After serving as a medical expert in more than 70 lawsuits, Naomi Lungstrom knows there are a lot of ways health care can go wrong.

The clinical assistant professor at the WSU College of Nursing lends her expertise to legal teams across the Western U.S. and in Hawaii. She’s hired by lawyers for both plaintiffs and defendants to evaluate charts and medical histories.

“When I read a case, I don’t care what side I’m on,” she said. Sometimes she tells lawyers she doesn’t think they have a case; sometimes she tells them she can’t defend their client’s actions. Both are conclusions informed by her career as a critical-care nurse specialist and family nurse practitioner.

Lungstrom talked about medical malpractice and professional negligence last week at an interprofessional education event hosted by Student Nurse Leaders at the WSU College of Nursing. She also talked about some of the cases she’s been involved in.

Though every case is different, there are some general lessons for medical professionals, she said.

For one, don’t assume – assess. One patient’s symptoms might not match another’s, even if they have the same condition. “Patients didn’t read the textbook,” she noted.

Make sure charts are complete and accurate, but don’t include information that’s not pertinent to care. Charts where medical professionals are arguing with each other, or worse, mocking a patient, have gotten people into trouble. She recalled one case where a woman suffered terrible pain and ultimately lost her leg to amputation because medical personnel read a monitor incorrectly. But the case was made worse from a legal standpoint because the older woman’s chart was filled with notations about the patient’s screams and her friend’s attitude, Lungstrom said.

She also said it’s important to report things that don’t seem right. Communication errors, or failure to follow policies and procedures, are common causes of medical malpractice claims. In one case, a judge ordered Lungstrom to visit a nursing home to review its policies and procedures after the facility failed to produce them for lawyers. The case settled the night before she was to visit, Lungstrom said.

But there’s another truism in medicine, she noted: people die. She told of a case of a 59-year-old alcoholic with pancreatitis who had been treated for the condition in the ER before. He didn’t follow doctor’s orders from that visit and wasn’t taking his medication. There was a treatment error, but the family lost the lawsuit because of the other facts of the case. Said Lungstrom, “You have to prove beyond a shadow of a doubt that medical harm caused someone’s death or injury.”

There are downsides to the legal work, of course. Some cases upset her deeply, and occasionally she feels like she’s on the wrong side of a lawsuit. Also, there are times “I feel like a traitor against my own profession,” she said.

But she thinks her work on legal cases makes her a better instructor, because it keeps her current with standards of care. Plus, it’s stimulating and interesting. Said Lungstrom, “I loved it from Day 1.”

–Story by Addy Hatch