Consulting Services Provided
- Screening and Interpretation of Medical Records with
summation both oral and written - Access to Standards of Care and Deviations
- Chronological Time Lines used to identify gaps, assess for
tampering and easily find what is missing - Authoritative Medical Research Expert
- Procurement of appropriate Expert Witness
- Demonstrative exhibit Preparation
- Attend Depositions
- Attend Independent Medical Exams and Defense Medical
Exams
Parks Medical-Legal Consulting is an Independent Medical-Legal
Consulting firm owned and operated by Mr. Paul Parks. A strong
patient advocate, Mr. Parks educates in all areas of medicine taking
complex information and breaking it down in an easy to digest way
that both jurors and clients can easily understand. Mr. Parks has had
extensive training and clinical experience working in some of the
most prestigious teaching institutions in southern California
including: UC Irvine, Loma Linda University Medical Center, Balboa
Naval Hospital, UC San Diego, and numerous free standing surgical
centers practicing special procedures in such areas as: pain
management, urology, plastic surgery, gastroenterology, same day
surgery both as an OR circulator and sedation nurse. He was also for
the administration of sedative hypnotic agents for sleep induction
both in the hospital setting and as an independent practitioner. He is
fluent and up to date on all of the latest standards of care and
guidelines in all areas of nursing and medicine and is an excellent
source for a thorough understanding of medical care in a truly
objective manner.
Consulting firm owned and operated by Mr. Paul Parks. A strong
patient advocate, Mr. Parks educates in all areas of medicine taking
complex information and breaking it down in an easy to digest way
that both jurors and clients can easily understand. Mr. Parks has had
extensive training and clinical experience working in some of the
most prestigious teaching institutions in southern California
including: UC Irvine, Loma Linda University Medical Center, Balboa
Naval Hospital, UC San Diego, and numerous free standing surgical
centers practicing special procedures in such areas as: pain
management, urology, plastic surgery, gastroenterology, same day
surgery both as an OR circulator and sedation nurse. He was also for
the administration of sedative hypnotic agents for sleep induction
both in the hospital setting and as an independent practitioner. He is
fluent and up to date on all of the latest standards of care and
guidelines in all areas of nursing and medicine and is an excellent
source for a thorough understanding of medical care in a truly
objective manner.
What is a Legal Nurse Consultant?
The Role of the LNC and Paralegal working together
§ Res Ipsa: A Monthly Newsletter Vol. 2 , #3
"Medical-Legal Implications All First Responders And Field Nurses Should Be Familiar With"
By Paul Parks, RN-Legal Nurse Consultant/Research Expert
With specialized knowledge and training all health care professionals are held to certain legal requirements,
this article is dedicated to the first responders and the very important medical-legal concepts such as
negligence, abandonment, duty to act, as well as assault and battery.
The care you give to a patient is outlined in your scope of practice. This scope of practice is most often defined
by state law. Legally, your medical director authorizes you the privelage of to provide patient care. For EMS
workers this done via telephone, radio or standing orders and protocols.. You must report any problems, such
as possible liability, exposure to airborne diseases and bloodborne pathogens to your medical director
immediatley.
Ethical Responsibilities:
In addition to legal duties, you also have certain ethical responcibilities to the public at large. Assess your
techniques from time to time-responce time, patient outcome. To improve performance with CE's and always
strive to learn more. Your first ethical responsibility should be honesty at all times and that includes reporting
it's no secret in the real world this is not always the case. Do all stable patient have a RR of 20 HR 72 and bp
120/80's? Absolutely not but when I moonlighted as an ACLS transport nurse it was uncanny how many
patients had the same VS, make no mistake the same thing happens in hospitals especially at night when
some nurses are to lazy to even check vitals and just write down what similar numbers the patient has been
running but I digress. Absolute honesty in reporting is essential, you must provide a complete account of the
events with details both oral and written for quality improvement. The old adage, “If it wasn't charted, it
wasn't done. .is very true and will not hold up in a court of law period.
Dealing with Advanced Directives:
At times you may respond to a patient who is dying. When you arrive on scene, you come to find out the
family members do not want you to resuscitate the patient. Without written documentation from a doctor
such as an advanced directive or{ DNR}do not resuscitate this request puts you in a conundrum. An advanced
directive is also called a living will. DNR orders give you permission NOT to attempt any heroic measures in
the event of cardiac arrest. At this point you may be faced with situation often because of nursing home
placement, hospice, and home health. Medical directors of ambulance service companies must have written
protocols for these situations and guidelines vary from state to state so check your states guidelines and
scope of practice. As the guidelines do vary there are 4 statements that are considered general guidelines:
1. Patients have the right to refuse treatment, including resusitation if they can communicate that.
2. In a healthcare facility, a written Dr.'s order is rquired for a DNR to have validity.
3. Review your local and state protocols regarding advanced directives as codes do change.
4. When in doubt resuscitate.
If death is obvious by rigor mortis, liver mortis, or levidity or obvious destruction of body parts such as brain
or heart-You respoceibility is to cover the body and and follow the protocols of your coroner and medical
examiner.
