The CommuniqueThe Communique The CommuniqueThe Official Newsletter of The West Virginia Bar Association
Volume XII No. 1
Richard A. ìRickî PillPresident
January 2006
It is a great honor andprivilege to assume theleadership of The WestVirginia Bar Associationas its 121st President.We have had fine lead-ership in our organizationfor many years, includingthat of Charles M. Love
III, last year. Charlie is the only lawyer toserve as President of both The West VirginiaBar Association and The West Virginia StateBar in the same year and his efforts helpedimprove the working relationship betweenthese organizations. Current West VirginiaState Bar President Debra Scudiere and I,along with our respective boards, intend tocontinue this progress.
I would like to also thank O. Gay Elmore,Ronald S. Rossi and G. Thomas Battle whohave completed their terms on the ExecutiveCommittee for their years of dedicated ser-vice. We welcome Anders Lindberg, Jim St.Clair and Marc Slotnick to the governing board.
The annual meeting this past September atStonewall Resort was quite a success, filledwith seminars, golf, fun, food and friendship.The dinner honoring our past presidents is al-ways a highlight with Lacy Rice, Jack Bow-man, Phil Hill, Howard Persinger, Jr., Char-lotte Lane, Dick Bolen, Larry Morhous andTyler Dinsmore and their spouses in atten-dance. At the Friday banquet, Tom Battle de-servedly received the Award of Merit. TheStonewall Resort provided a lovely venue and,as usual, our outstanding executive director,
Richard A. PillPresident
Pryce M. Haynes IIExecutive Director
1111 6th AvenuePost Office Box 2162Huntington, WV 25722
PH: 800.944.9822FX: 304.522.2795
Email:[email protected]
The West VirginiaBar AssociationFounded 1886
Mark your calendars now!
28
Pre-sort StandardU.S. Postage PaidPermit No. 229Huntington, West Virginia
P.O. Box 2162Huntington, WV 25722
120th Annual Meeting
West Virginia Bar Associationof the
The Homestead ResortHot Springs, Virginia
September 21 - 23, 2006
Pryce Haynes, his wife, Julie, and staff hostedand coordinated a fine event. This year wereturn to The Homestead on September 21-23, 2006, so mark your calendars now.
This past October, The West Virginia Bar As-sociation and West Virginia State Bar had theopportunity to host the Southern Conferenceof Bar Presidents Annual Meeting at TheGreenbrier. This event is for presidents, presi-dents-elect, past presidents and executive di-rectors of eighteen southern state bar associa-tions, and this is only the second time it hasbeen hosted by the two West Virginia bars.Attendees went to seminars, discussed theattorneyís role in society and exchanged ideason bar association functions and management.Disaster preparedness, as it pertains to the le-gal profession, was a major topic presented byour colleagues from Louisiana, Mississippi andTexas. Outstanding speakers included Gover-nor Joe Manchin, Chief Justice Joseph Albrightand Professor Jack Bowman. The conferencewas attended by more than 200 people andwas a huge success thanks to the efforts ofPryce, Tom Tinder, West Virginia State BarPresident Debra Scudiere and their commit-tees.
The Executive Committee has established agoal this year of membership growth and di-versification. The Real Estate Lawyers Divi-sion and Legal Nurse Consultant Section, es-tablished in recent years, have thrived and wehope to add other law specialty sections in thefuture. Our 120th year should be promising for
(Continued on p.2)
Presidentís Corner
1
West Virginia
West Virginia
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During the meeting, The WVBA presentedits prestigious Award of Merit for ìÖout-standing lifetime of distinguished service tothe legal profession and/or the judiciary inWest Virginia,î to G. Thomas Battle, a
member of theCharleston law firmof Spilman Thomas& Battle, PLLC.Presentation of TheWVBAís highestaward was made byPresident CharlesM. Love, III, whowas joined by Mr.Battleís son, H. DillBattle III.
The meeting culmi-nated with RichardA. Pill, of Pill and Pill,Martinsburg, beingelected president ofThe WVBA, and Lo-
gan M. Hassig, of New Martinsville, electedto the Executive Council, replacing PastPresident Charles M. Love III. Othermembers of the Executive Council at thetime were Robert M. Steptoe, Jr., Presi-dent-Elect, Ronda Harvey, Elisabeth H.
The West Virginia Bar Association held its119th Annual Meeting at Stonewall Resort,Roanoke, West Virginia, September 22-24,2005. Several speakers presented semi-nars, including: Chief Justice JosephAlbright of TheWest Virginia Su-preme Court ofAppeals; NanciePoppema, Execu-tive Vice-Presidentof The Communi-cation Council ofAmerica, Inc.; Ri-chard A. Angelo,CLTP, Vice-Presi-dent and SeniorRegional ClaimsCounsel for FirstAmerican Title In-surance Company;David L. Rader,President of WVPhysiciansí MutualInsurance Company; Robert Newton, CPA,CVA member of Suttle & Stalnaker, PLLC;David Bizzak, Ph.D., P.E. with RomualdiDavidson & Associates; Dr. Bobby Millerwith Forensic Psychiatry PLLC; and JohnR. Callcott, member of Steptoe & JohnsonPLLC.
