Category: Medical Records

Fifteen years ago, a psychiatrist moved to town and began conducting evaluations on behalf of various insurance companies. The reports (over l00) were very similar. My clients fit the following categories:
They were blatant liars
There was nothing wrong with them, or
There was something seriously wrong with them that pre-existed, or, even caused the accident
Well, I was confused.

Either I had this Bermuda Triangle over my office sucking all the bad clients of the universe into my waiting room, or, perhaps, the doctor might be a bit biased.

Deciding it was the latter, I spent the last l0 years of my plaintiff’s practice learning everything I could about the cross examination of a psychiatric witness. In so doing, my practice changed such that now I don’t handle cases directly, but am retained by attorneys to take the depositions and trial examination of their psychiatric and neuropsychological witnesses. The education has been astounding. I have had doctors do amazing things. They have alleged they did not need to report those scores that were favorable to the plaintiff’s and only report those scores showing the plaintiff was not brain injured. They claimed they could write a report concluding the plaintiff passed the mental status exam, when the transcript revealed they did not. They have walked out of depositions, cursed at me in Yiddish and advised me that I made them want to vomit. They have instructed me to remove my shirt during a deposition, claimed their powers of observation to be so great they could see under clothing and even identify the color of my underwear (the doctor was wrong, thank you very much).

In many of the depositions, the doctor has either obfuscated the data or outright lied. A pattern emerged.

These “experts” can be exposed. I suggest the following:

BEFORE THE EXAMINATION:

Do a Freedom Of Information Act Request to your state licensing board.

If the doctor works for a university, do a FOI request to the university too. Keep in mind, many universities will permit doctors to conduct outside consulting work. However, in order to do so, they must complete certain forms that list the income and by whom they were retained. This is very helpful in showing bias.

DURING THE EXAMINATION:

Send a court reporter who:

Never leaves your client alone, no matter how long the exam takes (remember, some can last as long as 8 hours and the reporter needs to know this in advance).

Provides the transcript in digital format. This makes it easier to share with other attorneys and is excellent for creating questions for cross examination because word searching capabilities in a digital document speed up the process.

Never releases a copy of the transcript to the defense attorney.

Remembers that YOU hired the reporter, and the reporter answers to you. Some physicians have tried to throw my reporters out of the evaluation. They stay. Period.

Can’t afford a court reporter? Send a tape recorder with your client(s) and make sure your client knows when to turn the tape over by loaning them a watch with an alarm preset to go off at the end of the tape.

Look What the Raw Data Reveals (and why they don’t want to produce it)

Look for erasure marks. I had a doctor instruct a client to erase an answer that indicated the client was suicidal.

Incorrect scoring. Some doctors will score tests and testify that the patient scores out as not brain injured in concentration tests. However, the doctor input the wrong birthdate, thus comparing the plaintiff to much older and more feeble individuals. When the correct birthday is input, the results indicate impaired cognition.

False scoring. It’s a great feeling in the middle of a deposition when the defense doctor admits to testifying that the plaintiff was a malingerer based on a test he or she scored incorrectly.

Using the wrong tests. Lately, many neuropsychologists have been testifying that certain malingering scales reflect lack of motivation. Be careful. Often these tests, in fact, reveal concentration problems.

Playing with cut off scores. Some doctors may testify that someone is flunked a “malingering test.” The test booklet in the doctor’s office reveals, in fact, the patient may have passed. Demand the test booklets and raw data.

Giving too many tests. Some tests suggest you administer several trials. Some doctors administer only one, or, if the test results are favorable to the plaintiff, they keep administering the same test until the plaintiff does poorly and only report the poor scores. The instructions are usually in the test booklet in the doctor’s office.

Giving clues. Many doctors will provide significant clues such as, “Who was the president killed in the 60’s in Dallas?” Then the doctor reports that the plaintiff could remember the presidents back to Kennedy and has no memory problems. Interestingly, the clues were not in the report, nor was the fact that the plaintiff left out most of the presidents between the current one and Kennedy.

Doctor interference. Some doctors administer tests and, in one case, took 6 cell phone calls during the concentration portion of the test. Other issues that affect concentration include the doctor frequently walking in and out of the room in which the is being given or refusing the patient a cigarette break. Make sure the doctor documents the effects of medication on tests. Often the defense doctor will accuse the plaintiff of exaggerating his or her inability to concentrate when, in fact, the doctor is the main cause for the concentration problems. Mild TbI can cause concentration problems but your patient may score out as even moderately brain injured depending on the doctor’s behavior.