Consent:
Consent is a long established legal right, for instance a person can NOT touch another person without
permission or consent. Expressed Consent: This occurs when a patient expressly says you can care and
transport them. Expressed consent may be as simple as a nod, it need not take the form of words. You should
alwaystry to obtain expressed consent whenever possible. For expressed consent to bevalid, the patient must
be of legal age and able to make a rationale decision agreeing to consent. Verbal consent is valid and
binding, albiet may be difficult to prove.
Implied Consent:
The law assumes that a patient who needs immediate medical attention tp prevent death or permanent
impairment would consent to care and transported to a medical facility. This is called Implied Consent-
Implied consent is limited to to true emergency situations. An example of this type of situation is appropriate
when you have a unconscious, delusional patient under the infuence of drugs or alcohol or incapable of
giving expressed consent. If the patient is so unresponsive that he/she is unable to express consent, you should
try to get consent from a family member who is responcible and obtain permission from that relative. In
most cases the law allows for the right of a spouse, close relative or next of kin that are available. As a caveat
minors can and do give consent, for example a 17 year old girl is likely to give a informed consent rather
than a 3 year old child. The laws and principils related to consent of minors only determine who has the right
to give consent-not if consent is needed. If a true emrgency arises, the consent to tretat the minor is implied,
just as an adult yet you should the parent's consent if possible.
Consent of the Mentally Ill:
A mentally incopmetant adult is NOT capable of giving informed consent. If the patient is declared mentaly
incompetant, a guardian or conservator can give consent on the patients behalf. You will cme across patients
who appear confused or in distress and you need to consider all the factors weather the patient can give
valid consent. The rule is when a TRUE emergency situation exists, you can assume implied consent applies.
Assulat and Battery:
Very serious legal problems can occur in situations where a patient has NOT given consent for treatment.
Assault is the unlawful placing a patient in fear or bodily harm. Even touching a patient or providing
emrgency care without consent is considerded battery in the eyes of the law. If you do so,the patient may
have grounds to sue you for assault, battery or both. In order to protect yourself from these charges, always
make sure you recieve expressed written consent or that the situation allows for implied consent.
The Right To Refuse Treatment:
Many mentally competent people have the right to refuse treatment at any time. These patient will provide a
dilema for you, such as do I provide care against their will only to be accused of battery or do you leave them
alone and risk the possibility of their condition deteriorating to be accused of abandonment and or
negligence? If a patient refuses transport and treatment-you MUST make sure that they understand and are
informed about the potential risksbenefits and treatment and alternatives to treatment. The patiemt must
also be fully informed about the risks and consequences of refusing treatment and encouraged to ask
questions. Remeber that there are competent adults who refuse treatment for religious reasons and have the
legal right to do so. When dealing with a delusional patient don't assume it's an informed refusal, when in
doubt, it is always best to treat-this is the best course of action cbecause providing tretment is a much more
defensable position than failure to treat, remember failure to treat is considereded abndonment.
Abandonment:
Once you begin to give care, you must follow through all the way with appropriate treatment. Youmust
continue to provide care untill that care is transfered to another medical professional of appropriate level of
training or the proper medical facility. Failure to continur tratment at any of these levels is considerded
patient abandonment. Out of all the legal pitfalls abandonment is legally and ethically the most serious act
you can commit.
Negligence:
Negligence consists of 4 elements: duty, breach of duty, physical or psychological injury, and cause. Once you
are called to the scene to provide care, you have a duty to act and help the patient. Your failure to act or give
care that is not in a manner consistent with the level of care another similarly trained first responder would
give is called breach of duty. If physical or psychological harm is caused by doing something or failure to do
something to the patient then you have acted in a negligent manner. If that's the case you may be liable to
the patient for harm. The important thing to understand here is that all 4 elements must be present for the
doctrine of negligence to apply. Examples--> failure to provide care to patient once you have arrived on
scene--> Failure to perform important or neccessary techniques and also--> providing care in a manner not
consistant with the skill that other similarl traned first responders would give under similar circumstances. If
your actions are judged reckless, careless,lacking in skill, you have violated the standard of care and may be
found negligent.
