Working with one of my Legal Forensic Nurse students and she asked this...
Best question ever!!!! This is one of the most common areas of confusion when nurses are new to legal forensic nursing. Many nurses are used to thinking like neutral clinicians, which is important in healthcare. But when you are hired behind the scenes by an attorney, you are not being hired as the neutral expert witness for both sides. You are being hired as part of one side’s litigation support team. That means your job is not just to list facts. Your job is to help the attorney understand what the records show, where the weaknesses are, where the strengths are, what the defense may argue, and what support exists to strengthen the case. In this example, the student is working on a personal injury dog bite case. The plaintiff was bitten by a dog and later reported symptoms involving his fingers, including numbness. However, the records also show that he has a history of diabetes. This matters because diabetes can sometimes be associated with numbness or nerve-related symptoms. So from a nursing perspective, the student correctly recognized that diabetes could be relevant, and was going to leave it at that in her report and opinion. But in a legal case, we have to think beyond the medical fact alone. The defense attorney may try to argue: “The numbness was not caused by the dog bite. He already had diabetes, and that is why his fingers were numb.” That is why the diabetes matters. It may become a defense argument. But the deeper question is: Did the dog bite cause a new problem, or did it make an existing problem worse? Was his numbness documented before the dog bite? Did it become worse after the dog bite? Did the symptoms involve the same hand or fingers that were injured? Did the records show a change in pain, sensation, function, treatment, or complaints after the bite? Did any provider connect the numbness or nerve symptoms to the dog bite injury? This is the part where we see nurses flop. A basic report by a legal nurse says, “Patient has diabetes and reports numbness.”