119th Annual Meeting Held atStonewall Resort
continued growth and development of TheWVBA.I encourage each of our members to takeadvantage of the many professional and so-cial opportunities we offer. They are highquality and a good value. Keep informed ofevents and CLE opportunities by visiting ourweb site.
The West Virginia Bar Association (the old-est legal association in WV) encourages andinvites lawyers from firms of all sizes, back-grounds, and types of practice to becomeactive members. Do your colleagues a fa-vor and ask them to join.
(Pill, continued from p.1)
Past President Charlie Love (right) congratulatesThe WVBAís newest leader, Rick Pill.
(Continued on p.3)
27
RICHARD A. “RICK” PILL (2000) ROBERT M. “BOB” STEPTOE, JR. (2001)President, West Virginia Bar Association President-elect, West Virginia Bar AssociationPill & Pill Steptoe & Johnson, PLLCP. O. Box 1938 P. O. Box 2190Martinsburg, WV 25402-1938 Clarksburg, WV 26302-219085 Aikens Center Third & Main StreetMartinsburg, WV 25401 Clarksburg, WV 26301Ph: 304-263-4971 Ph: 304-624-8142Fx: 304-267-5840 Fx: [email protected] [email protected]
RONDA HARVEY (2002) ELISABETH H. “LISA” ROSE (2003)Bowles Rice McDavid Graff & Love, LLP Rose, Padden & Petty, L.C.P. O. Box 1386 P. O. Box 1307Charleston, WV 25325-1386 Fairmont, WV 26554600 Quarrier Street 301 Adams StreetCharleston, WV 25314 Fairmont, WV 26554Ph: 304-347-1701 Ph: 304-363-4260Fx: 304-347-1746 Fx: [email protected] [email protected]
STEPHEN R. “STEVE” CRISLIP (2004) LOGAN M. HASSIG (2005)Jackson Kelly PLLC Snyder & HassigP. O. Box 553 P. O. Box 189Charleston, WV 25322-0553 New Martinsville, WV 261551600 Laidley Tower 500 Lee Street 233 Main StreetCharleston, WV 25301 New Martinsville, WV 26155Ph: 304-340-1180 Ph: 304-455-2180Fx: 304-340-1130 Fx: [email protected] [email protected]
JAMES W. “JIM” STCLAIR, CHAIRMAN MARK J. SLOTNICK, CHAIRMANSenior Lawyers Division Real Estate Lawyers DivisionHuntington Realty Corp. Bailey & Wyant PLLC630 ½ Seventh Avenue P. O. Box 3710Huntington, WV 25701 Charleston, WV 25337-3710Ph: 304-525-5910 405 Capitol Street, Ste. 1012Fx: 304-529-3043 Charleston, WV [email protected] Ph: 304-345-4222
ANDERS W. LINDBERG PRYCE M. HAYNES IIPresident, Young Lawyers Division Executive Director, West Virginia Bar AssociationSteptoe & Johnson, PLLC Pryce Haynes AssociatesP. O. Box 2195 P. O. Box 2162Huntington, WV 25722-2195 Huntington, WV 25722-21621000 Fifth Avenue, Ste. 250 1111 Sixth AvenueHuntington, WV 25701 Huntington, WV 25701Ph: 304-526-8096 Ph: 304-522-2652Fx: 304-526-8089 Fx: [email protected] [email protected]
West Virginia Bar Association2005-06 Executive Council
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Rose, Stephen R. Crislip, G. Thomas Battle,Ronald S. Rossi, O. Gay Elmore, Jr. and PryceM. Haynes II, Executive Director.
This meeting was sponsored by: LexisNexis;First American Title Insurance Company; CSXCorporation; Old Republic National Title Insur-ance Company; Moses Automotive and MosesBMW & Cadillac of Charleston; and Pryce
Haynes Associates. Exhibitors included: Ac-cess Document Systems; Disability Represen-tation, Inc.; Legal Nurse Consultants of TheWVBA; Romualdi, Davidson & AssociatesInc.; and Ntelos. The generous support ofthese sponsors and exhibitors greatly enhancedthe quality of our 119th Annual Meeting. Shouldyou have the opportunity, let them know youappreciate their financial assistance.
(Annual Meeting, continued from p.2)
Larry and Carolyn Morhous Andrea and Anders Lindberg
Laura Wareheim and Evan Zanic
Suzy and Lacy Rice
Lisa Rose, Lee and Judge Lilly
Judy and Seldon McNeer
26
Package DetailsSPACE IS LIMITED!
To register, call 800-944-9822 or email us at [email protected]
Package includes:
ï 4 rounds of golfï Double accommodation as per itineraryï Full Scottish breakfast each dayï Welcome dinner at the Golf View and Rusacks Hotelï Private driver guide with all transfers by luxury motorcoachï Airport meet and greetï Information packï Support from our Scottish office
Price per Golfer: $3976.00Price per Non-golfer: $2417.00
(Air transportation to Scotland is NOT included, but will be arranged for the groupprior to February 15, 2006. Estimated transportation cost is $700.00 per person.)
