The Boyk Brief
Go into chambers with attorneys Chuck Boyk, Mike Bruno, Zac Shaffer, and the attorneys of Charles Boyk Law Offices on The Boyk Brief, as we talk with interesting personalities from the legal world, celebrities, experts, business & community leaders, and other engaging people about a variety of topics.
The Boyk Brief
Boyk Brief Episode 33: Emma Sullivan - Boyk Law's Nurse Paralegal
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Attorney Chuck Boyk talks with Emma Sullivan, Boyk Law's Nurse Paralegal, about her role with the firm and how she helps clients win their cases by reviewing their medical records.
A video version of this episode of The Boyk Brief podcast is available on YouTube https://youtu.be/VHKqaeboyck
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I'm happy to introduce our guest. Her name is Emma Sulvan. Emma is a full-time nurse paralegal at our law office. She is both a registered nurse and a paralego. And I call her our comparative advantage. And what I mean by that is in a personal injury law practice, we deal with medical records, both prior medical records of our clients, the medical records for the treatment of our clients, and we discuss treatment options and we try to evaluate the case. And Emma has the unique knowledge both as a paralegal and as a registered nurse that gives us a comparative advantage compared to other law firms in order to help our clients get the best medical results and the largest recovery. So, Emma, I'm glad you're with us today.
SPEAKER_00Thanks for having me on the BoIC Brief today, Chuck.
SPEAKER_01I typically like to start and ask people about their journey, about how did they get to where they are today? So why don't you tell the listeners uh where you grew up, where you went to high school at, and tell us about your journey.
SPEAKER_00So I grew up in Oregon, Ohio. I lived near Maumee Bay and enjoyed riding my bike there with family and friends. And I lived there up until the seventh grade when my mom and dad decided that they were gonna buy the house that my mom grew up in as a child. So we moved to Woodville, Ohio, which is the speed trap. Don't speed there, because you will get a ticket. Um, and then I went to Woodmore High School, which was a pretty rural high school. I graduated in a small class. Three of the students in my class were actually my cousins. I went on to go to college at the University of Toledo and receive my Bachelor's of Science and Nursing. I sat for my state boards and I'm Ohio licensed nurse. And I returned to the University of Toledo to obtain my post-baccalaureate certificate and nurse paralegal studies.
SPEAKER_01So tell us about your family situation currently.
SPEAKER_00So currently I'm a resident of Toledo, Ohio. I live there with my significant other and our two children. Um my son is gonna be turning 15 here soon, and my five-year-old daughter just graduated from kindergarten. We also have a new addition to our family. Um his name is Zeppelin, aka Zeppi. He's a Bernice Mountain dog. You may have seen him on our on our Facebook webpage.
SPEAKER_01Right, we've had the opportunity for him to be a guest here, and we'll see how uh often he comes to visit uh the staff and clients in our office. Your prior experience, you've worked as a registered nurse for a substantial period of time, correct?
SPEAKER_00Yes. I've I've worked in long-term care, acute med surge, I was also um an ER nurse in which I was trauma certified at a level one trauma center. I was a sexual assault nurse examiner, and my last job was working for a local insurance company in which I was a health educator. And now I'm glad to be um working here at the BoIC offices.
SPEAKER_01Let's talk about um the advantages and what your job's duties are. How would you go about and explain um what you do and what your job is to uh your family or your friends or your dog's friends?
SPEAKER_00I would say I'm kind of like an investigator. So I analyze the material, I interpret it, and then I summarize it, and I kind of, you know, then give my my medical professional opinion on the matters, and you know, it kind of directs us into the next steps.
SPEAKER_01And I would assume on a daily basis, um every injury and every case is different. So I would assume that, you know, one of the, I guess you could look at it as an advantage or disadvantage that um every day is probably different for you.
SPEAKER_00Right, yes. And and I what I love about this opportunity is that in the other medical field, you kind of treat and then the patient is given to somebody else. I actually get to see the patient or the client um, you know, come to us with their complaint, treat, you know, and and see the whole continuum of their care and possibly see them get better or you know, and see them seek the or receive the justice that they deserve.
SPEAKER_01Yeah, and in our situation, normally a fast case might be six months, and a long case might be three or four years. So it's not really a short-term relationship that we have with these clients.
SPEAKER_00Right. And being here, I genuinely care about our clients and you know, I want to see them do better and form those relationships. So that's important to, you know, the quality and the fulfillment of my job.
SPEAKER_01Currently, you spend a lot of your time analyzing medical records for the attorneys, for the clients, and the legal assistants. And um, why don't you kind of explain um what the purpose of medical reviews are?
SPEAKER_00So, what I kind of do is I get all of the medical records together and I create a timeline. And that timeline helps me, you know, kind of see where the person was prior to the incident, you know, what kind of function they had, or maybe what kind of previous diagnoses they may have had. And then, you know, once the accident or the injury occurs to kind of see how their life has changed, um, or maybe possibly link, you know, secondary injuries to the incident that occurred. And I prepare these, you know, for our office and also for our clients to help with, you know, different things as you know, writing demands to insurance companies or also preparing the attorney or the client for depositions. We can also use them to assess like a case value, and also they help us know you know everything that's going on so that we don't have any surprises because we don't we don't want any of those.
