Episodes 16-18 and Webinar Highlights

Did you miss the last few episodes of Medplace's Reimagining Healthcare Podcast? Get caught up on crucial topics like staffing in SNFs, tips for medical expert witnesses, IMEs and more.

  • 00:10:11 - 05:10:11

    Barbara Pridemore 00:06

    To complain about it to lodge complaints to go on TV to participate in interviews with sensational stories of horrific findings, that doesn't really do anything but scare people. I mean, how do we how do we come together and focus on what's important, and isn't important that we do value those people. And if that's true as a society, we have to stand up and say, These people are important. They deserve to have appropriate care. There's been a big push this year from the White House. They're trying to put together a well, they have put together a some guidance that they want to put out where they require mandatory staffing for nursing homes. And I will tell you back in the day, when I was a very new surveyor, I thought, man, if we had mandatory staffing, this would be so easy. You walk in, here's your Census, you better have X number of RNs, LPNs, and CNAs. If not to get the deficiency. It's never been like that the way it's based, is you only state's site staffing, if they're not getting the care that they need. And that can be tricky to find that.

     

    So when you come in and across the board say, Well, we're going to demand that you have mandatory staffing ratios, that puts facilities in a hard spot, every facility is different. Every room is different, every patient is different, what your mom might need might be different from what my mom might need. So all of those things play into their level of acuity, how much care do they need? Do you have to provide 4.1 hour of care to somebody that doesn't need it, when you got somebody over here, that's only getting 3.4 hours, and they could use that extra. So they need to have some latitude. And I know that right now, CMS is currently doing a feasibility study, to look at this it's a governmental thing. So it's a process, but supposedly, they're going to have some results from that within a year. But part of what they're doing and I encourage people to go to medicare.gov and try to get some information. They're asking the public for their input public go give your input, let them know, what do you think of what you see in nursing homes, the shortages?

     

    Amy Hanegan 02:08

    All right. Now, one of the things that I have found this very helpful, is it certainly during my witness preparation sessions with experts is I find that there's a lot they want to tell the jury. But what you need to focus his focus on hard meat is what they need to tell the jury. Are they clear on the allegations that they are addressing? It's amazing to me how they can just go off and onto tangents. And I'm like, Whoa, how does that relate to the allegation. And when you keep bringing them back to what the allegation is that they're addressing, it's very helpful to them. And it keeps them in what I like a concept that I use with all my witnesses, whether they're defendants or experts, is what is their piece of the pie. So sometimes expert witnesses feel that they have a much bigger piece of the pie than they do. And it's your job as attorneys and even claim representatives, that they are clear as to what they are being hired for and what they're not being hired for. And this will help streamline and create effective testimony, once they understand what the their piece of the pie is, and the allegations to which they are referring. Next slide, please. All right. So when we get into specifics of working with experts, I find that the one thing that I need to hear over and over are the development of themes, or what we'll call reiterative statements that the jury can repeat. And sometimes I have actually pulled out or asked the attorney, not me, but I've asked the attorneys to pull out the verdict form. And let's look at the verdict form and which questions are they addressing, they may not be addressing liability, but only causation. And if that's the case, then we need to get them focused more on that. And what I really find important is to make sure that they are creating themes with you with your help, that the jurors can repeat that they can quote those experts I give you on the within the purple box here I've created two examples. There was no delay in Mr. Jones's cancer diagnosis. If that shouldn't be a failure to diagnose, or something a little more complicated. The placental pathology proves that the baby was damaged three months before birth. Some of you may know Rebecca Barragan, I worked on a case with her as an expert, she is the placental pathology expert. And we just had to get her to be able to definitively say this, though her slides were illustrative we had to work on getting them so a jury could understand them. Can we go to the next slide, please? Okay, now, I am an huge proponent of the expert witness working directly with a visual strategist. I work personally with Diane Meyer of legal presentations, I'm happy to provide her information to you. And what I have found is that a lot of and you've seen this too, a lot of experts think that if they just use the medical chart, or they have some kind of visuals, that they've prepared, that they will be effective for a jury, sometimes they have prepared those visuals for their peers. A jury isn't going to understand those. So I think it's absolutely critically important. I cannot stress this enough

     

    Jerrod Bailey 06:22

    that a claim goes through writing, talked about these different physicians along the way that might be providing opinions. I'd love to dig into that a little bit. That's been an area that we've been in for some time now. Do you do you guys use your own medical experts? How do they how do they play into the well,

     