Duty to Act:
One a unit responds to a call, it has a duty to act. In some situations there may be no legal duty for an
ambulance to respond .e. off duty, out of jurisdiction. So, if you are off duty and you or I happen upon an
accident scene you are not legally obligated to stop and assist any victims. However, if you happen upon an
accident you have a Moral and ethical duty to act due to your training and expertise, the same goes for
nurses and doctors who have the required skills. This is only a small picture of the medical, legal and ethical
issues you must deal with on a daily basis. The First Responders, EMT and paramedic are viewed as
responsible members of the the emergency medical team, your moral and ethical standards must also be of
the highest order in your job performance, I hope this medical-legal information will assist you in
understanding patients and families who only see you under extreme duress and give you pause about being
ethical and protecting yourself and your partner in all runs. With that in mind this article is dedicated to all
the flight nurses and paramedics and EMT's I have worked with.The first responders from 9-11 to Katrina,
Haiti and all my fallen brothers and sisters who have literally given their lives going down caring for their
patients.
For Medical-Legal Research please visit my research site at: http://legalrnblog.com
or click on the double helix DNA logo anywhere on this site.
Important Medical Resorces
Guide to Diagnostic Tests
Medical Dictionary
http://thelegalrn.vodspot.tv/
The Role of the LNC and Paralegal working together
§ Res Ipsa: A Monthly Newsletter Vol. 2 , #3
"Medical-Legal Implications All First Responders And Field Nurses Should Be Familiar With"
By Paul Parks, RN-Legal Nurse Consultant/Research Expert
With specialized knowledge and training all health care professionals are held to certain legal requirements,
this article is dedicated to the first responders and the very important medical-legal concepts such as
negligence, abandonment, duty to act, as well as assault and battery.
The care you give to a patient is outlined in your scope of practice. This scope of practice is most often defined
by state law. Legally, your medical director authorizes you the privelage of to provide patient care. For EMS
workers this done via telephone, radio or standing orders and protocols.. You must report any problems, such
as possible liability, exposure to airborne diseases and bloodborne pathogens to your medical director
immediatley.
Ethical Responsibilities:
In addition to legal duties, you also have certain ethical responcibilities to the public at large. Assess your
techniques from time to time-responce time, patient outcome. To improve performance with CE's and always
strive to learn more. Your first ethical responsibility should be honesty at all times and that includes reporting
it's no secret in the real world this is not always the case. Do all stable patient have a RR of 20 HR 72 and bp
120/80's? Absolutely not but when I moonlighted as an ACLS transport nurse it was uncanny how many
patients had the same VS, make no mistake the same thing happens in hospitals especially at night when
some nurses are to lazy to even check vitals and just write down what similar numbers the patient has been
running but I digress. Absolute honesty in reporting is essential, you must provide a complete account of the
events with details both oral and written for quality improvement. The old adage, “If it wasn't charted, it
wasn't done. .is very true and will not hold up in a court of law period.
Dealing with Advanced Directives:
At times you may respond to a patient who is dying. When you arrive on scene, you come to find out the
family members do not want you to resuscitate the patient. Without written documentation from a doctor
such as an advanced directive or{ DNR}do not resuscitate this request puts you in a conundrum. An advanced
directive is also called a living will. DNR orders give you permission NOT to attempt any heroic measures in
the event of cardiac arrest. At this point you may be faced with situation often because of nursing home
placement, hospice, and home health. Medical directors of ambulance service companies must have written
protocols for these situations and guidelines vary from state to state so check your states guidelines and
scope of practice. As the guidelines do vary there are 4 statements that are considered general guidelines:
1. Patients have the right to refuse treatment, including resusitation if they can communicate that.
2. In a healthcare facility, a written Dr.'s order is rquired for a DNR to have validity.
3. Review your local and state protocols regarding advanced directives as codes do change.
4. When in doubt resuscitate.
If death is obvious by rigor mortis, liver mortis, or levidity or obvious destruction of body parts such as brain
or heart-You respoceibility is to cover the body and and follow the protocols of your coroner and medical
examiner.
Consent:
Consent is a long established legal right, for instance a person can NOT touch another person without
permission or consent. Expressed Consent: This occurs when a patient expressly says you can care and
transport them. Expressed consent may be as simple as a nod, it need not take the form of words. You should
alwaystry to obtain expressed consent whenever possible. For expressed consent to bevalid, the patient must
be of legal age and able to make a rationale decision agreeing to consent. Verbal consent is valid and
binding, albiet may be difficult to prove.
Implied Consent:
The law assumes that a patient who needs immediate medical attention tp prevent death or permanent
impairment would consent to care and transported to a medical facility. This is called Implied Consent-
Implied consent is limited to to true emergency situations. An example of this type of situation is appropriate
when you have a unconscious, delusional patient under the infuence of drugs or alcohol or incapable of
giving expressed consent. If the patient is so unresponsive that he/she is unable to express consent, you should
try to get consent from a family member who is responcible and obtain permission from that relative. In
most cases the law allows for the right of a spouse, close relative or next of kin that are available. As a caveat
minors can and do give consent, for example a 17 year old girl is likely to give a informed consent rather
than a 3 year old child. The laws and principils related to consent of minors only determine who has the right
to give consent-not if consent is needed. If a true emrgency arises, the consent to tretat the minor is implied,
just as an adult yet you should the parent's consent if possible.
