Christine Tremblay

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To: Kara Di Cecco, MSN, LNCC
From: Chris Tremblay, R.N.
Re: LEI 233
Legal Nurse Consultant Mentorship
Date: 8/4/06
Place: Office of Child Advocate
Subject: Session #4-Final review of records for development of Medical Timeline

As a student in the mentorship class of the LNC program, this will be my last opportunity to review records of a child, for the development of a Medical Timeline.
Because I spent the first four hours of this mentorship at a trial, I found it necessary to schedule an additional session reviewing the records.
This is a very friendly environment. I always felt welcomed. Their goal and purpose is the protection and safety of Delaware’s children.
The administrator welcomes more students from the Widener LEI Legal Nurse Consultant program.

To: Kara Di Cecco, MSN, LNCC
From: Chris Tremblay, R.N.
Re: LEI 233
Legal Nurse Consultant Mentorship
Date: 7/22/06
Subject: Law Firm LNC
New Guidelines of CPR Certification at Silverside Medical Center
Workmans Compensation

I spent the morning hours of this mentorship reviewing requirements of confidentiality of information that is permissible to enter on a blog.
I also reviewed Delaware’s standard for allowing evidence or testimony to be entered at a trial i.e. the Daubert Challenge.
Mid-day, Kara, Jean and I went to Silverside Medical Center. Kara was instructing two Neumann nursing students on delivering CPR under the new guidelines of the American Heart Association with the portable defibrillator. This was demonstrated and reviewed on an adult, child and infant. The algorithms of protocol are included in my mentorship journal.
During lunch, we reviewed the importance and need for confidentiality when journaling online (blogs). Kara went over our outlines prepared after sessions with each mentor. It is very important to maintain confidentiality on the legal blog, to protect confidential information and testimony in a legal case.
Upon returning to the law firm, we settled down to review the laws and provisions of Workers Compensation under the Workers Compensation Act and Rules of Delaware. All employees are required to provide this benefit and make it available to their employees who are injured on the job. The law is administered by the Office of Workers Compensation under the Department of Labor. There are four provisions the employee may be entitled to if injured while working.
1. Two thirds of his/her gross wages with no tax applied.
2. Reasonable and necessary medical treatment with the availability of a second opinion if necessary. No fault is necessary for the processing of the claim.
3. One year after the accident or surgery, the employee may be evaluated for permanency of their residual disability or disfigurement.
4. Criteria for determining physical disfigurement using the “bathing suit rule”.

It was a full day. We will meet again on August 26. The planned topic is Personal Injury/Medical Malpractice.

To: Kara Di Cecco, MSN, LNCC
From: Chris Tremblay, R.N.
Re: LEI 233
Legal Nurse Consultant Mentorship
Date: 7/31/06
Place: Level I Trauma ER
Subject: Forensic and SANE Nurse Experts

This was my last evening or shift with Nurse K. We met at the Triage desk. She informed me that this previous week had been extremely busy with many interesting cases. Hopefully tonight would be a busy one!
Nurse K. was scheduled as the SANE for the 7PM to 7AM shift and was asked by her supervisor to make rounds to see if anyone could use a little helping hand. Again, it became very apparent, this was a nurse that the entire ER, no matter what the age of the nurse or doctor, was very respected. I felt very privileged and grateful for the experience of this mentorship in Forensic/SANE nursing.
My last four hours with Nurse K. would prove to be fairly quiet, but we were able to go over many interesting topics relevant to forensics.
I left at 11PM, somewhat saddened that my time with Nurse K. had ended. She truly is a professional and an inspiration.

To: Kara Di Cecco, MSN, LNCC
From: Chris Tremblay, RN
Re: LEI 233
Legal Nurse Consultant Mentorship
Date: 7/21/06
Place: Office of Child Advocate
Subject: Session #3- Review of records for Medical Timeline

The entire eight hour day was spent organizing/reviewing medical records for preparation of Medical Timeline for an attorney.

To: Kara DiCecco, M.S.N., L.N.C.C.
From: Chris Tremblay, R.N.
Re: LEI 233
Legal Nurse Consultant Mentorship
Place: Level I Trauma Center/Emergency Room
Subject: S.A.N.E. and Forensic Nursing in an Emergency Room setting

I arrived at the ER at 6:50 PM. This was to be a 12 hour shift working with Nurse K. We met at the front desk of the emergency room. Almost immediately after placing our personal articles in the office, there was an overhead announcement of a heli-transport auto trauma.

