Attorneys Blog

Electronic Discovery

We paralegals are in the story business. Through our work on legal cases, we are introduced to the skeleton of an account and must try to reconstruct the truth using the discovery process.

Most of our working hours are spent filling in the blanks. What we find when we do our jobs, and how we find it, can change a case’s direction, focus and even outcome.

Electronic discovery has revolutionized the way paralegals work and has given us unparalleled access to information. So our new challenges are time management and resource management: We must locate the most relevant information without becoming bogged down in the sheer supply of material. When we have accomplished this, the information fills in the gaps and can bolster our clients’ cases.

Not very long ago, discovery was limited to the hard copy files our clients kept (or did not keep). Ten associates and paralegals locked in a conference room would review 50 boxes of paper for days on end, creating “hot” document binders and sorting documents by relevance and issue. Numerous days and billable hours were required to weed through the information and then organize the material for use in a variety of trial scenarios.

Before the electronic database defined a new age of discovery, we occasionally found hidden gems of evidence or new ideas to support the client’s strongest position. But the infrequent cry of “Eureka!” is downright routine today. Because we have more data and it’s better organized, it’s so much easier to find new ideas and approaches. If a new approach to a case comes up during a document review, we can more frequently “discover” supporting information electronically.

This ability to more effectively manage the case information through the use of databases is just one example of how technology improves the litigation process.

At my firm we have established a practice group that focuses on providing discovery counsel, document review and production and litigation support services. At every stage, this group uses technology to improve its processes: by using databases to provide litigation support, by leveraging technology to assist in substantive document reviews for responsiveness and by conducting narrowly focused “snapshot” reviews even before the litigation is filed.

A perfect example of how technology enables litigation professionals to provide services that may not have been possible in the past, all-paper world is the snapshot review. It is a limited review done in order to quickly locate key information for the client Ñ e.g., for internal investigations or for pre-litigation risk assessment. This type of review can save firms and clients time and expense by allowing us to quickly get to the heart of the matter. And it can often help to produce an amicable settlement.

Consider this scenario: A client calls his law firm for help with a case. Adamant about his position, he waves around what he considers to be a “smoking gun” document and says he wants to file a complaint as soon as possible. The law firm persuades the client to conduct a snapshot review for additional fact-finding before filing. The firm harvests e-mail and other electronic documents from a few key players at the client’s organization. Using special software, the firm culls out redundant materials, applies date ranges and runs keyword searches – greatly reducing the volume of material for review. The attorneys then review the remaining documents, using the software’s visual mapping and search capabilities to quickly home in on the most relevant documents. They locate not only the smoking gun document that the client first brought to their attention, but also a number of e-mails and documents that clearly show the client’s case is not as strong as originally believed.

The snapshot review process has changed the complexion of early negotiations. The client now has a more accurate view of the situation and may decide not to pursue the case after all. But had the snapshot review shown his position to be well supported, the client could have proceeded to file the complaint and aggressively approach the next phase of litigation, confident that the more extensive document review required by the discovery phase would not likely introduce unexpected plot twists.

Technology also plays an important role in the discovery phase, where an even larger collection of information must be reduced to the subset of responsive documents that will be given to the opposing side and loaded into litigation support databases. And once again the litigation support team will need to zero in on the most important pieces of information.

Paralegals who effectively use electronic discovery and take advantage of technological innovations can bring clarity to a case. And with that clearer picture, the client has more data points to consider trial strategy and settlement negotiations.

Primer On Laparoscopic Gallbladder Surgery and Injury To the Biliary Tract

The biliary ducts carry bile from the liver to the small intestine. Bile aids in the digestion of fatty foods. The biliary tract begins as the left lobe duct and the right lobe duct which descend from the liver. These two liver ducts form at their bifurcation the common hepatic duct. As the hepatic duct descends toward the small intestine, the cystic duct which leads from the gallbladder joins the hepatic duct to form the common bile duct. The common bile duct descends into the small intestine. The ampulla of vater is the sphincter of tissue that controls the flow of bile from the common bile duct into the small intestine.

