Law Department Management Helping Companies To Get Their Arms Around The Costs Of Mass Tort Litigation

Sunday, May 1, 2005 - 01:00

The Editor interviews Donna Miller, RN, BSN,Chief Operations Officer, Medical Research Consultants (MRC).

Editor: Congratulations on your recent promotion. Please tell our readers about your new role.

Miller: In my new role as MRC's Chief Operating Officer, I am responsible for ensuring that our company's operations are efficient so we can provide the high quality services that the clients want and expect of MRC. Since being hired five years ago, I've been growing with the company. I started as a nurse reviewer and was promoted to be a project manager, then vice president of special projects, followed by vice president of nursing and now COO. The company's support and encouragement of my career growth is just one example of MRC's commitment to people who work here. My goal in my new role is to bring all of the departments together and maximize our team approach internally to get the best solutions for our clients.

I oversee human resources, nursing, and document management services, which include our records retrieval services. Our nursing department performs the nurse reviews that clarify and chronologically summarize all relevant medical records in table form for easy attorney access. Each significant medical event is included in the chronology, identified by treater, facility and page number in the medical record. Tailored to a company's specific needs, a brief analytic narrative defining medical-legal issues, areas of potential strength and vulnerability and suggestions for strategy and other resources available accompanies each chronology of medical records.I also oversee our medical malpractice division, personal injury division, expert placement services, and our transcription department. Our call center is part of my operations function as well.

Editor: What drives up the costs of mass tort litigation?

Miller: Mass tort litigation can consist of hundreds, possibly thousands of cases. Duplication of efforts, unfocused document review, poor communications and a lack of a strong technology infrastructure are just a few examples of poor defense practices that can all drive up costs.

Mass tort litigation has to be managed like a business. Effective management begins with a budget so that resources can be targeted on the strategies that will resolve the claim in the most cost effective manner. Early case assessment is an essential component of the budget process. As part of the assessment, we recommend that clients look across all of their claims and put them into buckets of risk. This enables a company to avoid allocating disproportionate resources to lower risk cases and to maximize efficiencies by focusing greater resources on the high-risk cases.

Editor: Why is it important to take the time to assign workers thoughtfully at the litigation's outset?

Miller: If internal staff has the right mix of experience, it may be possible to handle the mass tort with the workforce on hand. For larger volume cases or those outside the internal staff's knowledge zone, selecting additional experienced players can help put the right team in place to control the litigation costs from the very beginning.

Taking a team approach from the litigation's onset can help a company to maximize the performance of its in-house, law firm and vendor support while controlling costs and avoiding duplication. These benefits are enhanced by open communication to help ensure that the entire team understands the company's litigation strategy up front. As a general rule, establishing one primary contact as the "go-to person" for coordination of communications helps to expedite work, eliminate a lot of confusion and keep potentially threatening issues manageable.

Editor: How does staffing mass tort support functions with experienced nurses help a litigation team to control costs?

Miller: The professional expertise of our nurses helps them to validate the parameters for document retrieval and efficiently review medical records. MRC believes in up-front education for our nurses and brings in a medical expert to educate them on the specific medicine involved in a given mass tort. This eliminates costly, duplicative research by nurses. We provide a consistent work product that allows for efficiencies by both nurses and litigators. Anyone in the entire litigation network comes to trust the integrity of the product developed and is familiar with its format and content for easy use even in stressful circumstances. This allows for effective litigation, while controlling costs, despite the ebb and flow of staffing across the life of the litigation.

Editor: How does a strong, well organized technology infrastructure contribute to cost containment?

Miller: Technology adds efficiency to organizing the tremendous volume of medical records and other evidence associated with a major mass tort. Our WiseFilesª web-based software is one of the few software programs adapted to electronically manage the entire mass tort process. The WiseFiles comprehensive database gives our clients the capability to customize the fields to their specifications. Using the unique reporting capabilities in WiseFiles, clients can pull whatever reports they want. Providing the litigation team instant and secure 24/7 access to the litigation files results in huge savings in terms of both money and time. In addition, the communications keep the entire team current with progress being made and updated on any changes in the company's overall strategic direction.

