8 Basics 1 of 8 - General to Specific

Welcome to We Win. Things Change.

Whether you’re opening, cross examining or closing, move from general to specific.   

General to specific. For instance, you may want to begin your opening something like this.  “I’d like to take you back to January 3, 2018. Wednesday. 3 that afternoon. Here in New York. E Harlem. Metropolitan Hospital Center. Labor and delivery Dept. A patient . . .”  General to Specific. Or this, “Today I’m going to tell you the story of a 13-year-old girl . . .” “. . . Do you know who she is?” General to specific. 

Same for cross examining your witness. General to specific. For instance, the Code of Ethics for Nurses requires nurses to act on questionable practices – to advocate on behalf of their patients. It’s not optional. It’s required. When a nurse sees something amiss that may harm her patient, she’s required to advocate for – speak up for - her patient. A portion of your cross – general to specific – might look something like this.  All the answers you know from your depositions are, of course, yes.

You’re a Nurse?
You provide nursing care for your patients?
You provide nursing care for your patients at Metropolitan Hospital.
There is a Code of Ethics for Nurses?
Here it is. [SHOW]

Your Code of Ethics reads in part, [SHOW] “The nurse’s primary commitment is to the health, well-being and safety of the patient.”?
You agree that your primary commitment is to the health, well-being and safety of your patient?
The Code of Ethics for Nurses is there to help nurses keep their patients safe?
The Code of Ethics for Nurses is there to help you keep your patients safe?
To help ensure the safety of your patients.
You’re there to keep your patients safe?
Your Code of Ethics is not Optional?
You’re required to follow it? – 
Required to do what’s in it?

One of those patient safety requirements in the Code of Ethics for Nurses [SHOW] requires that.
When you see what you suspect is a questionable practice?
When you suspect it’s endangering your patient?
You are required by your Nurses Code of Ethics to Advocate on behalf of your patient?
You are required by your Nurses Code of Ethics to do something?
You’re required to speak up?
To say something?
On behalf of your patient?
For the safety of your patient? 
That’s not optional either?
It’s Required?
By your Code of Ethics for Nurses [SHOW] – [Hold it up!]

Your Code of Ethics for Nurses requires you to Confront the person whose practice is questionable?
Your required to Confront the person whose questionable practice is endangering your patient?
Whether that person is a doctor? PA? NP? Another nurse?
Does not matter?
You’re required to confront that person? 
Go all the way up the COC to the hospital administrator if you must?
Never alright stand idly by and watch someone harm your patient?
Especially true, where your Patient’s life is at stake?

I’d like to take you back to November 2018.
Your pt was dx Heparin Induced Thrombocytopenia (HIT)?
HIT Caused by the Heparin administered to your patient?
At your hospital?
Patient Dx w HIT can die?
So tx your patients HIT can be a Matter of Life and death?

When your patient Dx w HIT your patient’s Tx Requires 2 things?
You knew it required these 2 things in November 2018?
First, Stop Heparin? 
It is after all (“Heparin Induced . . .”)
The Heparin you gave your patient is causing the HIT?
Second, Administer a Non-Heparin Anticoagulant
If you just stop Heparin?
That’s only doing half the job?
That’s only doing half of what is required?
Without administering a non-heparin anticoagulant . . .
Your patient will likely die?

You knew [the doctor] stopped Heparin?
You were there?
You also knew [the doctor] didn’t order a non-heparin anticoagulant?
You were there for that too?
You knew both were required too?
Based on your own nursing education, training and experience?
Yet you chose not to say anything?
You chose not to speak up?
Not to do anything?
Your patient died?

Closing too. Start your closing with your most powerful point. Never bury your lead.  Still, general to specific. Arm your favorable jurors for their upcoming discussion about your case. We’ll talk a lot more about closings later. Still. General to specific. Your HIT closing may begin something like this.

When your patient is dx with Heparin Induced Thrombocytopenia (HIT), you’re required to do 2 things. 
Just 2 things.  [Hold up 2 fingers.  Keep them there.]
1. Stop Heparin (Heparin causing HIT). 
2. Start Argatroban – a non-heparin anticoagulant.

The Hospital Policy requires both. Right here. [SHOW]

You must stop the heparin because the heparin is causing the HIT. You must administer the non-heparin anticoagulant because if you don’t your patient’s blood will continue to clot until your patient’s blood supply is cut off, and your patient will likely die.

Your 16-year-old daughter needs brakes. If your mechanic takes the old brake pads off and doesn’t bother to put the new brake pads on, he’s done half the job. Sadly, when your daughter picks up her car and pulls onto the highway into oncoming traffic, she’ll be in real danger. 

General to specific. Are there exceptions? Of course, there are. Unless you have a specific reason though, try your hand at general to specific in everything you do – trial preparation – trial, opening, cross examining witnesses, closing, everything. Do that, you’ll win. You’ll change things too.  

Next up in 8 Basics, “Facts.”

Until next time,
James Hugh Potts II
We Win. Things Change.