Cholecystectomy is the removal of the gallbladder due typically to gallstones or sludge formation. Most often a cholecystectomy is an elective or planned procedure though emergency cases occur. The gallbladder is removed surgically by clipping and transecting the cystic duct and the cystic artery so as to allow the gallbladder to be removed. The gallbladder is not a vital organ and if gallstones or sludge formation have occurred, it can be readily removed without a change in lifestyle or liver or biliary tract function.

An open procedure used to be the surgical method whereby the patient’s abdomen was opened and the biliary tract was examined in a traditional manner by the surgeon. In the late 1980s, laparoscopic surgery became the popular method of removal of the gallbladder. Laparoscopic surgery was touted as causing less pain to the patient and a shorter recuperative period.

Surgeons who were in active practice in the late 1980s oftentimes went through training which included proctoring at their hospitals by qualified and experienced laparoscopic surgeons. Medical students began laparoscopic training in medical school and were not required to undergo training after medical school.

Preceding removal of the gallbladder during laparoscopic surgery, trocars are introduced into the patient’s abdomen. The trocars allow for lighting, video camera illustration, surgical instruments and carbon dioxide insufflation. The abdomen is insufflated with carbon dioxide initially and video camera and surgical instruments are used to scan the abdomen for any abnormalities. The liver is lifted and the gallbladder is exposed. The gallbladder is grasped and a process of meticulous dissection begins to remove tissue and/or adhesions from the gallbladder and cystic duct so that accurate identification of the anatomy occurs. The better practice is to pull the base of the gallbladder to the patient’s right so that the cystic duct is perpendicular to the common bile duct. When the base of the gallbladder is not pulled to the patient’s right side then oftentimes the cystic duct aligns parallel to the common bile duct and this can lead to misidentification. A short cystic duct can contribute to misidentification of the anatomy. However, a short cystic duct is not an excuse since meticulous dissection will reveal the junction between the gallbladder and the cystic duct.

Because there are variations in the biliary anatomy, most surgeons agree that the safest practice is to perform a cholangiogram before a transection of any duct. A cholangiogram is a test where dye is introduced into the biliary system and outlines the system so that the anatomy is more readily identified. A cholangiogram is a safeguard for the patient since it helps to confirm that the surgeon has properly identified the anatomy and also the lack of any ductal injury. It also confirms that a gallstone is not obstructing the biliary tract below thereby eliminating a possible problem requiring re-invasive treatment at a later time.

Surgical journals reveal that many iatrogenic (“physician-caused”) injuries during laparoscopic cholecystectomies are oftentimes due to lack of experience. The Southern Surgeon’s Club reported that the new laparoscopic technique resulted in a learning period. The learning curve reflected a higher incidence of bile duct injury. The Southern Surgeon’s Club’s study found that within the first 13 cases of any participant’s experience, the bile duct injury rate was 2.2%, compared with 0% after the 13th case. During the initial 12 – 13 procedures the surgeon is on his “learning curve”. Another cause for injuries is the surgeon’s overconfidence resulting in failure to meticulously dissect and conclusively identify the biliary anatomy prior to transection.

The Society of American Gastrointestinal Endoscopic Surgeons (hereinafter “SAGES”) sets forth well-established principles for the prevention of injury during laparoscopic biliary tract surgery:

the cystic duct should be identified at its junction with the gallbladder;
traction on the gallbladder infundibulum should be lateral rather than cephalad (towards the “head”);
meticulous dissection of the cystic duct and cystic artery is essential;
gallbladder holes should be closed to prevent loss of stones;
the surgeon should not hesitate to convert to an open operation for technical difficulties, anatomic uncertainties or anatomic anomalies, especially in cases of acute cholecystitis (infection of the gallbladder);
liberal use of operative cholangiography is desirable to discover surgically important anomalies, clarify difficult anatomy and to detect unsuspected common bile duct stones;
all energy sources can cause occult injury.
Correct dissection exposes the cystic artery and the entire gallbladder infundibulum but not the common bile duct. The steps of dissection that will avoid confusing the common bile duct for the cystic duct are:
retraction of the infundibulum laterally;
initiation of dissection on the gallbladder (dissection should begin on the gallbladder and proceed along the cystic duct towards the common bile duct rather than vice-versa);
opening up all folds in the gallbladder;
stopping medial dissection when a sufficient portion of the cystic duct has been cleaned for cholangiography and clipping; and
application of the first clip to the base of the pedunculated gallbladder where it begins to taper to its stalk.