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Chief Justice AlbrightEvan Zanic, Glenn Dunlap andScott Ruley
John Hankins, Jack Bowman andPryce Haynes
Lacy Rice, Tyler Smith, Tom Battle andRick Pill
Tyler Smith, Rick Pill, Lacy Riceand Tom Battle
Susie Fisher, Andrea Lindburg, Mitzie Hankinsand Suzy Rice
2005 Annual Meeting
WVBA Past Presidents: Jack Bowman, Lacy Rice, Phil Hill, Howard Persinger, CharlotteLane, Charlie Love, Larry Morhous, Dick Bolen and Tyler Dinsmore.
25
Play Golf at St. Andrews!May 18 - 25, 2006
Thatís right, you and your guest can join TheWVBA on an eight-day golf extravaganza toScotland! Seven nightsí accommodationsinclude four nights at The Rusacks Hotel, St.Andrews, a four-star hotel overlooking the firsttee and the eighteenth green of the OldCourse. Rusacks Hotel conceals a wealth ofcreature comforts and delights. Throughoutthe hotel, furnishings and dÈcor create a moodof relaxed elegance. Voted one of the top tengolfing hotels in the world, every room hasbeen individually themed to enhance the townand the hotelís unique history and tradition.
Play St. Andrews Jubilee! Opened in 1897,this course was named to commemorate theSilver Jubilee of Queen�Victoria. It is the most
seaward of the St. Andrews Courses, a verypopular course that offers a thoroughexamination of golfing ability and shot makingover its recently upgraded links. It is enhancedby some marvelous panoramic scenery of thesurrounding Eden Estuary, with a fantasticsunset view of the historic town from the 18thtee. (18 holes, 6805 yards, par 72) Thehighlight of your trip will be play on St.Andrews Old Course, the most famous golfcourse in the world with a unique traditionmore than six centuries old! (18 holes, 6566yards, par 72)
CLE seminars will be offered for just the rightmix of business with pleasure. We donít wantUncle Sam to feel left out!
Registration deadline: February 15, 2006
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Paul Frampton, Charlie Love, ChadLove and Mark Adkins
Myla Bowman, Kimberly Petersonand Susie Fisher
Charlie Love and Dean Fisher
Howard Persinger and David Ferretti
Brian Gartley, Andy Miller andJim Williams
2005 Annual Meeting
Dr. Bobby Miller
Jim Williams, Brian Gartley, AndyMiller and Phil Hil
24
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As we venture into another year, I am proud tosay that I am the new LNC Section President.For my first column, Iíd like to introduce my-self to the group, announce our new Board ofDirectors, and provide a report from the recentAnnual Meeting.
After great consideration, and with the supportof our outgoing president, I was voted into of-fice in October 2005. Prior to assuming therole of President, I served as a Director-at-Large on the LNC Section Board of Directors.I have 5 years experience reviewing cases andfunctioning as an expert witness in long termcare litigation for both plaintiff and defense firms.For my clinical background, I have 10 yearsexperience in long term care, including a posi-tion as a Senior Director of Nursing. I obtainedmy certification as a Director of Nursing Ad-ministration, and am licensed as a NursingHome Administrator. I currently work as acase manger with Hospice and as a charge nurse
at Thomas Hospital Skilled Unit. In my sparetime I work per-diem at Select Specialty Hos-pital.
I look forward to working with the 2005-2007LNC Section Board of Directors, which in-cludes: Michelle Winters, President;Karen Huff, Past-President; SusanRinehart, Secretary; Elizabeth Bridgeman,Director-at-Large; Bobbie McCarty, Di-rector-at-Large.
The LNC Section recruited two interestingspeakers for the CLE sessions at the 2005 An-nual Meeting. Dr. Bobby Miller, a forensic psy-chiatrist from Huntington, gave a fascinatingpresentation on ìDetecting Malingering.îDavid Rader, CEO of WV Physiciansí Mutualin Charleston, gave a very informative presen-tation on ìMedical Malpractice Insurance inWV. î
We also held our annual LNC Section luncheonmeeting at Stonewall Resort following theWVBA Annual Meeting. The highlight was alively brainstorming session about the future ofthe LNC Section. Many ideas were discussed,and the group expressed an interest in organiz-ing another Spring Conference in 2006. Themeeting adjourned with a special presentationby two of our members: Kyle Smith discussedìDisability Consultingî and Linda Wiater pre-sented her views on the ìRole of the LNC atTrial.î
In closing, I would like to thank our board forchoosing me as their new president. I wouldalso like to thank Karen Huff, our past presi-dent, for all she accomplished for our organi-zation. Our previous board worked hard todevelop a strong foundation from which ourgroup can continue to grow. I look forward tothe future and many new opportunities!
LNC Section NewsMichelle Winters, RN, BS, NHA, CDON, LNCPresident, LNC Section
The WVBA would like to congratulate LNC Section members Sue Blackhurstand Debra Pritts for passing the national certification exam and achievingthe Legal Nurse Consultant Certified (LNCC) credential. To becomecertified as an LNCC, eligible candidates must pass arigorous exam and meet the experience requirement in legalnurse consulting. The LNCC program is the onlycertification in legal nurse consulting accredited by theAmerican Board of Nursing Specialties and recognized bythe American Association of Legal Nurse Consultants.