    Bob Wisniewski 06:44

    I think what happens is there are medical experts that will testify and workers compensation matters. Doctors, like any other professional, they have a choice. Many of them don't even do workers comp, they don't want to deal with billing under a fee schedule. They don't want to deal with maybe the delays inherent in the system, they would prefer while they're familiar with health insurance, they use those systems. So we prefer to have a physician that is reachable that it who will talk to us, and when when they testify will testify in human terms in layman's terms rather than some of the highfalutin medical words. So I've over the years of doing this. For decades, I've seen reports that are like 30 pages long. And I know that doctor, he's wonderful. And he's he's figured out every conceivable problem this person has. But when it comes time to have him testify, and before it was just over the telephone, we did telephone now you have telephone and digital video. He can't talk, he can't be a teacher, he can't portray it, and explain it to the judge and explain why his opinion might be better than the other side's opinion. So we're looking for physicians that are regular people that can break it down, that have good rapport with the patient, and able to elicit from the patient, the information that makes the claim. Yeah, that person's consistent. Yeah, that person's a good story. In the end, that person's been a reliable patient of mine for all these years or months. I've asked them about their problem. Yeah, that's what we're looking for. And there's a handful of doctors on each side that can do that. It's the ones that are just maybe starting in the business who'd like to do workers comp, sometimes they need to be educated.

     

    Jerrod Bailey 08:40

    You already gave me some ideas of how that the system can be improved. Is there anything else on that list? Right? Oh, let me let me here's my, here's my punch list of things. I wish I had a magic wand.

     

    Bob Wisniewski 08:59

    Barbara Pridemore 00:06

    To complain about it to lodge complaints to go on TV to participate in interviews with sensational stories of horrific findings, that doesn't really do anything but scare people. I mean, how do we how do we come together and focus on what's important, and isn't important that we do value those people. And if that's true as a society, we have to stand up and say, These people are important. They deserve to have appropriate care. There's been a big push this year from the White House. They're trying to put together a well, they have put together a some guidance that they want to put out where they require mandatory staffing for nursing homes. And I will tell you back in the day, when I was a very new surveyor, I thought, man, if we had mandatory staffing, this would be so easy. You walk in, here's your Census, you better have X number of RNs, LPNs, and CNAs. If not to get the deficiency. It's never been like that the way it's based, is you only state's site staffing, if they're not getting the care that they need. And that can be tricky to find that.

     

    So when you come in and across the board say, Well, we're going to demand that you have mandatory staffing ratios, that puts facilities in a hard spot, every facility is different. Every room is different, every patient is different, what your mom might need might be different from what my mom might need. So all of those things play into their level of acuity, how much care do they need? Do you have to provide 4.1 hour of care to somebody that doesn't need it, when you got somebody over here, that's only getting 3.4 hours, and they could use that extra. So they need to have some latitude. And I know that right now, CMS is currently doing a feasibility study, to look at this it's a governmental thing. So it's a process, but supposedly, they're going to have some results from that within a year. But part of what they're doing and I encourage people to go to medicare.gov and try to get some information. They're asking the public for their input public go give your input, let them know, what do you think of what you see in nursing homes, the shortages?

     

    Amy Hanegan 02:08

    All right. Now, one of the things that I have found this very helpful, is it certainly during my witness preparation sessions with experts is I find that there's a lot they want to tell the jury. But what you need to focus his focus on hard meat is what they need to tell the jury. Are they clear on the allegations that they are addressing? It's amazing to me how they can just go off and onto tangents. And I'm like, Whoa, how does that relate to the allegation. And when you keep bringing them back to what the allegation is that they're addressing, it's very helpful to them. And it keeps them in what I like a concept that I use with all my witnesses, whether they're defendants or experts, is what is their piece of the pie. So sometimes expert witnesses feel that they have a much bigger piece of the pie than they do. And it's your job as attorneys and even claim representatives, that they are clear as to what they are being hired for and what they're not being hired for. And this will help streamline and create effective testimony, once they understand what the their piece of the pie is, and the allegations to which they are referring. Next slide, please. All right. So when we get into specifics of working with experts, I find that the one thing that I need to hear over and over are the development of themes, or what we'll call reiterative statements that the jury can repeat. And sometimes I have actually pulled out or asked the attorney, not me, but I've asked the attorneys to pull out the verdict form. And let's look at the verdict form and which questions are they addressing, they may not be addressing liability, but only causation. And if that's the case, then we need to get them focused more on that. And what I really find important is to make sure that they are creating themes with you with your help, that the jurors can repeat that they can quote those experts I give you on the within the purple box here I've created two examples. There was no delay in Mr. Jones's cancer diagnosis. If that shouldn't be a failure to diagnose, or something a little more complicated. The placental pathology proves that the baby was damaged three months before birth. Some of you may know Rebecca Barragan, I worked on a case with her as an expert, she is the placental pathology expert. And we just had to get her to be able to definitively say this, though her slides were illustrative we had to work on getting them so a jury could understand them. Can we go to the next slide, please? Okay, now, I am an huge proponent of the expert witness working directly with a visual strategist. I work personally with Diane Meyer of legal presentations, I'm happy to provide her information to you. And what I have found is that a lot of and you've seen this too, a lot of experts think that if they just use the medical chart, or they have some kind of visuals, that they've prepared, that they will be effective for a jury, sometimes they have prepared those visuals for their peers. A jury isn't going to understand those. So I think it's absolutely critically important. I cannot stress this enough