Paper reviews. If defense evaluation was done by a psychologist, was it a paper review or did the psychologist actually meet and evaluate the patient? If not, the report itself must contain a disclaimer.1

Transport client. Bring the client to the deposition of the doctor. Sometimes it helps keep the doctor a bit more honest.

Observe the doctor’s waiting room. Recently, a doctor admitted the video camera I observed in the waiting room was for the doctor to spy on the evaluees. If the doctor treats patients, often pamphlets in the waiting room describe brain injury conditions that mirror your clients and are excellent for cross examination.

Using old tests. According to research done by James R. Flynn, he discovered that IQ scores increased from one generation to the next for all of the countries for which data existed. Now, this is what is known as the Flynn Effect. Let’s say you are a defense doctor and you want to show a plaintiff does not have a brain injury. Administer an older version of a neuropsychological test and the plaintiff will score higher, maybe even not brain injured. Demand the doctor use the most recent test (as required by the APA Code of Ethics) and then you might find your client to test out as actually impaired.2, 3

Ignoring the RETEST effect. The doctor claims your client is not brain injured because he administered a test previously administered by your doctor and your client tested out much better. Therefore, defense doctor concludes either your client is malingering or cured. Try neither. Ask the doctor about the retest effect. Many tests, when administered twice, actually result in the patient getting a higher score the second time because they remember stories read to them the first time the test was administered. This does not mean they are better. This is simply a factor of retest effect and many studies exist to determine the exact increase in scores that might be expected based upon this phenomena.

TESTS CONSIDERATIONS

Lees Haley Fake Bad Scale: This is a scale applied to the MMPI2 and is commonly used by defense doctors to claim the plaintiff is malingering. This test is rejected by the authors of the MMPI2 as being unscientific and over-reporting malingering.4

Rey’s 15 Item Memory Test: This is a “malingering” test which defense doctors will claim show your client to be lying. However, if your client is elderly or has a low IQ they may erroneously be classified as malingerers.5 Furthermore, those with focal memory disturbances and diffuse cognitive impairment may perform poorly on this test.6

Halstead-Reitan Neuropsychological Battery (H-R): This commonly accepted neuropsychological battery comes with strict protocol requirements. The authors warn, “many altered and abbreviated versions of the tests in the HRB are being sold by numerous individuals and firms. Anyone using these versions should be aware that they have usually NOT been adequately validated, either through experimental studies or in clinical practice.”

Following strict protocol is crucial when administering this test. “The only authorized version of the HRB for Adults is the one that duplicates the tests EXACTLY as they were when the validation studies were done.”7

MMPI2. This test contains 567 true/false questions. However, frequently the defense doctors administer or interpret it incorrectly. Make sure and investigate the following:

Test should not be taken home (often psychologists, and even more so, psychiatrists permit it. It saves time) However, to do so violates test taking protocol.8

What software is used to grade the MMPI? The psychologists, especially if working for government or university setting, have no idea how the software was obtained or the differences between various software and simply approve the printout as gospel. “Research has shown that test interpretation services differ with respect to the amount of information and accuracy of the interpretations provided.”9

Did the patient leave 30 or more questions blank? If so, the test is invalid10

If the patient is not of this culture, was a culturally appropriate scoring key and proper norms used? In 18 years of deposing psychologists and psychiatrists I have NEVER had this answered in the affirmative. Consider how someone from Cuba might answer questions (a bit high on the paranoia scale?) verses someone from the US.

The defense doctor claims your client is lying because the F scale is elevated. (F= Frequency of items endorsed, NOT Fake) “Extenuating stressful circumstances in an individual’s life can also influence infrequent item responding. Stressful life factors tend to be associated with elevated F-Scale scores.”11 Different cultural background can cause an increase in the F scale. Therefore, culturally appropriate scoring keys and norms are vital.12

DURING THE DEPOSITION

Bring a laptop with an air card. When the doctor fails to bring the articles he relied upon, claiming they exist, turn the computer around and tell him he is more than welcome to look them up on the internet. This works great in a video depo.