SPEAKER_01Often in our case, the client comes in and we get information about their pre-existing treatment, and what I call that is what was their baseline before the accident. So in all of our cases, we typically order up the prior records, the prior family doctor, or any injuries that were substantially similar to the treatment they have out of the accident, and we get you all of those records, and then you would do a file review of the person's prior medical records and what their baseline was.
SPEAKER_00Correct.
SPEAKER_01And then we order up all the medical records from the actual treatment too, and then you would do a file review of that.
SPEAKER_00Yes. And make any type of recommendations too. If I see you know that maybe they're not treating with a certain type of specialist that can help mitigate further injuries as well. We we do do that as well.
SPEAKER_01Typically, if we have a case that we're going to do a demand for settlement, before we do a demand for settlement, um Emma will prepare a file review of the prior records and the current records, and that allows both the client, the attorney, and the paraligo to work together to get the best demand letter possible because we have an analysis of all the medical records.
SPEAKER_00Yes.
SPEAKER_01One of the things that's always been helpful for me is um when I'm trying to prepare a client for a deposition, um, I use your analysis of your medical records, and I use that to prepare myself uh for the deposition so I understand all of the medical treatment and and can have a higher level conversation with the client. But what I think is even more helpful is I call it my cheat sheet. I give the cheat sheet to the clients so the clients can prepare for their deposition. Umticed is most people don't even remember their medical treatment from 10 years ago. So having your prior records gives the clients a big uh comparative advantage. So that's really helpful. When we're doing intakes, so for example, today we had an intake together and you were in on the intake, and um it was a serious injury on a potential medical malpractice nursing home case, and you were able to ask questions uh to the client in the interview, and your expertise is something, for example, that you know I don't have, so you asked higher level questions than I would have been capable of asking.
SPEAKER_00Right, just you know, having that medical background allows me to know, you know, what treatments may have been used in those situations and what the standard of care is, and keeping up to date on that evidence-based practice, you know, to make sure that our clients do have receive the best care possible.
SPEAKER_01You'll review the medical records, and by reading the medical records, you'll tell us we're missing medical records, we're missing chart notes, we're missing additional medical records. Uh, can you explain how you would determine that?
SPEAKER_00Well, it depends from case to case, but many times we also order up the bills with our medical records, and the bills will list, you know, CT scans or x-rays, and so I make sure that all of those correspond with the medical timeline. But things are also referenced in notes. Um, so I oh when I go back through the medical records, I make sure that I have everything.
SPEAKER_01You mentioned about trying to assist them in treatment. So, for example, you would analyze the medical records, and could you give us an example of how you might realize that, for example, that either the client or the doctor may have missed something and maybe we need to refer to a specialist?
SPEAKER_00So, say if somebody is in a car accident and they're treating, and you know, there's comments within the review that maybe the pain is more mental than it is physical. Um, maybe getting it the client in to see a psychologist and get a mental evaluation, you know, to see how the pain, you know, may have affected their life in other ways psychologically and that they're not even aware of.
SPEAKER_01Sometimes I've noticed we'll get a complicated medical issue and we don't have an expertise in that. Maybe you could explain how you would do medical research and what tools you have available to you to do that research.
SPEAKER_00Most of the times I look at, you know, evidence-based practice, and we have subscribed to UpToDate, which is an app that you can get on your phone, or also you can use it through your computer. It's it's by Walters Kluer, and it's evidence-based research written by physicians and used worldwide. Um, it contains, you know, drug-to-drug interactions, and it also contains the standard of care. It provides clinicians with hierarchies in which they can use these hierarchies for tough decision-making, um, on-the-go needs, and to ensure that the client gets the best care. And we have paid for access to this so that we can better assess the standard of care and make sure that our clients are receiving that throughout their treatment. And I also use, you know, sources that come from peer-reviewed research. Um, and then I use that to, you know, support or, you know, sometimes unfortunately, you know, kind of refute our case.
SPEAKER_01Right. You know, one of the things that I think we try to do a good job is just to be open and honest with the client. So I like to be able to tell the client and look them in the eye and say, these are the strengths of your case, these are the weaknesses of the case, and I would rather just tell them the truth and not tell them just what they want to hear. And I think clients appreciate it, especially if you can actually give them a journal article that explains what the standard of care is, or you can give them the medical records and show them the specific medical record that kind of either makes your case or doesn't make your case. Why don't you talk about like uh reviewing standards of care?
SPEAKER_00So a standard of care is going to be, you know, what we hold the physician to, or in the medical world, you know, what is um their proper, you know, treatment line. Um and what we're looking for is a deviation from that. Um, you know, with a dehydrated baby, for instance, you know, there's gonna be standards of care that that baby has to have IV access and is receiving a certain amount of fluids, and they're monitor monitoring the lab values in addition to other things as well. Um, but when they're not doing that, you know, that could be a deviation from that care.