Sue Blackhurst, BSN, RN, LNCC, has 8 years experienceas a legal nurse consultant, with a background of 13 yearsin critical care nursing. She is currently employed bySteptoe & Johnson in Wheeling, WV. Debra Pritts, RN,LNCC, has 24 years of nursing experience, with 4 years asa legal nurse consultant. She is currently employed byHill Toriseva & Williams in Wheeling, WV.
LNC Members Blackhurst and Pritts receive LNCC
Pritts
Blackhurst
23
Serving the legal profession in
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Structured Settlements
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7
Karen Huff and Michelle Winters Rebecca Miller, Michelle Winters, Karen Huff andDr. Bobby Miller
Michelle Winters, Karen Huff and Kyle Smith Kyle Smith, Pryce Haynes and Dr. Bobby Miller
Kyle Smith, Lennie Davis, Karen Huff, Pryce Haynes,Michelle Winters, Susan Rinehart and Linda Wiater
2005 LNC Annual Meeting
22
Keep Your CaseLitigation Services
Counsel to Counsel LLCExperienced attorneys assisting in high-value/complex civil litigation claims of$1,000,000 or greater.
Principals, Thomas W. Henderson and Robert A.Creo, have more than 60 years experience trying andsettling cases.
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Webcredenza CLE SeminarSchedule
To sign up for one of these Webcredenza Sem inars ,p lease ca l l The WVBA at 1 -800-944-9822 .
01/10/06 Drafting Legal Opinions01/17/06 Estate Planning for Transfers of Real
Property01/24/06 Understanding the Fundamentals of
Securities Law, Part 101/25/06 Understanding the Fundamentals of
Securities Law, Part 201/31/06 Defending Clients Against IRS Audits02/07/06 Structuring Minority Interests in
Businesses02/08/06 Charitable Giving of Insurance
Proceeds02/14/06 Update for Attorneys Advising MDs02/21/06 Structuring Acquisitions & Disposi-
tions of Real Estate, Part 102/22/06 Structuring Acquisitions & Disposi-
tions of Real Estate, Part 203/07/06 Structuring, Administernig and
Defending FLPs03/14/06 2006 UCC 3 (Commercial Paper)
Update03/21/06 Employment Taxes: Principles and
Techniques in S Corps and LLCs03/28/06 2006 Estate Planning Valuation
Update04/04/06 Letters of Credit: Use in Business and
Commercial Transactions04/11/06 Allocating the Economic Interests of
LLC Members, Part 104/12/06 Allocating the Economic Interests of
LLC Members, Part 204/18/06 Life Insurance and Charitable Giving05/02/06 Sometimes It’s All About Losses05/09/06 Regulation of Debt Collection
Activities05/16/06 Estate Planning for the Non-
Traditional Family, Part 105/17/06 Estate Planning for the Non-
Traditional Family, Part 205/23/06 Liability Issues for Trustees: What a
Trustee Must Tell Beneficiaries05/30/06 Malpractice Insurance: What Attorneys
Should Know06/06/06 2006 Estate Planning Update
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Where Do We Go from Here?Jim St ClairChair, Senior Lawyer Division
This is the question the WV Bar Senior Law-yers Division must answer in the next fewmonths. Under the able leadership of priorChairs, Phil Hill and Tom Battle, the HistoryProject is in the final stages of publication.Soon, we will be able to read of the ìGloriesîof bygone years when our fore fathers madethe West Virginia legal system into the one weenjoy today.
What is to be our next project? Several havebeen suggested, including:
1. Mentoring young lawyers;2. Serving as discipline monitors;3. Mentoring middle age lawyer on pre-re-
tirement planning;4. Provide programs on health related mat-
ters, i.e., analysis of the Medicare newdrug plans, long term care, etc.;
5. Establishment of an ìinstituteî to discusstimely topics concerning what is wrongwith the judicial system in West Virginiaand what can be done to correct it; and
6. Estate planning techniques for Seniors.
Your new Senior Lawyers Executive Councilcomposed of Tom Battle, Phil Hill, Arch Riley,Dan Callaghan, Harold Brewster, Dick Fordand John Busch are discussing other possibletopics. We invite you to submit ideas of wherewe should invest our efforts over the next twoyears.
We Seniors have the experience and morediscretionary time than most younger attor-neys. We can make a difference if we applyour time and our talents.
Please contact Jim St Clair with your com-ments or suggestions concerning Where DoWe Go from Here?
Email: [email protected]: (304)525-5910Fax: (304)525-0509
Congratulations to G. Thomas Battle, 2005 recipient of the prestigious WVBA Awardof Merit! THis award is presented annually for ìÖoutstanding lifetime of distinguishedservice to the legal profession and/or the judiciary in West Virginia.î Presentation of thishighest award was made by President Charles M. Love III, who was joined by TomBattleís son, H. Dill Battle III. Tom Battle is a member of the Charleston law firm ofSpilman Thomas & Battle, PLLC.
Past recipients of the Award of Merit are Edward I. Eiland, John O. Kizer, Charles R.McElwee, Charles F. Bagley, Jr., Honorable Thomas B. Miller, John L. McClaugherty,Robert M. Steptoe, Sr. and the Honorable Robert E. Maxwell.