Bring a second laptop on which is loaded all prior depositions so prior testimony can be accessed with a word search function on your computer. This is much faster than tabbing hard copies.

The doctor claims to review the medical records. You are skeptical. Bring a plastic bag. At the conclusion of the deposition, seal the records in the plastic bag and advise the doctor you are giving them to the court reporter until your fingerprint expert can pick them up in the morning. Sit back and watch the fireworks.

The doctor claims he didn’t recently alter the raw data and you know she/he did. Get the plastic bag out. Seal the document and advise opposing attorney you are having the ink dated at the lab of your choice. Some labs can tell you if ink is 2 years to 6 months old.

Point out the selective reporting that goes on in virtually every CME. High scales, such as scale 8 on the MMPI2 can indicate the presence of a head injury. Never have I ever had a defense doctor admit to this in a report.

Ask them if the plaintiff did well on the mental status exam. Most doctors administer the Folstein Mental Status Exam which is actually a screening device for Alzheimer’s patients. However, most doctors don’t score the test, fail to ask all the questions, and, more importantly, lie about the results. Ask the doctor if the patient answered the questions correctly. When the doctor says yes, present the doctor with the transcript that reflects many of the questions were answered incorrectly. Then file your Motion to Strike based on fraud.

The doctor testifies that he does 1/3 plaintiff work. Yeah, right. He/she then hands you a list of cases in which he has testified for the last several years but they do not identify if they are plaintiff or defense referral. Point out that he is hiding that information and it would only take a second or two to note on each case who referred it but in leaving that information out, you cannot address bias. Then ask the doctor to identify on the list each plaintiff referral. In every case in which I required the doctor to do this, he was only able to identify one or two percent of his referrals as plaintiff.

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

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

Example:
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

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.

Scott Turow is considered by some as the father of the modern legal thriller. He achieved literary fame in 1977 with the publication of “One L: An Inside Account of Life in the First Year at Harvard Law School”. Before attending Harvard, he earned a master’s degree in creative writing at Stanford University.

In 1987 Turow burst onto the literary scene with “Presumed Innocent”, which became an international bestseller and is often credited with creating popular demand for legal thrillers. Later this book was made into a hit movie starring Harrison Ford as the prosecutor Rusty Sabich. Turow has followed this breakout success with a string of best sellers.

Turow served as an assistant U.S. Attorney in Chicago in the 1980’s when the FBI and Justice Department conducted Operation Greylord. This operation was a massive undercover investigation into judicial corruption in Chicago’s Cook County. Fifteen local judges, and 49 lawyers were convicted. Turow prosecuted one of the most notorious judges, who received an 18-year prison sentence. After service in the Attorney General’s office, he entered private practice with the Chicago law firm of Sonnenschein, Nath, and Rosenthal.

The action in Turow’s most recent project, “Ordinary Heroes”, moves from the courtroom to the battlefields of World War II. When retired newspaperman Stewart Dubinsky (last seen in 1987’s Presumed Innocent) discovers letters his deceased father wrote during his tour of duty in WWII , a host of family secrets come to light. The characters and situations portrayed in Turow’s newest suspense novel are inspired in part by stories and letters shared by his father, who was an army physician.

Recently, Mr. Turow took time to visit about his career, and his thoughts on the modern judicial process.

Please tell us about your law practice and how you divide your time between the law firm and writing.
Turow: These days I am more writer than lawyer. I have practiced part time since roughly 1990, but I spend only about 300 hours a year now in legal work. Most days I write in the mornings, and as that peters out, turn my attention to the phone, or email, or else go into the office downtown. My practice is divided between criminal representation and my work as chair of the Illinois Executive Ethics Commission, A quasi-judicial agency involved with regulation and discipline of state executive branch employees.

Please tell us about your background and when you first realized you wanted to write, and practice law.
Turow: I realized I wanted to write and practice law when I realized I wasn’t going to support myself as a writer. In 1974 I had the choice of teaching, going to Hollywood for a studio staff job, going into advertising, or going to law school, with the promise that I’d find some way to continue to write. I chose the latter path.

You do pro bono work, and have had fund raising book events; what types of charitable activities are you involved in, and what is your philosophy?
Turow: I’m involved in a variety of charitable activities. I’m a trustee at Amherst College, a member of the Council of the Author’s Guild, and active with several local charities, including Literacy Chicago.