SPEAKER_01You can take a complicated medical issue and try to put it into layman's terms. Is that something when you work as an RN that you try to do with your patients?
SPEAKER_00Yes, that's a real big part of you know communication with our patients and also education. You want to use teachback methods to ensure that the patient is understanding what you're saying and to address any questions that they may have. Because if there's a barrier to their understanding, then they're probably not going to carry out what they need to do to manage their health in an appropriate way. I'm kind of like the translator between the medical and the legal world.
SPEAKER_01And that's both a big advantage in the material, the research, and the medical reviews you provide, and also you know, one advantage if we actually meet with the clients that you can be in there and you can uh you know translate the uh medical terms and the medical language into English, both for the attorneys and for the client.
SPEAKER_00Yes.
SPEAKER_01You give us um a lot of written information that we use um to prepare ourselves and prepare our clients for depositions and to evaluate the case. Why don't you explain for our listeners how that gets accomplished?
SPEAKER_00So I review all of the medical records starting from previous treatment to the incident to the treatment after the incident, and I take all of that information and I compile it into a timeline. And then once I get done, I review the timeline and I look for like any gaps in treatments or issues that we may have with the case. Um, you know, maybe you had back pain prior to the incident, um, so we need to be aware of that, or previous, you know, surgeries that may um be similar to what your injury currently is. Um, and then I write up a medical opinion or summary of all the weaknesses and strengths that we have, and then I give it to our attorneys here and the legal assistants, and you know, we kind of review it to see what we're up against.
SPEAKER_01Right, and I think that that's helpful for me because I really don't want somebody to tell me what I want to hear. Um, I want the case analyzed, like our opponents, uh the defense attorneys or the insurance companies would analyze the case, so then we can uh prepare and preempt those arguments both in deposition or a trial. So that's a big advantage. When you're doing medical research, maybe you can explain, you know, how how that gets to you and then what you do to come up with your research and your opinions.
SPEAKER_00I I think like we talked about, each case is different, so it just depends. Um but the research, I it's gonna be on the topic that I need, and I look for evidence-based practice and peer-reviewed literature. Um, but I I do try to get multiple sources. You know, I don't only want what's gonna support our case, I want to make sure that there's no information out there, too, that's going to be damaging to us. Um and then I prepare that and and I, you know, include that in the opinion of the file review.
SPEAKER_01And an example I can remember is recently you did a file review on a very complicated auto accident case, and um you basically told me that there's a good part of the treatment that really has nothing to do with the accident and it's related to the pre-existing condition. So it didn't help the case uh from that perspective, but it helped me eliminate the big weakness in our case so we could emphasize the strong part of the case.
SPEAKER_00Yes.
SPEAKER_01Once again, I think the important thing is you're giving us whatever the real truth happens to be so we can get the best uh result for the client. Um, oftentimes, clients will tell me that they'll go into the doctor and they'll them and the doctor will have a discussion about something, the doctor told them something, but then when you look at the records, there's like zero mention of any of that in the records. Um have you noticed that that oftentimes doctors don't put in everything that was said into the records?
SPEAKER_00Yes, and I notice a lot of times they'll put something in the subjective information, and then in the objective, it's something different. Subjective information is gonna be something that somebody says in conversation, typically the patient, and then objective is gonna be what the doctor sees. Like, are they having labored breathing? Um, can they see that they're grimacing or grabbing their sides? So it's gonna be what they're what they're seeing in their assessment.
SPEAKER_01If the client complains of pain, that's a subjective complaint. Where if let's say the doctor might have done like some sort of orthopedic testing or some sort of objective um test, that would be an objective sign. Right.
SPEAKER_00Which is very important to you know support our case.
SPEAKER_01There's some doctors I've noticed that correspondingly with the meeting with the client, they'll dictate their notes. And then there's other doctors that I would bet don't dictate their notes till maybe the end of the day or a few days later. And obviously, who can have that good of a memory from something that happened, you know, six hours before or two days before?
SPEAKER_00Right.
SPEAKER_01In order to make a diagnosis of a herniated disc, of a torn meniscus in the knee, they have to do an MRI. So oftentimes um, you know, we'll look at some of Emma's exams or some of her file reviews, and you know, the client is is claiming all the subjective symptoms of a herniated disc, of a torn meniscus, of a torn labrum. So we'll try to encourage the client to ask the doctor to order an MRI, and the MRI will be the objective test that proves that the torn labrum or the torn meniscus actually is there. So that's kind of how we use Emma's research, the attorney review, and uh providing full information to the client in order to better evaluate the case. Anything else you think you would like to add about your job or what you hope to accomplish in the future?
SPEAKER_00Yeah, I'm excited to be a part of the team here at the BoIC offices, and also we're hoping to expand, you know, our social media content on um helping our clients, our future clients, through like any type of hospital-related injuries or personal injuries and educating on those matters and you know, teaching our clients what their patient rights are.
SPEAKER_01Thanks for being with us today, Emma, and uh I look forward to working with you and you helping our team and our clients in the future.
SPEAKER_00Thanks for having me. I'm excited to be a part of the team.