G. Thomas Battle ReceivesAward of Merit
21
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Medical ViewsMedical ViewsInformative articles on medical issues of interestprovided by our Legal Nurse Consultant Section
(Continued on p. 10)
Brenda Snyder Shaw, RN, PHRN
Triage: Heads or Tails, Itís Still a Beast
Hospital Component
The Emergency Medical Treatment and ActiveLabor Act (EMTALA) of 1986 has had para-doxical effects upon the ED. Physicians canobtain deposits/partial payments/insurance infor-mation up front, once the medical screening exam& treatment options discussion are complete.Conversely, itís increased ED usage for non-urgent care. These screening exams causeovercrowding and contribute to bottlenecking.This affects EMS in two ways. The obviousone is when the non-urgent patient chooses thismode of transportation to the hospital. The sec-ond is when the ED becomes overcrowded &cannot take patients; the ED must go on diver-sion, which stresses the EMS system. Both canchange patient outcomes by disabling EMS fromworking efficiently, as they must then take pa-tients to another facility, increasing transporttimes & taking them out of their zone/serviceareas. Their objective is the nearest appropri-ate facilityÖitís a continuous loop.
Legal Point: Monthly, hospitals track & recordDiversion, Rotation, ìClosed to Trauma,î ìClosedto OBî etc. status. The ED Nurse Director orTrauma Nurse Coordinator may keep thoserecords.
Under-triage vs. Over-triage
Under-triage occurs if a patient is triaged ashaving a minor or non-urgent illness/injury, whenrealistically their condition is more serious than
the assigned category. This risks increasing:death, disability, complications, medical re-source use and medical/lost productivity costs.It can also delay diagnosis/treatment. Over-triage is the inverse. The patientís assignedcategory is higher than their illness/injury re-ally requires. Paradoxically, both cause in-creased: costs, medical resource use & thesame ED backlog effect, by wasting the re-sources of EMS and EDsÖwhile someone inreal need is delayed. Within a Trauma Sys-tem, itís generally acceptable to have an over-triage rate of 30-50%. This precaution helpsavoid missed diagnosis/delayed care during thetrauma patientís ìGolden Hour. î
Triage Tier Levels
Presently, no universal triage system existswithin the United States. It varies from hospi-tal to hospital. There is, however, standard-ization by the American College of Surgeons,Committee on Trauma, regarding Trauma Cen-ter Designation as either Level 1, 2, 3 or 4.These are high minimum standards, not eas-ily obtained, especially for Levels 1 & 2. Fa-cilities can exceed the criteria. Examples are:When a Level-3 hospital has 24-hour in-houseneurosurgeon coverage or a micro vascularsurgeon on staff, though not required.Sidebar: Locally, the D.C. Department ofHealth follows the ACSCOT designation cri-teria to a point, but has specific criteria of theirown that hospitals under their jurisdiction must
Part II - The Tail (Tale) of theBeast
Brenda Shaw, amember of the WVBALNC Section, is a legalnurse consultant andowner of ShawLawgistics, LLC, anindependent medical-legal & life careplanning practice inLeesburg, Virginia.She specializes in pre-hospital, emergency,trauma, pediatric/ burncases & is an ACLSInstructor. Sheístaught in PALS/TNCC/BTLS/EMSprograms and hasaudited the PhysicianATLS Course. Sheís aformer Flight Nurse &was the Trauma NurseCoordinator at GeorgeWashingtonUniversity Hospital inWashington D.C. from2000-2002.
20
2005 Real Estate Conference
Dean Fisher, Clyde Smith
Alex and Becky Ross
Jim and Mickey St. Clair and Logan Hassig
Sherry and Andy Miller Tom and Holly Price
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(Shaw, continued from p. 9)
follow. Hospitals in D.C. must become Level1 Trauma Centers or not at all.
Legal Point: LNCs can provide the attorneyspecific information regarding their city, stateor system. This applies to all trauma patients.
1. Spot Check Triage is a ìquick lookî as-sessment. Itís the initial impression a medicalprofessional gets when they look at a patient.Itís best performed by experienced practitio-ners. It becomes so innate to the seasonedhealth care provider, itís hard to explain & prac-tically impossible to ìteach.î Itís not meant tobe an assumption or comprehensive in nature.The Emergency Nurses Association refers toit as ìAcross the Roomî triage. It quickly as-sesses when a patient looks critical, unwell oris having difficulty with airway, breathing or cir-culation. It should not be the only form of tri-age an ED uses, but rather, the first step in amore complex, tiered system, which also con-siders the patientís chief complaint & medicalhistory. It does expedite more serious/criticalpatients (especially those self-presenting) to thebackÖwhere treatment is initiated before any-thing else is formally done. An asthmatic inacute distress is one example. Some ED Tri-age Stations are equipped with oxygen,bronchodilators, nebulizers, etc., so the TriageNurse may begin treatment before other infor-mation is obtained, without the delay of trans-ferring to the main ED immediately. If the treat-ment is successful, triage continues in a normalfashion. One such facility I worked in usedthree Triage Nurses. The Pre-Triage Nursewas the first person to see patients, literally asthey walked in the door. S/he elicited the chiefcomplaint, while assessing the LOC, airway,breathing & circulation. Then the four optionswere: Emergent�ED Major side, Urgent�EDMinor side, Fast Track or Triage Two.
