Legal nurse consultants are often recognized for assisting medical malpractice and personal injury attorneys in personal injury cases. However, a lesser-known area of expertise is criminal defense.
A legal nurse consultant can analyze medical records for the criminal defense team and determine if the medical records support or counter the claim made by the opposing party.
As it relates to criminal defense, legal nurse consultants are highly skilled at the following:
| Reviewing, organizing, and analyzing the medical records and law enforcement discovery such as body cam footage. |
| Locating and working with experts who provide crucial insights into medical conditions, injuries, or treatment plans. |
| Conduct thorough research on medical literature and standards of care. |
| Assist attorneys regarding the direction of the case and offer insights that may affect the defense’s arguments. |
| Prepare defense attorneys for depositions and preparation of trial questions. |
| Evaluate the significance of an injury, wound, or toxicology report as it relates to the overall medical picture. |
Criminal Defense Areas of Focus:
- Strangulation
- Blunt force Trauma
- Gunshot Wounds
- Domestic Violence
- Driving under the influence
- Attempted murder
- Assault and battery
Background:
Seizures are episodes of abnormal electrical activity in the brain, often manifest in various ways.
Seizures are broadly categorized into two main categories:
| Generalized Seizures | Focal (partial) seizures |
From there, the classification is based on the affected area of the brain, where the abnormal electrical activity began, and how it spread.
| Absence Seizures: Formerly known as “petit mal” seizures, these are characterized by a brief loss of consciousness and staring into space. The person may appear momentarily unaware of their surroundings and not recall the seizure afterward. | Simple Focal Seizures: The seizures originate in a specific brain area and cause localized symptoms without loss of consciousness. The person may experience altered emotions, sensations, or movements. They may exhibit repetitive movements, unusual tastes or smells, or involuntary limb twitching. |
| Tonic-Clonic Seizures: Formerly known as “grand mal” seizures, these are perhaps the most widely recognized type of seizure. They involve two phases: Tonic phase: Marked by stiffening of the muscles.Clonic phase: Characterized by rhythmic jerking movement of the muscles. Loss of consciousness and often a period of confusion or fatigue follow the seizure. | Complex Focal Seizures: These seizures also originate in a specific part of the brain but result in altered consciousness or awareness. During the seizure, the person may display automatic, repetitive behaviors and appear dazed or confused. Afterward, they have no memory or only partial memory of the event. |
| Atonic Seizures: Characterized by a sudden loss of muscle tone, leading the person to collapse or fall. This type of seizure is brief and may cause the person to drop objects they are holding. | Secondary Generalized Seizures: These seizures start as focal but then spread to the entire brain, leading to a generalized seizure. This may result in convulsions, loss of consciousness, and other widespread symptoms. |
| Myoclonic Seizures: These seizures involve brief, jerking movements, usually in the arms or legs. They can occur individually or in a series and may happen in combination with other types of seizures. | Febrile Seizures: Only occur in children aged 6 months-5 years. These seizures usually occur in the presence of a fever (100.4 F temp or higher). |
Case Study:
In October 2021, a man named David drove home after a routine grocery shopping trip. Suddenly, David swerved erratically across multiple lanes as he approached the intersection and collided head-on with the oncoming vehicle. Several passersby witnessed David’s accident and immediately called the authorities, who promptly responded to the scene.
The driver of the other vehicle was injured and required immediate transportation to a level-one trauma center. Police noted that David was sitting in his driver’s seat, slurring his words, had urinated himself, and was not oriented to his surroundings. Emergency medical services triaged David and noted he had no significant injuries. While he was in the back of the ambulance, David suddenly became belligerent with personnel, which prompted the authorities to detain him. Police officers noted David became uncooperative, was spitting on them, and required constant re-orientation. Police officers transferred David to the local county jail under police custody on suspicion of driving under the influence.
During the booking process, David began to recall the chain of events and explained to jail staff that he believed he had a seizure. He had a history of seizures as a teenager and was taking medication for over fifteen years. Jail staff did not follow the chain of command, and David was jailed with medical attention for approximately eight hours. Later that evening, jail medical staff on duty evaluated David, recognized the signs of seizure, and called for an ambulance to transport David to the hospital for a proper medical evaluation.
Police officers mistakenly confused David’s seizure and post-seizure symptoms that caused his erratic driving and accident for intoxication.
Legal Nurse Analysis for David’s Case:
Depending on the type of seizure and the patient’s overall health, the post-ictal (post-seizure) phase, the patient may experience various physical, cognitive, and emotional changes as the brain recovers from the effects of the seizure activity. This phase can vary in duration and intensity and depending on the type and severity of the seizure.
During the post-ictal phase, individuals may exhibit symptoms that overlap with those seen in a state of intoxication, leading to potential confusion or misinterpretation by observers, including law enforcement. Some common features of the post-ictal phase that may contribute to this overlap include:
| Confusion and Disorientation: Individuals who are post-ictal may be disoriented and confused. They may struggle with understanding their surroundings and following directions. They may even become aggressive, and they struggle to regain orientation. |
| Slurred Speech: This symptom is not uncommon and may be associated with intoxication. |
| Fatigue and Weakness: Seizures can be physically and mentally exhausting. After a seizure, individuals may feel extremely weak and fatigued, causing them to appear sluggish and unsteady. This physical state can be misinterpreted as the effect of alcohol or drug intoxication. |
| Impaired Motor Function: Impaired coordination and unsteady gait are common in the post-ictal phase. This may be mistaken for drunkenness. Additionally, some people lose control of their bowels while they seize, which can occur during states of intoxication. |
| Memory Impairment: Memory deficits are common in the post-ictal phase, including difficulty recalling events or conversations that just occurred. These memory lapses overlap with alcohol intoxication. |
In David’s case, law enforcement was unaware he had a seizure and a history of seizures. David was clearly showing signs of symptoms, including confusion and aggression that overlapped with signs of intoxication.
It was not until he arrived in jail that he began to regain complete awareness in his post-ictal period and expressed to medical staff he had a history of seizures and was taking medication to control them. Law enforcement and other first responders must be trained in recognizing the signs of seizures and the post-ictal phase to avoid misinterpretation and potential legal consequences.
A legal nurse consultant can play a role in educating legal professionals about medical conditions, helping them understand the distinction between post-ictal symptoms and signs of intoxication. Thorough medical evaluations and documentation of the individual’s medical history can help clarify the situation and prevent unwarranted legal actions such as in David’s case.
