Every firm handling medical cases faces the same intake pressure: more inquiries than can be worked up, limited hours to spend on screening, and real cost attached to being wrong in either direction. Declining a good case is a loss. Signing a weak one is more expensive still, and the cost shows up late.
Clinical screening addresses one part of that decision — and only one part. It does not answer whether to take the case. It answers what the medical record actually contains, which is the input the decision needs.
Here is the framework we work from.
Step one: define the clinical question
The screening question should be narrow and answerable from the record. “Is there a case here” is not that question; it is a legal judgment and it belongs to counsel.
A workable clinical framing looks more like: does the record document a clinical course consistent with the injury alleged, and does it document assessment, intervention, and response consistent with what would ordinarily be expected in that situation?
Getting this framing right at the outset determines the scope of the review and, practically, its cost.
Step two: establish the timeline and the baseline
Before anything can be evaluated, two things have to be fixed: the sequence of clinically significant events, and the patient’s condition before the event at issue.
Baseline does most of the analytical work. A resident with documented advanced comorbidities, prior functional decline, and multiple prior admissions presents a different picture than a resident who was independent and stable the week before. That is not a judgment about the merit of anyone’s claim; it is the clinical context every downstream reader — expert, mediator, jury — will bring to the record anyway. Better to know it at screening than at deposition.
Step three: identify what the record shows
The core of the review. Working through the chart, we identify:
- What was assessed, when, by whom, and using what tool
- What was found, including trends rather than isolated values
- What was ordered, and whether the administration record shows it happening
- What changed, and whether the response followed the change or lagged behind it
- Who was notified, and when
- What is absent where the record’s own conventions would lead a clinician to expect an entry
That last category is stated as an observation with a date range and a source, never as a conclusion about what the absence signifies.
Step four: identify what cuts the other way
A screening review that only reports helpful findings is not a screening review. It is confirmation, and it costs more later than it saves now.
An honest clinical screen identifies documented alternative explanations for the injury, pre-existing conditions that reasonably account for part of the outcome, evidence of appropriate care that was delivered and charted, documented non-adherence or refusals of care, and known complications that occur despite appropriate management.
Counsel needs those before signing, not after the defense produces them.
Step five: identify the gaps in the production
Screening is usually done on incomplete records, because full production has not happened yet. Part of the deliverable is a list of what is missing and what it would likely resolve — therapy records, outside pharmacy records, prior hospital admissions, facility policies in effect on the relevant dates, staffing documentation, imaging and its reports rather than just the summaries.
Frequently the honest screening answer is that the available record is insufficient to reach a clinical view, and the useful output is a targeted list of what to obtain next.
Step six: report plainly
A screening report should be readable in one sitting and should state clearly what is documented, what is not, what supports the allegation clinically, what undercuts it, what remains unresolved, and which records would resolve it. In plain language, with sources.
It should not contain a recommendation to accept or decline, a legal opinion, a valuation, or a conclusion on liability. Those are yours.
When screening is worth it
Clinical screening tends to earn its cost when the record volume is large, the medicine is outside your usual subject matter, the injury involves a setting with specialized documentation such as skilled nursing or long-term care, the statutory or filing deadline is approaching and the decision cannot wait, or you are weighing an expert retention and want to sharpen the question first.
It tends not to be necessary when the record is small and the clinical picture is plain on its face.
What you get
A screening engagement typically produces a written clinical summary, a working chronology of the key events with Bates references, a list of clinical strengths and weaknesses in the documentation, a records-gap list, and a conversation about what we found. Scope and turnaround are set before the work starts.
Our reviews are grounded in 24 years of direct practice in skilled nursing and long-term care and [VERIFY: 12] years in case management — the settings where a great deal of this documentation originates.
If you have a file you need to make a decision on, send us the records. We will tell you what is there.