Legal Point: LNCs assess triage systems com-prehensively, as all ìtimesî are not equal.
2. Two-Tier Triage utilizes Spot Check Triagefollowed by a more in-depth chief complaint/past medical history interview & vital signs.Patients may be sent to the Fast Track area ifavailable. Fast Track criteria include patientswhose presentation is minor & such that itíspossible to work-up, treat & release within aspecified time period, usually about 1 hour. FastTrack patients are seen for routine follow-upcare, vaccinations, sprains, etc. Protocols shouldexist here.
Legal Point: An understanding of ED policy& procedure, Protocols, Standards & PatientRatios are especially important when only two-tiered triage is used or Fast Track exists.
3. Three-Tier Triage is popular within manyEDs in the U.S. The levels are: Emergent,Urgent & Non-urgent. The latter two catego-ries can have time ranges that vary a great deal,from minutes to hours. Time ranges, rather thanspecific minutes are universal. Itís not possibleto accurately predict outcome with the limitedinformation available in triage.
Legal Point: Too few categories can be toogeneral rather than specific. Patient outcomescan be affected greatly by depending upon onlyUrgent or Non-urgent categories. Time framescan be large. Whatís the difference betweenCategory 2 with a maximum range of 1 hour &Category 3 with a minimum range of 1-2 hours?Research found this lacked in intra-rater agree-ment. The LNC should check policy for reas-sessment time parameters for patients still in thewaiting room & not yet seen for medical screen-ing. (Note: Intra-rater reliability holds that thesame person would get the same result on thesame case when tested later).
4. Four-Tier Triage may use Emergent, Acute,Urgent and Non-urgent categories. Again, timeranges vary. The lesser three may have timesfrom 15 minutes to hours in length. Research
(Continued on p. 11)
19
Glade Springs was the venue for the2005 Annual Real Estate Conferencehosted by the Real Estate LawyersDivision. Although it was planned tohold the meeting at Gladeís new hotel,its completion was behind schedule andwe made do in the old ConferenceCenter. Enough of the new hotel wascomplete to see that it will be quite anaddition to their property, and futureWVBA events held there will find itmost accommodating.
The turnout for this conference was up 25%from last yearís attendance! Andy Millerstood in for Gay Elmore, past president ofthe RLD who was recuperating fromsurgery, and conducted the conference inGayís stead. Richard Angelo with FirstAmerican Title Insurance Company, Jim St.Clair, Vance Golden and Dean Fisher all gaveinteresting and informative presentationsregarding real estate law. Following the
Annual Real Estate ConferenceKeeps on Growing
seminar, attendees and their guests weretreated to cocktails and a prime rib dinner atthe Club House. As an added bonus, FirstAmerican Title Insurance Company treatedattendees to golf on Gladeís Cobb CourseSunday following the conference.
This is the third year for this conference,which has been generously sponsored by FirstAmerican Title Insurance Company since itsinception. United Bank of Beckley sponsoredthe lunch between seminars. Again, our loyalsponsors make it happen and we appreciatetheir support!
Real estate attorneys will not want to missthis yearís conference, which will be held atStonewall Resort in the fall. Be on the lookoutfor the date. If you are a member of theRLD, the registration fee for the conferenceis included in your dues!
Speakers Vance Golden, Dean Fisher and Jim St. Clair
Darlene and Jim Brown
Bob and Shelly TebayNancy Trudel, Laura Wareheim and Bill Holmes
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7. Reassessment guidelines should reflectpriority level. (Non-urgent shouldnítneed VS every 30 minutes & Urgentshouldnít get VS every 1 hour).
8. Triage takes longer for patients whohave: moderate to severe pain (5+ ona 10 scale), moderate to severe nau-sea/vomiting, communication/languagebarriers, infection control needs oracute psych needs.
9. Triage takes longer for those who are:Pediatric, Geriatric or Obstetric pa-tients.
10. Triage takes longer for patients whogive vague/changing/false medical his-tory information. Outright lies affectED throughput in general & posegreater risks for errors.
11. Triage nurses following protocols foradministering treatments, medicationsor ordering labs/x-rays, will automati-cally take more (upfront) time, but lessED time overall, so ìtimesî must beconsidered with perspective.
12. Triage time means they should onlywait ìthisî long for a medical exam.
13. Not all Emergent or Urgent patientsneed admission, i.e. asthmaattackÖtreated & released & someNon-urgent patients need admission,i.e., pneumonia.
14. Backlog will happen & wait times willincrease during an active TraumaCode.
has found this type of triage lacks in reliabilityand reproducibility.
5. Five-Tier Triage was first developed inAustralia in 1993. It was proposed for nationaluse by both the Canadian Association of Emer-gency Physicians & the British Association ofAccident and Emergency Medicine in 1995 and1996 respectively. Categories 1-5 may usetimes such as 0, 10, 30, 60 & 120 minutes re-spectively.
Legal Point: Triage times are assigned ac-cording to how long a patient can safely waitto receive a medical evaluation/treatment. Thisis ìtime to physicianî not ìwait time to astretcherÖto wait some more.î LNCs canevaluate the ìsystemî considering inherent de-lays such as disrobing, Vital Sign (VS) checksby a tech, being seen first by a Medical Stu-dent (who then reports to the Resident, whothen reports to the ED Attending physician, whothen has to find the chart) etc. The TriageNurse should consider this in his/her categori-zation also. LNCs can evaluate Staff Ratios& the Performance Improvement (PI) Pro-gram, depending upon discovery issues.
