone has tampered with information,” she says. “An audit trail records every touch of the records with a timestamp, so we can see who loaded the records and when. We can also see if they simply viewed the records, or if they modified, deleted or printed them. Medical records can literally tell us everything.”

By way of example, Bryson offers the details of her work on a case in which a client entered an urgent care facility with abdominal pain and a fever and was subsequently discharged. When a case was brought against the facility, the front desk staff acknowledged the request for medical records.

“From the point the provider knew someone was requesting medical records, [an individual] began making changes to the record. She said she requested a [peripherally inserted central catheter] line and she said she recommended the patient go directly to the ER. None of that was in the original discharge.”

Bryson says the details she uncovered gave the attorney on the case information about the individual, her charting behavior and her mindset during the incident.

“We lead attorneys to the conclusion that’s appropriate for the patient based on protocols, guidelines and policies.”

Bryson says a thorough review of records can also enable a legal nurse consultant to identify the specific kind of expert witness an attorney needs for a case, whether it’s a physical therapist, a respiratory therapist or another specialist.

They can also assist in the search for a physician with the appropriate expertise, Melnik adds.

“A doctor can step in if the attorney needs an expert to testify or a physician’s opinion. We can facilitate finding an appropriate doctor.”

Although Bryson and Melnik spend most of their time on the clock elbow-deep in medical records, they can also testify during a deposition. Bryson has even sat in the witness chair during a trial – an experience she says was intimidating but useful to the attorney.

“I had to stay calm and remember the information I was providing would be helpful to the patient. It wasn’t about me; it was about the [attorney’s] client,” Bryson recalls. “So I remained calm, stuck to the facts and answered only the questions I was asked.

“Nurses are people pleasers; we care for others and sometimes go over the top to provide helpful information, but in depositions and testimonies, we have to answer only the questions we’re asked.”

Before Melnik and Bryson became legal nurse consultants, they were nurses with a zeal for caring for others.

A family tragedy placed Meknik on the path to becoming a nurse when she was still a child. After her younger sister drowned in her family’s swimming pool, she decided she wanted to someday be able to save people.

“My admiration of heath care workers was imprinted on me after my sister died,” Melnik remembers. “I respected their knowledge and wanted to have those same skills when I grew up. That carried me through nursing school and kept me going during exams.”

A native Ukrainian whose parents moved to the U.S. when she was 2, Melnik earned an associate degree at Chattanooga State and a bachelor’s degree at the University of Tennessee at Chattanooga. She became a registered nurse eight years ago after serving as a certified nursing assistant for three years.

A New Mexico native who’s been a nurse for 25 years, Bryson discovered her passion for health care while helping to care for her aunts as they aged and became ill. She’s says being a nurse came naturally to her and is the only profession she considered.

“Nursing is tough right now and a lot of people are leaving the profession,” she says. “Some are even saying they wish they’d never become nurses. But I’d never do anything different. I’m happy I’ve been a nurse and I’ll always be a nurse.”

To become legal nurse consultants, Melnik and Bryson completed courses that taught them how to write reports and market their services. They later connected through the local network of BNI International chapters and decided to collaborate on a program that offers a 10% discount on their services to members of the Chattanooga Bar Association.

Melnik says she’s wanted to become a legal nurse consultant since first hearing about the service while in nursing school.

“While I do enjoy the bedside, I also enjoy using my experience as a nurse to assist with cases. Instead of helping people at the hospital, I’m helping them through the legal field. The attorney clients are like my patients – I take that approach with them – and it brings me joy to know my work can help their clients be properly compensated for the injuries they sustained.”

Michael Holloway, an attorney with Litchdord, Pearce & Associates, also connected with Melnik and Bryson through BNI and introduced the nurses to the leadership at the Chattanooga Bar Association. Although he’s never consulted with a legal nurse, he says he believes they have intrinsic value to the legal field.

“I don’t handle many personal injury matters or matters involving bodily injury but can certainly see myself using a legal nurse whose focus is on legal competency and capacity,” Holloway says. “I can think of several cases I have right now where the legal capacity of an adult is a critical issue in some form or another.”

Holloway adds that he also believes legal nurse consultants have the ability to help make legal services more affordable.

“They’ll allow attorneys to provide a broader range of services without sacrificing time elsewhere or charging too much to do something as simple as review documents.”

Contact Melnik at 423 827-5290 or legalnurse@melniklnc.com. Contact Bryson at 602 290-6554 or cerissa@cerbryconsulting.llc.