Expert insights to underpin your medical case

Do you need an expert opinion to support a case of medical negligence? Is your firm often on the back foot when trying to find a qualified specialist for a medico-legal opinion?

Nursing is an essential part of every modern healthcare system, and with around 450,000 registered nurses and midwives in Australia, it is the largest clinical workforce in the country.

advicor’s team of highly qualified and clinically active nurses and midwives consults extensively on healthcare cases involving adverse medical events.

With significant clinical and specialty knowledge within their scope of expertise, our expert nurses and midwives are ideally suited to conduct forensic medical reviews and can play a central role in  a medical negligence case.

Our expert nurses and midwives are ideally suited to conduct forensic medical reviews, and can play a central role in the outcome of your medical negligence case.

What is an expert nurse/midwife?

An expert nurse is a registered nurse or nurse practitioner who uses their experience and expertise as a healthcare professional to provide objective opinions on professional standards of care in medico-legal cases.

They can provide a variety of services including the review of medical records and standards of care, and provide their opinion in verbal or written reports. They may also attend depositions, arbitrations and mediations or appear in court as an expert witness.

Similarly, an expert midwife is well-qualified and experienced to provide a comprehensive review and analysis of medical records and consult in cases of injury or malpractice.

advicor Expert nurses and midwives are highly experienced in their field of practice, usually holding postgraduate qualifications and roles in clinical education or research. They receive training in medical record review and root cause analysis, and only provide opinion within their area of expertise. Both must hold full and current professional registration.

They perform a variety of services including reviews of medical records and standards of care, and provide their opinion in verbal or written reports.

What types of medical negligence cases can they resolve?

Expert nurses and midwives are often asked to provide opinion on nursing and midwifery practice in cases where poor standards of practice led or contributed to poor health outcomes.

Because of their experience, training and knowledge of medical records, they are expert at identifying such things as irregularities and inconsistencies in nursing and midwifery practice, record tampering, missing evidence, failures of nursing staff to provide competent professional care, or failure of a hospital to provide a safe environment for its staff or patients. They can also provide expert opinion on nursing and midwifery law, standards, policy and procedures.

Expert nurses and midwives often provide expert opinion in cases involving:

  • Referral or triage errors
  • Insufficient examinations
  • Misdiagnosis
  • Unnecessary or incorrect treatment
  • Medication issues
  • Improper procedural applications
  • Failure to adequately monitor the patient
  • Failure to provide information and advice
  • Nurse work-related injuries and assault

Case studies

Here are two examples where an expert nurse can support a medical negligence case:

Case 1: post-operative death

Don, aged 55, was admitted to the local hospital for minimally invasive elective heart surgery. During the surgery there were complications and the procedure was changed to open heart surgery.

Following the operation, Don was transferred to the intensive care unit (ICU) for critical care. An ICU nurse attended to the wrong patient and switched off the humidifier that controlled the oxygen being delivered to Don. Over the next 8 hours, other nurses did not notice the humidifier had been turned off, and there was no evidence of clinical assessment and documentation at the start of each nurse’s shift noting there was any change in Don’s condition. Hourly checks should have been undertaken of oxygen flow rate, patency of tubing and humidifier settings. Consequently, Don’s breathing tube become blocked with mucus and these secretions obstructed his breathing. He subsequently suffered a heart attack and died.

The Coroner was critical of the care provided to Don. Initially the hospital denied liability and an inquest was held into his death. Don’s wife consulted a law firm which referred the case to an expert nurse who forensically reviewed all the hospital clinical notes, various other medical reports, hospital policies and procedures. The expert nurse identified significant gaps in the nursing notes and found that ICU nurses failed to provide Don basic medical care which included: failure to record vital information on the patient’s chart; failure to follow the cardiac surgeon’s instructions; failure to assess the patient’s condition including blood pressure and other vital signs; and misuse of a medical device.

The expert nurse was able to establish that the nurses on shift did not perform their duties as per essential guidelines in assessment and monitoring. These included: Observation and Monitoring Nursing Clinical Guideline re: pulse oximetry monitoring, Nursing Assessment Nursing Clinical Guideline, Australian Nurse Competency Standards, and Code of Ethics for Nurses. In addition, there was a breach of adherence to hospital procedures relating to oxygen therapy delivery. In the final analysis, the expert nurse was able to provide a robust and detailed evidence-based report that identified many instances of breaches of care. The evaluation by the expert nurse was ultimately able to show irrefutable evidence that the nurses involved provided a poor level of care expected from their role. The law firm acting for Don’s widow and children was able to settle the lawsuit for a significant sum.