Because the cystic duct and cystic artery are the structures to be divided, it is these structures only that must be conclusively identified in every laparoscopic cholecystectomy. Accordingly, the cystic duct and artery should not be clipped or cut until conclusively identified. To achieve conclusive identification, Calot’s Triangle must be dissected free of fat, fibrous and areolar tissue and the lower end of the gallbladder dissected off of the liver bed. (The latter is an essential measure that precludes the possibility of injury to an aberrant duct.) At the completed dissection, there should only two structures seen to be entering the gallbladder, and the bottom liver bed should be visible. Note that it is not necessary to see the common duct. It is at this point that the surgeon has achieved the critical view of safety and the cystic structures may be occluded because they have been conclusively identified. Failure to achieve the critical view of safety because of difficulty of dissection as a result of inflammation or any other cause is an absolute indication for cholangiography or conversion to open cholecystectomy to define ductal anatomy.

If an injury is recognized early, it can be repaired by the surgeon and the patient stands a much greater chance of no resulting complications. Therefore, the standard of practice requires the surgeon to search for potential injuries prior to completing the surgery. The omission of cholangiography increases the odds of an injury failing to be recognized.

Injuries to the biliary tract can have a devastating impact on a patient’s life. Injuries that are discovered post-operatively should be referred to a specialized center with expertise in hepatobiliary surgery because the first attempt at repair is critical. The biliary ductal anatomy often has modest blood circulation when healthy. After an injury, a stricture or narrowing of the duct or lumen may occur due to inadequate blood supply and/or scar tissue. Further, studies show the probability of increased risk of stricturing after the initial stricture as well as increased mortality.

When a stricture occurs follows an injury, one effect is “back flow” pressure in the liver since the bile no longer flows to the intestine. If this pressure is not relieved, liver damage can result. One of the effects of prolonged stricture formation is dilation of the intra-hepatic ducts. (The extra-hepatic ducts are the ducts that flow out of the liver towards the intestine. The intra-hepatic ducts are the ducts within the liver.)

Repair of an injury to the common bile duct by the surgeon involves bringing up a loop of the small intestine and suturing it directly to the remaining duct. A Roux-en-Y hepaticojejunostomy is a surgical procedure often used to attempt to repair bile duct lesions or injuries high (towards the liver) on the bile duct. A hepaticojejunostomy involves removing a 8-10 inch loop of bowel from the small intestine, suturing one end closed, suturing a top portion of the loop to the remaining bile duct, and re-suturing the lower end into the intestine. Strictures also occur at the site of the anastomosis or the location where the remaining duct is sutured to the loop of intestine.

Cholangitis is infection or inflammation of the bile ducts. Since the ampulla of vater no longer is present in the injured patient, the sphincter of tissue that normally control the flow of bile from the common bile duct to the small intestine is no longer present. Therefore, the bacteria and other matter present in the small intestine can flow up the previously “sterile” biliary duct to cause infection possibly extending into the liver. Antibiotics are used to treat the cholangitis which is then usually resolved but may re-appear intermittently. Severe cases of cholangitis can be life-threatening particularly after several episodes due to the effect on the ducts and possibly the liver.

After a repair surgery, stricturing and re-stricturing occurs unfortunately. Many studies reflect that only 10-28% patients undergoing hepaticojejunostomy in these circumstances experience a stricture of the ductal anatomy. However, these studies arguably include “selection bias” of the physicians in choosing their patients reporting their results and the studies do not involve long periods of patient history review. Further, re-stricturing is more likely after an initial stricture. The author’s contact with experts reveals that strictures may occur as late as 20 years after the initial repair surgery. A minimum of 5-7 years is required in follow-up of the patient before a patient’s chances of stricture following a repair surgery diminish significantly.