As a “baby boomer” born in 1949, how do you feel the events of the 60’s may have shaped you, and possibly the “boomer” generation?
Turow: The 60’s were basically a statement that our parent’s world would not do and that there had to be fundamental changes. I am one of those who thinks those years changed our way of life so much that for those who come later it’s impossible to even understand it. There was, to use a term that came much later, a paradigm shift.

Please tell us about some of your favorite characters, and if you have a favorite among your books.
Turow: No favorite book B it is like naming a favorite child, truly impossible – but I’m especially attached to Sandy Stern and Sonny Klonsky.

Your latest book, Ordinary Heroes, is a novel about a man’s decisions and actions during World War II. Please tell us a little about researching and writing material for the military versus civilian life and systems.
Turow: “Ordinary Heroes” was a gigantic research project that began with my father’s letters home from the European front and went in a zillion different directions; histories of the OSS , of Negro troops, or the JAG department, to reading the 1943 Edition of the Rules of Court-Martials and literally hundreds of narratives of the war, ranging from Robert Kotlowitz’s “Before Their Time” to many internet postings.

Can you explain how you achieve the balance of thoughtfulness and mystery to achieve the compelling scenarios?
Turow: There’s no formula. I love the plot, so forward movement is essential, but reflection is also indispensable in creating a believable world, at least one that’s believable to me.

How do you organize your writing, from beginning to end, or in certain segments, and approximately how long does it take to craft each one of your manuscripts?
Turow: Each novel since “Presumed Innocent” has been published three years after its predecessor, but that time has not always been spent the same way. For example, I finished a non-fiction book about the death penalty, “Ultimate Punishment”, in the interval between “Ordinary Heroes” and “Reversible Errors”. But I always start by just letting myself go and writing something different each morning. I’ll write “all over the book” as I put it, at first snatches of dialogue, a scene I like, a character’s background. Nothing organized. Eventually it becomes more whole in my mind. I do a “draft” which involves inserting blocks of the previously written material in some order. Then I write a continuous draft.

Have you ever actually tried a big case? What did you like the most about such trials? What did you like the least?
Turow: There’s a question that makes me laugh, since there was a time when I was a relatively prominent trial lawyer in this city. As an Assistant U. S. Attorney, I tried dozens of jury cases, the best known probably being the prosecution of a Reginald Holzer, a sitting judge, and former candidate for the Illinois Supreme Court, who was convicted of extortion and bribery. I was also the Junior Prosecutor on the trial of William J. Scott, then the Attorney General of Illinois.

Trial is the most consuming activity I have ever been involved in, which is what’s so great and what’s so awful about it. Life has few moments, aside from a birth, that are more dramatic than the instant before the jury renders a verdict in a major case; history is about to be made.

What did you do to prepare your self mentally for the trial of the case?
Turow: I haven’t tired a case in five years now, but I was by my own admission a maniac. I tried to imagine every conceivable permutation of events that might occur at trial and then be ready for it.

What role do paralegals play in your practice of law?
Turow: Large. I’ve worked with some great ones. Carolyn Dixon at the U.S. Attorney’s Office. Mary Kramer and Lynette Johnson at Sonnenschein. I – and several thousand documents – would have been lost without those great professionals.

What do you think of the jury system in America, if you could make any changes, what would you think would make for a better jury system?
Turow: I’m mildly skeptical about juries, but I’m not really sure that judges are any better. It might be interesting to try the system in Vermont, a Judge and two jurors to decide a case.

What role should redemption play in applying a death sentence?
Turow: The defendant’s capacity for redemption has traditionally been recognized as a prime consideration in determining whether a death sentence is warranted.

Do you think there is a constitutional right for the government to spy on US citizens without court oversight?
Turow: I had thought it was established by the U.S. Supreme Court in 1972 that the Government could not eavesdrop on private conversations within the United States without a warrant. Then again, I also thought that the Government could not take an American citizen into custody on our soil and hold him incommunicado, including without counsel – until I heard about Jose Padilla.

Perhaps I am wrong about the Constitution, but I doubt it. I think this will be remembered as a shameful period, in which we allowed Osama Bin Laden to diminish our freedoms, a victory he never deserved.