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Who is Performing Your Medical Record Review?


Who is Performing Your Medical Record Review?

Resuscitation=noun; the action or process of reviving someone from unconsciousness or apparent death. “Paramedics were called and aggressive resuscitation was performed.” (The Merriam-Webster Dictionary)

Most attorneys are familiar with the act of resuscitation and generally know what is involved. One would expect that physicians are acquainted with this term as well.

Sometimes, however, medical records will use the word “resuscitation” to mean something different. For example, the term “fluid resuscitation” or “volume resuscitation” means fluid replacement; it is the process of giving intravenous fluids to correct low blood pressure or to maintain organ perfusion.

Most health care providers in the United States understand the difference between “resuscitation” and “fluid resuscitation.” It is evident from a recent situation that offshore physicians performing medicolegal reviews may not be familiar with the term “fluid resuscitation.”

OnPoint Legal Nurse Consulting recently worked with a New Jersey attorney who hired a company using offshore physicians to prepare a medical chronology and case summary. The case involved a 60-year-old male, “Mr. Smith,” who underwent a routine screening colonoscopy. After the procedure, Mr. Smith suffered a syncopal episode (“fainting spell”) with no apparent injury. His doctor ordered intravenous fluids and sent him to the nearest emergency department (ED).

The ED physician documented, “Mr. Smith required fluid resuscitation…” Mr. Smith was admitted to the hospital overnight for observation. He was discharged home the following day without incident. His discharge diagnosis was “dehydration due to his colonoscopy preparation.”

The offshore physician provided the attorney with the requested chronology and analysis. He advised the attorney the case was meritorious because Mr. Smith “had to be resuscitated” and underwent many medical procedures. (The procedures were an abdominal x-ray, a head CT scan to rule out a brain injury, non-invasive telemetry monitoring, and three sets of blood work for cardiac enzymes, a basic metabolic panel, and a complete blood count.)

The offshore company advised the attorney he had a compelling case. The attorney was not convinced this was accurate and asked OnPoint to review the medical records. We pointed out the errors made by the offshore physician and informed the attorney the case was not meritorious.

It is tempting to see the lower dollar amounts offered by some companies performing medicolegal consulting. We would caution you to think about who is performing this work. Some foreign medical schools are substandard. For example, medical students in India are rarely exposed to emergency departments and therefore lack critical care expertise (1). According to the Indian Medical Association, about 45 percent of the people in India who practice medicine have no formal training (2).

OnPoint Legal Nurse Consulting uses nurses across the United States, many of whom are clinically active, to perform our reviews. A nurse educated and trained in the United States is intimately familiar with the standards of care that will be important to your cases. Every nurse has an undergraduate degree (or diploma) in nursing, but some of our nurses have a master’s degree or a PhD.

OnPoint Legal Nurse Consulting strives to match the consultant to your case. If you have a baby with a birth injury, we will assign a labor and delivery nurse to perform your record review. This experienced nurse can focus his or her review on the essential matters at hand and provide you with a concise report.

Similarly, if you have a nursing home or skilled nursing facility (SNF) case, we can help determine the type of expert you need. It could be a Director of Nursing (DON), a wound care nurse, or a nursing home administrator (NHA). Our reviews will address the strengths and weaknesses of your case. We will identify any missing records and make recommendations. Our reports also highlight “red flags” with your case to alert you to potential complications.

At OnPoint, your success is our success. We are a team of experienced nurses committed to helping you win your case. We are always respectful of your resources, including time and money. We look forward to helping you with all your litigation needs.

(1) Anand A, Bammidi S. Medical education and training: implications for India. Ann Neurosci. 2014 Jan;21(1):3-4. doi: 10.5214/ans.0972.7531.210102. PMID: 25206045; PMCID: PMC4117145.


Lisa Mancuso, RN, BSN, CCRN, CLCP,LNCC
Program Director, Consults


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