The trauma room was prepared and staffed for the patients arrival with doctors, nurses, radiology, ultra-sound technicians, Psych and Forensic Nurses and a chaplain. Upon the patient’s arrival, the EMTs gave verbal announcement reports regarding the particulars of the auto accident as it related to the victim and his condition. The team goes to work quickly and in perfect harmony. When this patient was stabilized, he was transported to ICU.

The next case was another trauma victim who was apparently one of multiple individuals who had sustained a reported GSW (Gun Shot Wound). Chest x-ray indicated a possible/probable pneumothorax and internal injuries. The Chief Trauma Surgeon ordered the patient transported to the OR. Before this was done, Nurse K. took photos of the patients wounds after receiving the patient’s permission.

We went back to the office and secured the documentation. Nurse K. explained examination of an entrance/exit wound. Nurse K. and I
discussed alternative possibilities. Nurse K. explained if the surgeon retrieved a bullet, he would use plastic surgical instruments to extract the bullet. This is to prevent denting or changing the casing of the bullet, to further identify the gun. After removal of the bullet, the surgeon would call the Forensic Nurse to prepare packaging the bullet for the police.

Through the night, I shadowed Nurse K. as she helped fellow staff members in assisting with patient care.

At 6 AM, the announcement was made that another heli-transport was arriving in 3.5 minutes. Again, everyone readied themselves and the trauma room. It was a MVA. The patient was not conscious. Signs were taken and neurological evaluation indicated no reflexes in the lower extremities. The EMTs had reported the patient had been extracted by the jaws of life. Further testing and neurological evaluation would be indicated.

Nurse K. and I ended our shift together at about 7:10 AM. I must say that all of Nurse K.’s co-workers tell me I am working with the best!

To: Kara DiCecco, M.S.N., L.N.C.C.


From: Chris Tremblay, R.N.


Re: LEI 233


      Legal Nurse Consultant Mentorship


Place: Level 1 Trauma Center/ER


Subject: S.A.N.E. and Forensic Nursing in an Emergency Room setting


 


            I met with Nurse K., a Sexual Abuse Nurse Expert and Forensic Nurse Examiner at a Level I Trauma Center/Emergency Room.  I was given an orientation to the physical layout of the emergency room. The average number of patients seen in this emergency room is just under 300 patients per day.  The department is divided into specific disease entity categories, such as a Cardiac, Gastrointestinal, Infectious Disease, Pediatric, Trauma and General Care.


           


          I arrived at the emergency room at 6:50 P.M.  Nurse K. and I had previously arranged to meet at Triage. I met many of her co-workers and two fellow SANE nurses.  I was allowed to observe only with the permission of the patient and/or guardian.


 


         Nurse K. had just finished an interview with an alleged pediatric assault victim. I noticed Nurse K. immediately documented her findings. She reviewed what was necessary to be included in this documentation.  Upon completion of the records, she prepared the sexual abuse kit and finalized documentation, including visual records. Both confidentiality and Chain of Custody are essential in this process. This is not for the eyes of employees of the hospital. There are varied forms for different types of assault or abuse. This case appropriately took Nurse K. several hours.


           


       Later that evening, a patient was brought in with a gunshot wound/stabbing.  It is believed this patient was the victim of the crime per the police escorting the EMTs. The patient refused pictures, as was his right.  He was quickly taken to the OR, due to possible pneumothorax and internal bleeding.


      


      When not being called to the duties of a SANE or Forensic Nurse, Nurse K. may work areas secondly assigned or where she is needed in the ER. 

To: Kara DiCecco, R.N.
From: Chris Tremblay, R.N.
Re: LEI 233
Legal Nurse Consultant Mentorship
Date: 7/7/06
Place: Office of Child Advocate; Wilmington, DE
Subject: Second Meeting and review of records for Medical Timeline

Entire eight hour day organizing records and reviewing records for preparing a Medical Timeline for an attorney.

To: Kara DeCecco, R.N.


From: Chris Tremblay, R.N.


Re: LEI 233


      Legal Nurse Consultant Mentorship


Date: 6/30/06


Place: Confidential


Subject: Review of Records for Medical Timeline 


 


            I spent all day at the office reviewing the copious records of “X” for possible child abuse.  The developed medical records on hand are over 11 inches high when standing alone on a desk.


            I feel somewhat overwhelmed and frustrated that with my time scheduled with this rotation, will not afford me the time needed to thoroughly get through these records and then develop a Medical Timeline. To devote this time, I would need to forgo other mentorship experiences.


 


           

To: Kara DiCecco, M.S.N., L.N.C.C.