Triage Practice Caveats
1. The Five-Tier Triage Scale is more accu-rate
2. Use time ranges, not absolutes.
3. Time ranges within a Level should be ac-curate enough to truly prioritize patients.
4. When a patient scenario falls on the bor-derline, ìtriage up.î
5. Establish timeframes for reassessment ofVS/patient condition.
6. Set guidelines for who reassesses. (RN,LPN, ED Tech, NA?)
(Shaw, continued from p. 10)
(Continued on p. 12)
18Rick Pill and Kimberly Peters
Rob Fisher
Southern Conference ofBar Presidents
Nick Casey and John Bailey inMargaritaville
Mary Pat Steptoe, Carolyn Morhous, Jeanne andHoward Persinger
Myla and Jack Bowman, Sally and Charlie Love
The CommuniqueThe Communique
12
Are the policies adequate? Were they fol-lowed? Did the patient/other impede the pro-cessing? Triage is complex & should be doneby experienced/well-trained providers. Newgrads put in this position will likely benefit noone, check training programs.
Itís the nature of the beast to receive patientswho donít belong at a facility, due to over-triage, under-triage (requiring specialists) orself-presentation. Not all ED ìtimesî arealike. Itís highly specialized, requiring that
same eye to pick out zebras from horses. Ques-tions are as important as answers. But itís para-mount to understand that Emergency Medicine/Nursing vastly differs from all other specialties:Medicine approaches conservative to aggres-sive. Emergency Medicine must assume worst-case scenarios FIRST and then deductively ruleout, eliminating life & limb threats.
Triage demands the best judgment, with the leastamount of information & resources, in the short-est amount of timeÖa beast indeed.
The coming year should be an exciting andenjoyable one for The West Virginia BarAssociationís Young Lawyers Division. Ihave appointed an energetic and capableExecutive Council consisting of MichaelMarkins, Huntington; Nate Tawney,Charleston; Mindy Dugas, Martinsburg andEric Holmes, Ripley. We will work hard toensure that this yearís Young Lawyerevents are a complete success.
Plans for this year include the annual Benchand Bar Reception in Charleston, co-hostedwith the Kanawha County Bar Association.This event will be held at the CharlestonMarriot on March 22 from 5:00 - 8:00 p.m.There will also be a ìLegal Easeî recep-tion and CLE in a location TBA. We arecurrently leaning toward Beckley becauseit is one of the few areas in the state whereThe Bar Association has not recently hostedthis event. However, this is still undecidedand I would like your input on possible lo-cations and topics.
There are also plans for a BIG receptionimmediately following the July Bar Exam
in honor of those who make it out of the Charles-ton Civic Center that day. It will take place at aconveniently located watering hole near the testsite where we will welcome in our stateís new-est lawyers with a bang. This year we will makea concerted effort to attract as many currentlypracticing Young Lawyers as possible to thisevent in order to meet and greet our professionísnewest members. The event will be fun and agreat opportunity for West Virginiaís newestlawyers to meet us and feel part of the BarAssociation.
Finally, it is not too early to start making plans toattend the 120th Annual Meeting next Septem-ber 21st thru 23rd at The Homestead. As an addedincentive to increase attendance, I will make aproposal to the Executive Counsel providing thatany Young Lawyer that attends the annual meet-ing at The Homestead will get this yearís mem-bership dues either waived or reimbursed. Makeyour plans soon, good golf, good food, good timesand CLE hours await!
Please contact me at [email protected] to share your ideas, comments andsuggestions for this upcoming year.
Young Lawyers Division is Fired Up!Anders LindbergChair, Young Lawyer Division
(Shaw, continued from p. 11)
17
Bob and Mary Pat Steptoe
Jack and Myla Bowman
Loganís own Bob Noone
Southern Conference ofBar Presidents
Debra Scudiere and Rick Pill
Tom and Rebecca Tinder
Julie and Pryce Haynes
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WVBAUpcoming EventsBench & Bar ReceptionMarch 22 , 20065 :00 p .m . - 8 :00 p .m .Charleston Marriot
LNC Spring ConferenceMa y 1 9 , 2 006Charleston Marriot
YLD After-Exam PartyJu ly 2006
Legal Ease ReceptionT B A
Real Estate ConferenceFa l l 2006
WVBA Annual MeetingSeptember 2 1 - 23 , 2006The Homestead Resort
LNC Annual MeetingSeptember 23 , 2006The Homestead Resort
Join us!
James Bruce BartlettD.O.D.: 12/19/05Charleston, WV
Chester LovettD.O.D.: 8/14/05Charleston, WV
Richard George RundleD.O.D.: 11/08/05
Pineville, WV
Honorable Clarence L. WattD.O.D.: 10/16/05Charleston,WV
In Rememberance
As a member of The West Virginia BarAssociation, you can take full advantage ofa number of great quality services!