Another option (other than surgical re-attachment higher on the duct) available to resolve the obstruction caused by stricture is a balloon dilation. During a balloon dilation, a catheter is inserted into the biliary duct above the stricture and a balloon is introduced. The balloon is threaded down to the stricture where it is threaded into or across the stricture prior to the ballooning which expands the duct allowing the flow of bile. The risks of the significant bleeding, infection and other complications of the balloon dilation procedure is approximately 11%. Further, repeated balloon dilations efforts and other necessary gastrointestinal studies increase the risk of scar tissue within the ductal anatomy at the anastomosis and at other locations where friction occurs.

In one patient’s case presently in litigation, the repair surgeon wrote in the Operative Notes that there was a 90% chance that the patient would completely recover from the repair surgery. Four months later, the patient experienced a stricture of the anastomosis or repair site, cholangitis, a balloon dilatation sequence involving two dilatations and repeated episodes of an apparent continuing peptic ulcer. Another result of the hepaticojejunostomy repair is that stomach acids no longer neutralize the bile as before. Rather, the bile acids directly flow into the intestinal loop and this can cause an ulcer as the acids inflame the intestinal tissue.

Another client’s experience began in 1990 when her bile duct was divided during a laparoscopic cholecystectomy. A cholangiogram was not performed and the injury was not diagnosed nor repaired until approximately 14 days later. This patient’s management has included two major surgeries (re-attachments) and numerous balloon dilatations of recurrent stricture. Therefore, the author suggests that an attorney practicing in this field of medical malpractice should not resolve his or her client’s case without an understanding of the significant and chronic risks facing the injured patient.

Tips for Requesting and Reviewing Medical Records

Whether your practice involves medical malpractice, personal injury, toxic tort or even family law you will at some point in time have the need to request medical records.

Most states have a section in the Rules of Civil Procedure covering specifics of request format, time to respond and charges for medical billing. Be sure to check your state code prior to preparing a request for medical records.

Below are some tips for paralegals and attorneys who will need medical records in order to substantiate a claim and answer discovery through production of medical records.

Interview the client to obtain as complete a medical history as possible. If they have billing records copy and retain those, as they will contain important contact information for health care providers.

Remember billing and medical records may not be maintained at the same facility and a separate request for each is needed.

Obtain the pharmacy billing records prior to and subsequent to the incident in question. Have the potential client bring these for the initial interview. They will contain a thumbnail sketch of the patient’s medical care prior to the incident in question, identify prescribing/healthcare providers as well as document medication taken (such as pain medication) to aid in supporting damages.

Many medical records, especially nursing documents are multiple pages with dates, signatures only on one page. It is suggested you request multiple pages be stapled in order, this is crucial for establishing dates/times and providers in a chronological order.

Often treatment and medications records are double-sided with initials/signatures and comments on the opposite side. Be sure to request double sided copies, or if single sided copies, request they be stapled together. These records may contain crucial information in a case.

As in any case of medical negligence or malpractice, the medical records are extremely important in proving the facts showing negligence, causation, and damages.

Obtain ALL of the nursing home, clinic, urgent care, emergency room, ambulance, visiting nurse, occupational therapy, speech therapy, physical therapy and respiratory therapy records and ALL doctor and hospital records.
Sometimes urgent care, ambulatory care clinics, emergency rooms, ambulances, nursing and various therapy services, etc., are independent contractors. Establish with the hospital or institution what care is provided by independent contractors and where to address medical records requests to ensure you are ordering ALL of the available medical records.

Even if all of the available medical records are not part of the alleged incident and hence are not subject to the medical review, they should still be obtained as reference material.

The records just prior to and after an alleged incident are especially important in providing documentation as to the person’s medical condition, the extent of the alleged injuries as well as an indication of any probable long-lasting complications that may now exist.

Key Point: Information is often obtained from seemingly obscure records, hence the need for ALL of the medical records.

Components of the Medical Record


Hospital records include, but are not limited to:

Admission Information/Summary – documents date/time of admission, admitting diagnosis. Admitting physician and other basic admission information

Discharge Summary – documents condition at time of discharge, any post discharge instructions for lab tests, physician appointments and medications prescribed, as well as instructions for physical activity and other treatment modalities.