     

    Jerrod Bailey 06:22

    that a claim goes through writing, talked about these different physicians along the way that might be providing opinions. I'd love to dig into that a little bit. That's been an area that we've been in for some time now. Do you do you guys use your own medical experts? How do they how do they play into the well,

     

    Bob Wisniewski 06:44

    I think what happens is there are medical experts that will testify and workers compensation matters. Doctors, like any other professional, they have a choice. Many of them don't even do workers comp, they don't want to deal with billing under a fee schedule. They don't want to deal with maybe the delays inherent in the system, they would prefer while they're familiar with health insurance, they use those systems. So we prefer to have a physician that is reachable that it who will talk to us, and when when they testify will testify in human terms in layman's terms rather than some of the highfalutin medical words. So I've over the years of doing this. For decades, I've seen reports that are like 30 pages long. And I know that doctor, he's wonderful. And he's he's figured out every conceivable problem this person has. But when it comes time to have him testify, and before it was just over the telephone, we did telephone now you have telephone and digital video. He can't talk, he can't be a teacher, he can't portray it, and explain it to the judge and explain why his opinion might be better than the other side's opinion. So we're looking for physicians that are regular people that can break it down, that have good rapport with the patient, and able to elicit from the patient, the information that makes the claim. Yeah, that person's consistent. Yeah, that person's a good story. In the end, that person's been a reliable patient of mine for all these years or months. I've asked them about their problem. Yeah, that's what we're looking for. And there's a handful of doctors on each side that can do that. It's the ones that are just maybe starting in the business who'd like to do workers comp, sometimes they need to be educated.

     

    Jerrod Bailey 08:40

    You already gave me some ideas of how that the system can be improved. Is there anything else on that list? Right? Oh, let me let me here's my, here's my punch list of things. I wish I had a magic wand.

     

    Bob Wisniewski 08:59

    I just think we if we could get our we could have the system compressed a little bit in terms of the time. Again, these are people's lives in there. And not only the injured worker, the entire families affecting the children, the spouse, if we could just get the system moving a little faster. We'd all be better off I mean, even from the claims and but people are, we're all remote. We're not going to the Industrial Commission to give me a file. We don't know I don't want to do it. You know, it can be done. It's an opportunity you'd be done from your living room be done digitally. So people are I don't know whether it's we have to change the ethics of the country to say move along. Let's proceed a little bit better. We you know, take care of yourself. Everybody wants somebody else to take care of them and I understand in the system, we get hurt. The system is supposed to take care of you. But I see a little bit more need for participation. Maybe the employer should educate the people that they're getting hurt. This is what to do. They just told them azica.gov, they could file a claim. Oh, my employer didn't tell me that my employer didn't do this. And they don't know. Maybe if the employer would take him to the hospital a couple of times that might be nice or send him a get well card. People get really, really upset that they're not being listened to. That's the biggest. No one listens to me. I go to my doctor. He's zooming in zoom. Yeah. And I didn't tell him about my other shoulder. Mostly my elbow was broken, but that shoulder was bothering me. So then that doesn't become part of the claim. Oh, gee, it wasn't documented right away. So I think if we could use a little common sense, system would move a little better.

First, Medplace's Barbara Pridemore, an experienced LPN, calls for long-term solutions for better SNF staffing that respects patients and workers alike. Next, Amy Hanegan of Better Witnesses explains how to better equip testifying physicians to persuade juries. Finally, Arizona Attorney Robert Wisniewski outlines what he looks for in medical experts and the need for a faster-moving workers' compensation industry.

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Multiple Contributors

Experts Across Healthcare, Law, and Patient Safety

Barbara Pridemore, LPN - Medical Expert Liasion, Medplace

Amy Hanegan - President at Better Witnesses Trial Consulting Services

Robert Wisniewski - Attorney, Law Offices of Robert E. Wisniewski

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