From: Chris Tremblay, R.N.


Re: LEI 233


       Legal Nurse Consultant Mentorship


Date: 6/28/06


Place: Office of Child Advocate, Wilmington,DE


Subject: First Meeting (Interview) with Anne Pedrick, M.S. Program Director


 


            This was my first scheduled meeting/interview with Anne Pedrick, of the Office of the Child Advocate.  Anne is the Program Director for this very busy office, whose mission or job is to monitor Delaware’s child protection system to ensure the health, safety and well-being of Delawares abused, neglected and dependent children.


           


            When we spoke, I did not have the feeling associated with most interviews, i.e. the formality and tension.  On the contrary, the atmosphere was very relaxed and friendly.  We spoke about children in general and Anne gave a very brief explanation of what their office does on a daily basis.


 


           Strict adherece to confidentiality must be maintained, so I will not be posting specific information regarding this rotation. It is enough to say that this rotation is one of an exceptional opportunity and chance to help make a difference in the lives of their clients. 


           


          Anne was very delighted to have a nurse from the LEI program at Widener Law School considering and applying for a mentorship with the Child Advocate Office.  She voiced to please let my instructor know she would love to continue with this involvement in the LNC mentorship program.


            


          Anne said she would be glad to count this toward my hours in the program. I am really grateful to have this opportunity.

To: Kara DiCecco, M.S.N, L.N.C.C.


From: Chris Tremblay, R.N.


Re: LEI 233


      Legal Nurse Consultant Mentorship


Date: 6/24/06


Place: Law Firm of Doroshow, Pasquale, Krawitz & Bhaya


Subject: Journal on Social Security Disability


 


            The topic for discussion and review was that of Social Security and applying successfully for disability.


           


             It came as a surprise to me how useful and valuable a nursing background was for participating and supplying the necessary key information to the disability process.  By the end of the day I had to admit… a perfect fit.


           


            Jean Marie McKinney and I met at the law firm where Kara DiCecco is the Legal Nurse Consultant.  We spoke of the website that is very valuable as a reference source for any topic in regards to Social Security benefits, i.e. www.nosscr.org (National Organization of Social Security Claimant’s Representatives) and the homepage for social security, www.ssa.gov. Anything anyone would want to know about social security is on this site.


 


             One of the pages on this website is www.ssa.gov/work. Known as the “Red Book” this is information concerning SSA’s “ticket to work” program.  Anything anyone would want to know about social security is on this site.


           


             The two basic programs for social security are Social Security Disability Insurance also known as SSDI and Supplemental Security Income, also known as SSI.  It was very interesting to learn that if you become disabled and it is determined not totally disabled,  the claimant can be placed down in skill level (requiring less than your current educational/work experience) in the workforce, but you cannot be placed up in skill level (harder than your current educational/work experience) in the work force. 


 


A Five Step Process:


 


             Step 1: A claimant must be unable to work one full year or a physician believes the individual’s condition will prevent them from working at least a year or longer (based on 2004 criteria). If you earn more than a set amount ($810.00 a month gross (in 2004), Social Security presumes you are not disabled.  The individual cannot be working when they apply.


           


           Step 2: There must be a physical and/or mental condition that prevents them from working.  Social Security Administration gives a lot of weight to specialist opinions.  The medical and/or emotional condition should be severe and be evaluated to meet a listing.  This is a list of body systems and impairments that is the Gold Standard (eligibility requirement) for argument to the judge.  Body systems are assigned certain numbers and if those the claimant’s impairment meets the criteria on the list, they qualify. 


 


           Step 3: If you don’t meet a listing, you go on to Step 3. This exact degree of severity of condition is step three in the analysis. 


 


         Step 4 is: Can you return to any of your former jobs going back 15 years?


           


          All of these steps in the analysis are determined based on the medical information in front of the reviewer.  They will make a decision without these records if they are not all gathered in front of the adjudicator. 


           


          Step 5: The burden of proof shifts to the Government and no longer the claimant’s as in Steps 1-4. It is the Government’s burden to prove you can work a full time job and show the jobs exist in competitive numbers in the workforce (good odds of getting the job).


           


         The copy of the Dictionary of Occupational Titles (DOT) with the Copy of the Listings and Copy of Grids was reviewed and explained as the tool for determining the degree or severity of disability. It simply tells the reviewer yes or no for the applicant question: Do I qualify for Social Security disability?


 


        This law firm has several attorney’s that specialize in representing Social Security claimants and knows the value of the Legal Nurse Consultant’s contributions.