Admission History and Physical – documents condition at time of admission, usually performed by admitting physician, but sometimes deferred to a medical resident or physician assistant. There may also be a separate document, “Physician’s Admission History and Physical” in some health care facilities.

Physician’s Progress Notes – daily chronology of patient’s progress, often gives rationale behind change in treatment or medication and documents physician visits.

Emergency Room Records – documents condition upon arrival, chief medical complaint and may also include emergency room physician evaluation of any tests performed such as ultrasound, radiology and laboratory tests. Also recommendations for referral, admission and/or discharge are obtained here.

Consultation Reports (Physician and other professional.) documents evaluation and recommended treatment by physicians, and other health care providers asked to consult in reference to patient care.

Physician’s Orders – documents date and time of treatments and medications ordered by treating physicians. These are to be signed by the physician ordering, even if a telephone order or phone/verbal order given to a nurse.

Operating Room Records and Report (Physician, Nursing and Anesthesia Record) – documents procedure performed, surgeons, nurses and anesthesia personnel present during surgery. Also documents patient condition before, during and after surgery. Some hospitals document post operative care in the “PAR” (post anesthesia recovery) record.

Laboratory Reports – documents results of tests performed in the laboratory. Includes not only blood and urine tests, but also cultures of tissue and microscopic exam of tissue.
Graph Sheets – documents basic vital signs and other basic functions such as urinary and intestinal elimination. Some graphic sheets also document dietary and fluid intake.
I and O record – documents fluid and solid intake and output on a daily basis. Usually tallied on a daily basis, but may be recorded with each shift (two to three times a day)
Treatment Sheets – documents all manner of treatments such as wound care, hot and cold therapy not given in physical therapy, etc.
Medication Sheets – documents medications given. PRN medication is given on an “as needed” basis and may be listed separately from regularly scheduled medications.
X-ray/Radiologist Reports – documents radiologist’s impression of radiology tests. Will also contain name of ordering physician.
Physical Therapy Records – documents treatments/therapy given in the Physical therapy department as well as the patients response to therapy.

Speech Therapy Records – documents therapy given by speech pathologist.
Occupational Therapy Records – documents therapy given by occupational therapist. May be included as part of physical therapy records in some institutions.

Nurse’s Notes/Nursing Progress Notes – Chronological documentation of patient’s condition, physician visits, change in condition and treatments given as well as patient responses. Usually written in longhand, but more and more frequently are seen as a computerized record.

Nursing Care Plans – Each patient has a general plan of care, and the foundation is determined by the policy of the health care facility. However, generally the nursing care plan covers all treatments, medications and therapies ordered for the patient. Goals are also stated for patient care.

Interdisciplinary/Multidisciplinary Progress Notes (Not utilized in all facilities.) – documents progress of each therapeutic department in chronological order, rather than a separate progress note maintained by each department. May include notes made by more than one department, such as speech, physical and occupational therapies.
Other records found but not consistently maintained by all facilities may include:

  • Records/Treatment Logs
  • Treatment Records, Nursing Treatment Records (Sometimes in with the medication records; sometimes listed separately.)
  • Physical Therapy
  • Speech Therapy
  • Occupational Therapy
  • Rehabilitation Therapy, Restorative Services
  • Recreational Therapy, Activity Therapy or Service
  • Any other form of therapy records
  • Visiting Nursing or Home Care Nursing Records
  • Records from Independent Medical Laboratories

Records from Independent Radiology and Nuclear Medicine Services

Ambulance Records (EMS — Emergency Medical Service) – these records may be maintained by either an independent EMS service or a municipal fire department, or hospital EMS service.
Emergency Room Records (These are often not part of the hospital records, where the emergency room is operated by an independent contractor.)

In some situations, the records of emergency response personnel such as the local police and rescue portions of the fire department will also apply and will be separate from other EMS records, and a separate request for each entity will be required in order to obtain all records.

Building Your Medical Library

Whether your practice involves a client injury in the workplace, injury due to medical negligence, product defect, or toxic chemicals you will have a need to obtain and review medical records.