A Comprehensive Insurance Program...The WV Bar Association endorses thebenefit plans (including life, disability, health,and long-term care) administered by PryceHaynes Associates in Huntington,WV.
The CommuniquÈ... A quarterly newsletterdesigned to keep you informed aboutprograms and activities.
An Annual Meeting...Members have the opportunity to attend thisannual meeting that features nationallyrecognized speakers, social events and CLEopportunities.
Representation in Charleston... The WVBAadvocates the interests of West Virginialawyers during the legislative sessions.
A Legislative Update...The WVBA provides its members informationabout any information affecting the practiceof law on the state and federal levels.
Visit our website to learn more!www.wvbarassociation.org
Why Join the WVBA?
16
On October 27-30, 2005, The WVBA co-hosted with the WV State Bar the 36th An-nual Meeting of the Southern Conference ofBar Presidents at The Greenbrier. This pres-tigious conference is held once a year by oneof the 21 member bar associations (WestVirginia, Virginia and North Carolina havingtwo bars) from 18 south-ern states. Included inthese conferences arepresidents, past presi-dents, presidents electand executive directors ofthe respective bars.
More than 200 bar lead-ers attended this yearísmeeting from all 18southern states, whichmade it one of the moresuccessful SCBP confer-ences in recent years. We were honored tohave presentations made by GovernorJoeseph A. Manchin III, Supreme CourtChief Justice Joseph P. Albright, WVU LawSchool Emeritus Professor and our own pastpresident Forest J. ìJackî Bowman. Every-one especially enjoyed the entertainment on
Friday evening provided by Bob Noone fromLogan, and Saturday eveningís bluegrass mu-sicians Johnny Staats and The Delivery Boysfrom Ripley. Among the WVBA attendeeswere Rick Pill, President; Bob Steptoe, Jr.,President-Elect and Past Presidents HowardPersinger, Jr., John P. Bailey, Charlie Love,
Larry Morhous andJack Bowman. Nextyearís meeting will beheld October 12-15,2006 in Charleston,South Carolina.
Among the corporatesponsors were: LegalDirectories PublishingCompany; LexisNexis;Martindale Hubble;ALPS; Old RepublicNational Title Insurance
Company; BB&T; and MBNA. We wereextremely fortunate to have the following lawfirms and attorneys support this meeting:Bailey, Riley, Buch & Harman; Bowles RiceMcDavid Graff & Love; Brewster, Morhous,Cameron, Caruth, Moore & Kersey; Burton& Kilgore; Charles V. Critchfield; Flaherty,Sensabaugh & Bonasso, Ford Law Firm; C.Howard Hardesty; Kay, Casto & Chaney;Lewis, Glasser, Casey & Rollins; Manchin &Aloi; Martin & Seibert; Offut, Fisher & Nord;Persinger Law Office; Richardson & Davis;Steptoe & Johnson; Tinney Law Firm; Rob-ert J. Wallace. The generosity of these spon-sors made it possible for The WVBA and theWV State Bar to provide a memorable meet-ing enjoyed by all. Thank you each and ev-ery one of you!
Southern Conference of Bar PresidentsMeeting a Huge Success
Larry and Carolyn Morhous
Jack Bowman and Nick Casey
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during the week declaredìConstitution CelebrationWeekî by Senator Rob-ert C. Byrdís sponsoredCongressional Proclama-tion.This was a very well at-tended and highly suc-cessful event. Due to itssuccess and the warmreception given the Jus-tices, the WV SupremeCourt of Appeals will re-turn to Marshall Univer-sity in 2006 for anotherregular session of theCourt. The WVBA waspleased and honored toparticipate in this oppor-tunity and is eager to bea part of this yearísevent.
Generous financial support for this luncheon wasprovided by the following law firms: Campbell,Woods, Bagley, Emerson, McNeer & HerndonP.L.L.C.; Farrell, Farrell & Ferrell, L.C.;Huddleston Bolen, LLP; Jenkins Fenstermaker,
PLLC; Kenneth P. Hicks,L.C.; and Lloyd Jackson, At-torney at Law. On behalfof The John Deaver DrinkoAcademy, we thank thesebenefactors in helping tomake this auspicious occa-sion all it could be.
On September 20, 2005,the WV Supreme Courtof Appeals held a regularsession of the Court at theJoan C. Edwards Centerof Performing Arts onMarshall Universityísmain campus.
Following the Court ses-sion, The WVBA andThe John Deaver DrinkoAcademy co-hosted aluncheon for the Justicesand invited members ofthe legal and MarshallUniversity community.Charlie Love, our Presi-dent, delivered a wel-come presentation inwhich he remarked aboutthe involvement of TheWVBA along with The John Deaver DrinkoAcademy, established by nationally renownedattorney John Drinko. This momentous occa-sion for the WV Supreme Court of Appeals, onthe campus named after former U.S. SupremeCourt Chief Justice John Marshall, was held
WV Supreme Court Holds Session atMarshall University
2004-05 WVBA President Charlie Love
Kemp Morton and David Baker
15
WV Supreme Court at Marshall
Justice Maynard, Ret. Judge Egnor
Justice Benjamin, Charlie and Sally Love
Joe Farrell and Paul Farrell
Bob Levy, Jack Vital, DC Offutt
Bill McGee and Tom Scarr