Case 2: midwifery

Baby Ryan was born at a major city children’s hospital in 2018. The maternity ward staff failed to recognise that he was unwell despite his parent’s concern about his colour and breathing. Hours after his birth, Ryan suffered cardio-respiratory problems and became unconscious. By the time a maternity nurse checked on him, he had gone blue and it was estimated his brain was starved of oxygen for some 20 minutes. It was determined he was left with cerebral palsy because of the brain injury. It appeared the midwife and team of nurses overestimated his condition during the immediate neo-natal period. It was also identified the paediatrician present at his birth left it to a nurse to examine Ryan after birth, as the midwife on duty was helping another mother experiencing a complex birth. Consequently, no-one adequately observed his condition immediately after birth.

Ryan is now 5 and needs 24/7 care from his parents, who both had successful careers. His mother had planned to return to her full-time job after six months’ maternity leave. She is now her son’s full-time carer and his father has taken on a second job to pay for Ryan’s care. They have also had to make many home modifications and buy expensive equipment to meet his needs. The appointed legal firm obtained expert evidence from a midwife and paediatrician who confirmed there was inadequate monitoring and care, and that it was only when Ryan had a seizure and became unconscious that emergency responses were activated. Both experts found that while the maternity team managed to resuscitate Ryan, it was too late and the period of hypoxia was sufficient to cause brain damage. The expert midwife was able to identify additional notes and records that showed further inconsistencies. There were indicators that the CTG (cardiotocography testing monitoring a baby’s heart rate) traces immediately after birth were concerning, and there was little evidence of how tightly the umbilical cord was wrapped around Ryan’s neck. In addition, the notes relating to his blood gases after birth and his heart rate measures were scant and incoherent.

In an integrated medical negligence report, the midwifery and paediatric experts were able to show evidence of several instances of lack of proper monitoring and care. The defence team denied liability with respect to monitoring and accuracy of the notes but accepted that if the paediatrician had been able to attend to Ryan sooner, there would have been a better outcome for him. The court found in favour of Ryan and his parents and ordered the defendant pay damages supporting Ryan’s life-time care and loss of earnings for his parents. The judge also ordered a complete audit of the maternity ward clinical practices against the standards of maternity care be undertaken immediately, with review audits every six months for two years to ensure proper standards of care.

Our expert solutions

advicor’s expert nurses and midwives work across the continuum of general and specialist nursing care, providing our customers with a comprehensive pool of medico-legal knowledge to support their medical cases.

We advise on case viability, provide medical opinion of the highest quality, and ensure reports stand up to the utmost scrutiny in court.

advicor offers a range of expert opinion services: 
Assist in early case identification and managementReview and analysis of best-practice evidence
Timeline and event chronologyExpert witness and providing evidence in court
Clarifying terminology, tests, and proceduresPharmacological and medication reviews
Literature reviewsTreatment plans
Comprehensive medical record review and interpretationRisk and safety assessments
Consulting with legal counselHospital policy and procedure reviews
Expert nursing and midwifery opinions

Specialised advice

Our experts are able to provide specialised advice across the following areas:

Aged care

Critical care

Emergency

General medical and surgical

Maternal and baby

Mental health

Primary health

Theatre

Why choose us?

At advicor, we are proud of the fastidious approach we take to curating our world-class medical expert panel. Our robust recruiting process selects expert consultants with postgraduate tertiary qualifications and those with experience in desirable speciality areas, such as critical care nursing.

We engage only those suited to expert nurse consulting and provide them ongoing support and learning opportunities to continue to develop advanced skills in report writing and other services. All must be registered with the Australian Health Practitioner Regulation Agency and are bound by strong codes of ethics and professional conduct, as well as stringent competency standards.

Combined with the support of our account management team, who communicate with our customers regularly throughout the process, we are always working to actively assist you.

In selecting the right nursing or midwifery expert for your case, we ensure:

  • There are no known or potential conflicts of interest
  • They can provide an impartial, objective and unbiased opinion
  • They have the time to act as an expert witness and can perform a thorough review of all documents, conduct research and prepare a defensible written report
  • They have the right skills required for your case

Find out more

advicor has access to more than 29,000 medical specialists who practice in 50 specialties across three continents. Like our medical specialists, our expert nurses and midwives can play a central role in the outcome of your medical negligence case.

For more information call us today on (02) 8467 6767 or email us at contact@advicor.com.au