At times the terms used in the medical records can be confusing and the rationale for diagnosis and treatment is not clear. In other instances you wish to review a standard of care as it relates to your client’s diagnosis and treatment.

Below is a general listing of resources, both in text print as well as online which might be of benefit to your office.

We are all sensitive to the issue of overhead for the law office. Therefore, you may want to consider obtaining some of these books as library materials for a shared legal medical library established through your local bar association or in co-operation with other law firms in your immediate area.

Medical Abbreviations: 24,000 Conveniences at the Expense of Communications and Safety, by Neil M. Davis
Temple Univ., Philadelphia, PA. Annual pocket quick-reference guide to 24,000 meanings of medical abbreviations and 3,400 cross-referenced generic and brand drug names. Thumb-tabbed pages. Includes single-user access code to the Internet version of the book which is updated with 80-120 new entries per month. Softcover.

Laboratory and Diagnostic Tests with Nursing Implications (6th Edition)

Each test is discussed in seven subsections in the following sequence: (1) reference values/normal findings, (2) description, (3) purpose, (4) clinical problems, (5) procedure, (6) factors affecting laboratory or diagnostic results, and (7) nursing implications with rationale. Following the name and initials for each test, there may be names of other closely associated tests. Reference values/normal findings are given for children and adults, including the elderly. The description focuses on background data and pertinent information related to the test. The general purpose for each test is listed. Clinical problems include disease entities, drugs, and foods that cause or are associated with abnormal test results. The procedure is explained with a rationale for the test and with appropriate steps that the nurse and other health professionals can follow. Factors affecting laboratory or diagnostic results alert the nurse to factors that could cause an abnormal test result. The last subsection and most valuable information for each test concerns the nursing implications with rationale. For most diagnostic tests, nursing implications are given as “pretest” and “posttest.”

Alexander’s Care of the Patient in Surgery

ALEXANDER’S CARE OF THE PATIENT IN SURGERY, considered the standard in perioperative care for over 50 years, is a comprehensive reference for students and practitioners alike. Unit I covers basic principles and patient care requisites. Unit II details step-by-step procedures for over 400 general and specialty surgical interventions. The unique needs of ambulatory, pediatric, geriatric, and trauma surgery patients are discussed in Unit III. New features include highlighted patient education and discharge planning, sample critical pathways, expanded coverage of endoscopic/minimally invasive procedures, and internet resources. A new chapter, Surgical Modalities, addresses today’s technologically advanced perioperative environment.

Merck Manual Diagnosis & Therapy (Includes Facsimile of 1st ed. of the Merck Manual)

The most widely used medical text in the world and the hypochondriac’s bible, the Merck has the lowdown on the vast expanse of human diseases, disorders and injuries, as well as their symptoms and recommended therapy. It’s intended for physicians and medical students, but though the type is tiny and the language technical, the Merck’s a valuable volume for anyone with more than a passing interest in bodily ills.

Rosen’s Emergency Medicine: Concepts and Clinical Practice (3-Volume Set)

ROSEN’S EMERGENCY MEDICINE continues to be the premier source that defines the field of emergency medicine. It describes the science of emergency medicine and its application, focusing on the diagnosis and management of problems encountered in the emergency department. This stellar new team of editors has introduced many new features including a “Cardinal Presentations” section, chapter consistency, and more diagnostic imaging throughout. All existing chapters have been extensively revised, and reference lists have been edited to include more significant, up-to-date references.

Joint Commission on Accreditation of Healthcare Organizations. (CAMH) Comprehensive Accreditation Manual for Hospitals: The Official Handbook: Accreditation Policies, Standards, Scoring, Aggregations Rules, Decision Rules.
Oakbrook Terrace, IL, Joint Commission on Accreditation of Healthcare Organizations, 2001. CAMH, $350.00; CAMH and 1-year update, $565.00; CAMH annual subscription update, $245.00.

Cecil Textbook of Medicine (Single Volume)

Cecil Textbook of Medicine, 21 Edition CD-ROM provides rapid-access to the complete text, illustrations, tables and references. Review questions with answers are linked to the relevent sections of the textbook and complete drug monographs from Mosby’s GenRx are included. Plus, this CD-ROM gives you FREE access to Cecil Online! –This text refers to the CD-ROM edition.

