Vickie L. Milazzo, legal nurse consultant

How did you go from nurse to legal nurse consultant?
Even when I was in nursing school, I knew I was interested in owning a business. I explored different options. One area I was interested in was patient education, and I did some classes for health care consumers. But the system didn't really offer the opportunity to make a business out of it. The income opportunities would not allow me to give up my day job.

Then, in 1981, a friend who was a psychiatric nurse was involved in a legal case as an expert witness to an attorney. When she told me about it, the lightbulb just went off and I said, "I know I can do that." When I was little, I wanted to be a lot of things. One of the things I had on my list was attorney.

How did you get your first case?
Back then, RNs sometimes were hired as expert witnesses, but none with a full-time career as a legal nurse consultant. I still worked in the hospital and I marketed myself to attorneys, trying to educate them about what I could do for them as a nurse.

I asked a woman who had done typing for me if she knew any RNs who worked for attorneys. She knew a nurse who did life care planning and this nurse put me in touch with an attorney. He said he was engaged with a case and told me to call him back. I called him back three times before he was able to talk to me.

When I started to work for him, he requested that I only research articles and literature. I was excited at the idea of earning $40 an hour to do that, but I thought, "How's he to know what an RN can do for him?" So I researched the articles and wrote a five-page opinion report. He said, "This report is going to help me more than this stack of articles. Here's a second case, write me a report." In the beginning, I educated the attorneys and they educated me.

What has been your most interesting case?
I always go back to the Genene Jones case. [Jones, an LVN who worked at hospitals in the Austin area, was convicted in 1984 for the murder of two children and is suspected of murdering at least 20 other babies in her care.] It was a civil case filed by the parents of a young child who was allegedly killed by Jones.

The child had accompanied her sister to the pediatrician's office. Jones allegedly grabbed her and said, "This child is due for a vaccination," and injected her with Anectine (succinylcholine chloride). After the injection, the child arrested and died. At first, I was a little bit in disbelief when the attorney hired me. It was hard for me to believe that a nurse would commit that kind of act. Ultimately, it was painful to me as an RN when it became clear that the plaintiff's allegations were valid.

What was your role in the case?
I went through the medical records. I especially tried to show how Jones' documentation was not consistent with standard documentation done by RNs. Her documentation was quite bizarre. I also reviewed peer committee reports. The case was eventually settled out of court.

What does a nurse legal consultant do?
There are about 30 different things that legal nurse consultants do for lawyers. We help them analyze the case. We transcribe medical records, screen the cases for merit, locate expert witnesses and write reports as study aids for the attorney. We write 25- or 50-page reports, whereas an expert witness might write only one or two pages. We also help with the discovery process.

How much does a legal nurse
consultant earn?
Some nurses work in-house and some are independent consultants with their own businesses. An independent consultant might make between $75 and $100 an hour, while a nurse who works in-house might earn $20 an hour.

What do you teach in your classes?
We teach everything from the role of the legal nurse consultant to legal theories and how to apply them as a legal nurse consultant. We teach the litigation process. We teach how to screen and how to write reports. We hold an intensive six-day program. We also have a whole day on marketing and business development because nurses tend to not have those skills.

Last year, I trained about 2,000 nurses. In all, I've probably trained 15,000 to 20,000 nurses.

Why did you become a nurse?
When I was a senior in high school, my father had a cardiac bypass. I was impressed with the role of the nurses who cared for my father. Also, I had worked as a candy striper in high school and my sister was an RN. My mother had always wanted to be a nurse. Really, I wanted to be a lot of things. I wanted to be a doctor, I wanted to be an attorney, I wanted to be a journalist. But that was the era when young girls weren't encouraged to do those things. Our choices were nursing and teaching.

It's interesting because now, later in life, my interests have merged. I write. I teach. I get to do the things in the two areas I love-health care and the law. I'm able to help nurses who want to change their careers.

I miss healing patients, but I get to do that with RNs now. I still think of myself as a healer, but I think we can nurture and heal all kinds of people.

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