Consent of the Mentally Ill:
A mentally incopmetant adult is NOT capable of giving informed consent. If the patient is declared mentaly
incompetant, a guardian or conservator can give consent on the patients behalf. You will cme across patients
who appear confused or in distress and you need to consider all the factors weather the patient can give
valid consent. The rule is when a TRUE emergency situation exists, you can assume implied consent applies.
Assulat and Battery:
Very serious legal problems can occur in situations where a patient has NOT given consent for treatment.
Assault is the unlawful placing a patient in fear or bodily harm. Even touching a patient or providing
emrgency care without consent is considerded battery in the eyes of the law. If you do so,the patient may
have grounds to sue you for assault, battery or both. In order to protect yourself from these charges, always
make sure you recieve expressed written consent or that the situation allows for implied consent.
The Right To Refuse Treatment:
Many mentally competent people have the right to refuse treatment at any time. These patient will provide a
dilema for you, such as do I provide care against their will only to be accused of battery or do you leave them
alone and risk the possibility of their condition deteriorating to be accused of abandonment and or
negligence? If a patient refuses transport and treatment-you MUST make sure that they understand and are
informed about the potential risksbenefits and treatment and alternatives to treatment. The patiemt must
also be fully informed about the risks and consequences of refusing treatment and encouraged to ask
questions. Remeber that there are competent adults who refuse treatment for religious reasons and have the
legal right to do so. When dealing with a delusional patient don't assume it's an informed refusal, when in
doubt, it is always best to treat-this is the best course of action cbecause providing tretment is a much more
defensable position than failure to treat, remember failure to treat is considereded abndonment.
Abandonment:
Once you begin to give care, you must follow through all the way with appropriate treatment. Youmust
continue to provide care untill that care is transfered to another medical professional of appropriate level of
training or the proper medical facility. Failure to continur tratment at any of these levels is considerded
patient abandonment. Out of all the legal pitfalls abandonment is legally and ethically the most serious act
you can commit.
Negligence:
Negligence consists of 4 elements: duty, breach of duty, physical or psychological injury, and cause. Once you
are called to the scene to provide care, you have a duty to act and help the patient. Your failure to act or give
care that is not in a manner consistent with the level of care another similarly trained first responder would
give is called breach of duty. If physical or psychological harm is caused by doing something or failure to do
something to the patient then you have acted in a negligent manner. If that's the case you may be liable to
the patient for harm. The important thing to understand here is that all 4 elements must be present for the
doctrine of negligence to apply. Examples--> failure to provide care to patient once you have arrived on
scene--> Failure to perform important or neccessary techniques and also--> providing care in a manner not
consistant with the skill that other similarl traned first responders would give under similar circumstances. If
your actions are judged reckless, careless,lacking in skill, you have violated the standard of care and may be
found negligent.
Duty to Act:
One a unit responds to a call, it has a duty to act. In some situations there may be no legal duty for an
ambulance to respond .e. off duty, out of jurisdiction. So, if you are off duty and you or I happen upon an
accident scene you are not legally obligated to stop and assist any victims. However, if you happen upon an
accident you have a Moral and ethical duty to act due to your training and expertise, the same goes for
nurses and doctors who have the required skills. This is only a small picture of the medical, legal and ethical
issues you must deal with on a daily basis. The First Responders, EMT and paramedic are viewed as
responsible members of the the emergency medical team, your moral and ethical standards must also be of
the highest order in your job performance, I hope this medical-legal information will assist you in
understanding patients and families who only see you under extreme duress and give you pause about being
ethical and protecting yourself and your partner in all runs. With that in mind this article is dedicated to all
the flight nurses and paramedics and EMT's I have worked with.The first responders from 9-11 to Katrina,
Haiti and all my fallen brothers and sisters who have literally given their lives going down caring for their
patients.
For Medical-Legal Research please visit my research site at: http://legalrnblog.com
or click on the double helix DNA logo anywhere on this site.
Important Medical Resorces
Guide to Diagnostic Tests
Medical Dictionary
http://thelegalrn.vodspot.tv/
 | American Nurses Association member | |
| American Association of Legal Nurse Consultants member | |
| National Patient Advocate Foundation Member | |
| Listed in Martindale-Hubbell | |
| Desert Bar Association member | |
| Califironia Bar Association member | |
| Listed in Cambridge Who's Who in the field of Research, Medicine | |
| & Healthcare |
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