Current Pediatric Diagnosis & Treatment

Provides clinical information on ambulatory and inpatient medical care of children from birth through adolescence, focusing on clinical aspects of pediatric care and their underlying principles. Emphasis is on ambulatory care, acute critical care, and a practical approach to pediatric disorders. This edition contains new chapters on developmental disorders and behavioral problems, substance abuse, allergic disorders, and fluid, electrolyte, and acid-base disorders and therapy, plus expanded illustrations.

Clinical Nursing Skills & Techniques

The 5th edition of Clinical Nursing Skills and Techniques offers new up-to-date content and improved features, in addition to complete coverage of more than 200 nursing skills, a nursing process framework for a logical and consistent presentation, and a convenient 2-column format with rationales for each skill step.

Critical Decisions in Emergency Medicine, reliable, relevant clinical updates/risk management. two lessons each month. Subscription for non member $244 a year.

Index of past issues found at:
Order by calling ACEP or going to and order online
ACEP – Foresight CEU Risk Management

Print monthly from online resource.
AMA – Medicolegal Forms with Analysis – Documenting Issues in the Patient-Physician Relationship.
Covers issues such as consent, informed refusal, ama, and others. Contains current forms and references to legal citations related to each issue discussed.

Other suggested Book Lists/Links

Brandon/Hill selected list of print books and journals for the small medical library

“Selected List of Books and Journals for the Small Medical Library” was published almost forty years ago, this series of selection guides has been heavily used and highly valued by librarians, nurses, health care practitioners and publishers. The Small Medical Library list was followed in 1979 by the “Selected List of Nursing Books and Journals” and by the “Selected List of Books and Journals in Allied Health Sciences” in 1984. In 2001, the publications were made available on the internet, promoting unrestricted access.

It was always the instruction of Alfred Brandon and Dorothy Hill, the original authors, that the selected lists would not be published under their names without their direct involvement which is why they retained copyright of the lists. With the recent retirement of Dorothy Hill, this longstanding project has drawn to a close.

Brandon Hill Journal Links

This list of Journals available in full text online was updated on a regular basis by the National Library of Medicine through May 12, 2003, This page is valuable in terms of information to online resources, but this page, “MLA Brandon/Hill Journal Links”, is no longer updated.

General Reference Internet Links


Medscape is a multi-specialty Web service for clinician and consumers that combines information from journals, medical news providers, medical education programs, and materials created for Medscape. Here you will find a combination of peer-reviewed publications, a free version of drug information via the “First Data Bank File” and free Medline.

MD Consult

Founded by leading medical publishers that include Mosby and W.B. Saunders, MD Consult integrates peer-reviewed resources from over 50 publishers, medical societies, and government agencies. From this site you can obtain full text from respected medical reference books from a variety of specialties, medical journals, and MEDLINE. In addition you can obtain comprehensive USP drug information (beyond the scope of a PDR), as well as more than 600 clinical practice guidelines. This is not a free service, but for a small fee you can have access by the day, month or year. Also there is a free seven day trial membership.

Guidelines Clearing House

This site is a public resource for evidence-based clinical practice guidelines. NGC is sponsored by the Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and Research) in partnership with the American Medical Association and the American Association of Health Plans. A medical term search will retrieve objective, detailed information on clinical practice guidelines. Results in a search will obtain: structured abstracts (summaries) about the guideline and its development, a utility for comparing attributes of two or more guidelines in a side-by-side comparison, syntheses of guidelines covering similar topics, highlighting areas of similarity and difference, links to full-text guidelines, where available, and/or ordering information for print copies and, annotated bibliographies on guideline development methodology, implementation, and use.

CPT Codes

This website gives users of CPT the opportunity to perform CPT code searches and obtain information about Medicare’s relative value payment amount associated with the codes. Searches can be performed using 5 digit CPT code numbers or key word(s) in the code description. Also you can order the CPT coding handbooks in paperback format. The codes are updated annually.