Medical records can be a roadmap for understanding what has happened to a victim. But unlike the medical dramas on TV, medical records can be hard to read, challenging to understand, and dry.
They can, however, be lynchpins to a case involving domestic violence, elder abuse, child abuse or car accidents.
Join us for this recorded webinar as Dyanne Greer and Hilary Weinberg of the Maricopa County Attorneys Office discuss:
- a basic understanding of what is included in most medical records (now that most of them are digital),
- what records should be requested to facilitate charging criminal cases,
- how to organize medical records once they have been received,
- what to focus on in reading the records,
- how to determine which physicians or other medical personnel you might need to interview or subpoena.
- and why interviewing medical personnel may be necessary, as the records may not address the questions necessary to charge the case.
Justice Clearinghouse Editors (JCH): Dyanne, you’re new to the Justice Clearinghouse audience. Can you tell us more about yourself and your unique expertise in understanding Medical Records?
Dyanne Greer: Sure! I was a medical social worker in a level one trauma center, working in the pediatric inpatient/outpatient services, the emergency room and the psychiatric emergency room, prior to going to law school. Sometimes I think the only reason I was assigned the severe child abuse cases was that I could read the doctor’s handwriting and have some understanding of what they were saying! Even though I am not a fan of EMR (electronic medical records), it has made it easier to decipher them. Since I had to enter my notes in the medical record I became familiar with how the hospital organized them…and believe me, every hospital is different. Relying on that background, and my 31 years of experience as a child abuse/DV and sex crimes prosecutor, I have learned (painfully in some instances) how to deal with the hospital bureaucracy and individual physicians. I don’t have all the answers, but hopefully I can help others gain a basic understanding of how to approach the “medical complex," if you will, in a way that will make it easier for them to get the medical information/testimony they need to prove cases in which medical issues arise.
JCH: Investigators and prosecutors no doubt will access medical records for domestic violence cases or child abuse cases… What are some types of less obvious cases when it might be a good idea to get copies of medical records that prosecutors or investigators might not typically think of?
Dyanne: Any kind of trauma case involving injury or death…gunshot wounds, stabbings, motor vehicle accidents. They may also need to obtain records for a suspect, which is a whole different kettle of fish, as hospitals are very reluctant to release these records. There are ways to do it, but it’s important to do it correctly.
It is important to become familiar with the format and reasoning
behind medical records in order to help us know where and who to ask for help.
JCH: Your webinar is about Medical Records. For some people, that can sound like a really dry subject. Why are medical records an important part of the investigative and prosecutorial process?
Dyanne: It can be very dry, especially when we lawyers are trying to understand “medicinese," if you will. However, it is important to become familiar with the format and reasoning behind medical records in order to help us know where and who to ask for help. You won’t learn all the lingo in this webinar, but hopefully you’ll learn how to organize and evaluate the medical information you need and how to find resources to help you understand what the records say. Believe me, Google is invaluable in this endeavor! In many cases, we need the medical records to guide us to witnesses who can help us prove the elements of our case. However, even this can be treacherous if you don’t know how the hospital is organized. For example, is it a teaching hospital? If so, even though a note is written by a “doctor," that could be an intern 2 weeks out of med school…certainly not the one you want on the stand! I’ll help you know how to figure out who is the most senior medical provider, who is often the one you’ll want to subpoena. Another example is a hospital who contracts with their ER staff…they often won’t accept service for these providers, so you need to know early on how to reach them for court.
EMR is a game changer in many ways. I used to be able to rely on nursing notes as they documented interactions in the room between a patient and a visitor, and nurses tend to blend into the background, so I would periodically get really good statements from suspects. Nurses can document them, but they may not be in the EMR, so it’s important to find out how the hospital has them record these observations.
I strongly recommend meeting with the hospital's
legal/med records/risk management personnel to establish a relationship.
JCH: What are the biggest misconceptions prosecutors and other justice professionals might have about understanding or reading medical records?
Dyanne: First of all, understand medical records are a means to an end…finding out what happened to your victim and who can testify to it. Medical records are seldom admitted in their entirety leaving the jury to figure them out; you need to have the treating professionals whose notes are in the records to testify, and the only way you can figure out who you need is to review them. You shouldn’t be discouraged if it seems like Greek to you…the providers should help you understand what is important to establish the elements of your crime. Our goal is to help you get a handle on the often voluminous records and sift through what is important to your case and then reach out effectively to the hospital/provider to get you the info you need to prove your case.
You don’t have to read the entire record like a novel…and you shouldn’t! It’s a sure fire way to fall asleep and miss what you really need from them! You have to approach it in a way that focuses on what you need from the records, or really, what you need to know in order to figure out who to subpoena (not everyone who had any involvement should be in court), and what questions you need to ask them ..in advance of trial!… to prove your case.
Medical records are impossible to obtain…the hospitals keep throwing up roadblocks. You have to remember that they are worried about liability, even more so with the enactment of HIPAA, and the med records people have no more comprehension of the criminal justice system than you do of the medical system. However, a primer on HIPAA requirements and a review of your own state law can provide you with the correct way to obtain the records.
Doctors will not talk to us. Unfortunately, they are worried about liability as well, plus they often don’t want to take time out of their busy schedules to testify. You can help ease their minds by learning ways to approach them: for example, don’t just show up and expect them to drop everything to talk to you or the law enforcement officer. Hospitals often do rounds in the morning, so that is an especially bad time for them. Learning who their secretary is and establishing a relationship with him/her can go a long way, as does trying to work around their schedule as much as possible. I often will establish 2 days for possible testimony, so if the trial runs late, I move them to the second date. Some hospitals have specific requirements before their medical personnel will talk to you, which you need to determine in advance and comply with, and they may provide the medical professional with an attorney. Don’t panic if that happens; they have their own internal requirements we need to be cognizant and respectful of.
Medical records benefit the defense. They may, but reading them yourselves with an eye to potential defenses can go a long way to meeting them at trial. Prior existing conditions, reactions to medications, misdiagnoses can all be addressed in many cases during your case in chief, or in rebuttal, but you need to be aware of them, and a thorough review of the records can help.
Understand medical records are a means to an end…
finding out what happened to your victim and who can testify to it.
JCH: You’ve learned a lot about medical records over the years. What do you wish you would have known or realized about medical records years ago that you finally understand now?
Dyanne: I had the fortune to work as a medical social worker in a level one trauma center prior to becoming an attorney, so I worked with the record on a daily basis. It’s important to learn how the hospitals you work within your community are organized, as that will help you understand how to request what you need. I strongly recommend meeting with the hospital's legal/med records/risk management personnel to establish a relationship. Helping them understand that you are not trying to inconvenience them in requesting records and/or interviews with the doctors. They don’t understand why we need such detailed records, but once you explain that, for example, you need the medications records to show that the medicine given to a patient would not have an impact on the patient’s ability to accurately describe what happened to them, they may be more willing to cooperate.
Click Here to Watch "How to Understand General Medical Records for Your Investigation and Prosecution of Criminal Cases."