Editor: Please give an example of innovative approaches to budgeting and invoicing litigation support costs.

Miller: To help set a realistic budget, we recommend that the litigation team consider applying "triage," which is the term we use to describe that process that MRC's professional staff uses to assess the key medical (or other) liability, causation, damage elements and other critical factors in a case. The client can use this aerial view to prioritize litigation activities and fully comprehend the value and costs of the litigation.

Planning invoicing and payment schedules can eliminate a lot of billing problems. Among our innovative approaches, we've negotiated flat fees, cost sharing and paperless systems.

Cost sharing can work in a number of different ways. When co-defendants don't share costs, each defense firm goes after the records independently. If instead they all agree to use the same copy of the record, the costs associated with collecting, storing and cataloging the record for retrieval can be shared. In addition, if the record is stored in a central repository, it does not have to be copied and shipped to countless places. Any authorized personnel can go to the same repository and simultaneously view the document. This can result in huge cost savings. Cost savings also result when plaintiffs agree to share costs associated with a central document repository with the defense.

Editor: What are the components of MRC's quality control program?

Miller: We use a blend of the Lean Thinking and Six Sigma principles. Lean Thinking focuses on improving customer satisfaction through continuous and incremental improvements to processes, including removing unnecessary activities and variations (or waste).

At the heart of the Six Sigma quality program is DMAIC - define, measure, analyze, improve and control. This methodology increases productivity and decreases the process variation that leads to defect reduction and improvement in profits, employee morale and product quality.

If we identify a problem, we apply these principles to make immediate improvements and, after their implementation, evaluate whether further changes may be needed. MRC's commitment to our quality control program runs throughout our company, starting at the top with our Director of Quality Management Nancy Bennett, who reports directly to our CEO Doreen Wise.

Editor: DuPont has been viewed as an industry leader in developing innovative ways to manage litigation and control costs. How has MRC partnered with DuPont?

Miller: We are excited about being selected by DuPont as a Primary Service Provider. We share the same cultural values. For example, both our companies highly respect people and see them as our greatest asset. We also share a commitment to the qualities of a business relationship that focuses on the long term.

Among the many benefits of being part of DuPont's network of Primary Law Firms and Service Providers are the synergies that DuPont fosters among its members. The network works together to help each other, which is a great approach.

Editor: Are you seeing other companies embrace the DuPont model?

Miller: The DuPont model is known throughout the industry and well respected. We have a link on our website to where companies can get a comprehensive introduction to the model. Following the model for more than a decade, DuPont has cut costs, increased productivity, improved the quality of its services and seized new opportunities like never before. Other companies see that and are interested in learning more.

Editor: How is MRC putting its commitment to public service in the local, regional and global community into action?

Miller: MRC sponsors two non-profit corporations. The first is Gabriel's Gifts, which provides support for families and the volunteers searching for missing children; it also educates the public on prevention of child disappearances. Among its other activities, Gabriel's Gifts manages the Amber Alert program in Houston and has become a model for training other Amber Alert programs around the country.

Our second commitment is to Admissions Control, which is a take off from the name of NASA's Mission Control. Its goal is to identify economically-disadvantaged high school students who have the potential and desire for college. We found a disconnect between the students, who are smart enough to attend college and the schools that are waiting to accept them: the students could not achieve acceptable SAT scores, nor manage the admissions process. We provide the students with information and support they need to get through that process, including designing the curriculum to help the students prepare for the SATs.It has been very successful with about 80 percent of the participating students achieving their desired goal of attending college.

Our most recent outreach to the global community has been raising money for the tsunami relief efforts.

Editor: Where can our readers learn more about MRC?

Miller:They can visit our web site at or contact me at

[Editor's Note: To learn more about how MRC's technology can help a company to manage even the most difficult logistical problems in healthcare litigation, visit and put "Medical Research Consultants" in the site's search box.]