1. Performing those nursing activities for which the professional nurse has been prepared through basic education and additional skills which are obtained through approved continuing education programs. It also states:
   
2. Assessing the patient's needs, planning for, implementing, evaluating, and documenting the nursing care being provided to each patient.
   

1. Boundaries of Competence:
   
   Rehabilitation Counselors will practice only within the boundaries of their competence, based on their education, training, supervised experience, state and local professional credentials and appropriate professional experience. Rehabilitation Counselors will demonstrate a commitment to gain knowledge, personal awareness, sensitivity and skills pertinent to working with a diverse client population. Rehabilitation counselor will not misrepresent their role or competence to clients.
   
   
2. Referral:
   
   Rehabilitation Counselors will refer clients to other specialists as the needs of the clients dictate.
   
   
3. New Specialty Areas of Practice:
   
   Rehabilitation Counselors will practice in specialty areas new to them only after appropriate education, training and supervised experience. While developing skills in new specialty areas, Rehabilitation Counselors will take steps to ensure the competence of their work and to protect the client from possible harm.
   

When providing forensic evaluations, the primary objective of Rehabilitation Counselors will be to produce objective findings that can be substantiated based on information and techniques appropriate to the evaluation which may include examination of the individual with a disability and/or review of records. Rehabilitation Counselors will define the limits of their report or testing, especially when an examination of the individual with a disability has not been conducted.

Life Care Planners who are Certified Life Care Planners must be aware of the Code of Professional Ethics of the Commission on Healthcare Certification. In part this states:

The primary objective of the disability examiner and life care planner is to the disabled person in question.

Principle 1-Moral and Legal Standards:

Disability Examiners and Life Care Planners shall behave in a legal, ethical and moral manner in the conduct of their profession, maintaining the integrity of the Code of Professional Ethics and avoiding any behaviors which would cause harm to others.

Once the life care planner is satisfied that he/she has the qualifications necessary to accept the assignment, review of the other case can begin and other potential dilemmas confronted.

I. Case Review

Review of records is a critical component in the development of a Life Care Plan. Records are foundation to the opinions of the Life Care Planner. It is important to realize, however, that records may:

1. Be incomplete and fail to include adequate information required to provide foundation to the Life Care Plan;
   
2. Be conflicting and provide inconsistent information with regard to subjective complaints and objective findings;
   
3. Not provide any information at all to support the opinions of the life care planner
   

1. Unless the Life Care Planner has the M.D. credential, he/she is not a medical doctor and is not entitled to practice medicine and offer medical opinions within the context of a Life Care Plan;
   
2. Even if the Life Care Planner happens to be a medical doctor, the same foundational requirements required by a non-M.D. life care planner have to be met.
   

1. Does the content of the Life Care Plan have its origin in medical or psychological conditions or disabilities arising from the alleged negligence of the tortfeasor, or to unrelated conditions or factors?
   
   A Life Care Plan can only include what is necessary by virtue of a medical, psychological condition or disability. When involved in litigation, the forensic rehabilitation professional must also be concerned with providing content to the Life Care Plan that is made necessary due to the alleged negligence of the tortfeasor. For instance, although there is probably little doubt in the medical community that taking vitamins contributes to good health, unless vitamin therapy is specifically recommended due to a disability arising from the alleged negligence of another, it would not be appropriate to include the cost of vitamins in the Life Care Plan;
   
   
2. Subjective Complaints vs. Objective Findings
   
   In developing a Life Care Plan, especially in cases involving chronic pain syndrome, does the Life Care Planner solely embrace the subjective complaints of the subject of the Life Care Plan when the reason(s) for the subjective complaints may not have their origin in medical or psychological conditions arising from the alleged negligence of the tortfeasor?
   
   To simply accept such subjective complaints as being legitimate may compromise the integrity of the Life Care Planner and jeopardize the remainder of the content of the Life Care Plan. Similarly, to summarily reject the subjective complaints may also be problematic.
   
   To reconcile this dilemma, it is critical to get foundation from the appropriate medical or psychological experts upon whom the Life Care Planner can rely for guidance.
   
   
3. Conflicting Medical or Psychological Opinions-What to Do?
   
   It is not uncommon for Life Care Planners in forensic settings to confront diverse medical and psychological opinions. Does a life care planner retained by the plaintiff only rely upon medical or psychological experts retained by the plaintiff or treaters as opposed to independent examiners? Very often, a life care planner retained by the plaintiff will only have information provided by treating physicians at the time a Life Care Plan is developed. Independent Medical Examinations ordered by defendants may not be done until long after the Life Care Plan has been prepared.
   
   When confronted with oftentimes-different opinions of the physician or psychologist retained by the defendant, does the life care planner retained by the plaintiff refuse to acknowledge these differing opinions? To refuse to acknowledge them would be a great mistake. Does this, then, require the development of an alternative Life Care Plan? The answer to that is, "perhaps." The reality is that the retaining attorney may not want to spend the money to do this, or the discovery rules under which the case is being tried may preclude it.
   
   What I would suggest is that the life care planner is to be prepared to offer different Life Care Plan outcomes depending on the medical or psychological opinions he or she is asked to consider. This preserves the life care planner's credibility and displays a willingness to consider whatever information is presented for consideration. The time for this may not occur, though, until the life care planner is deposed.
   
   This issue, however, leads to one of the key dilemmas confronted by life care planners.
   
   
4. Is the Life Care Planner Expected to do Merely What the Referral Source Requests Regardless of its Ethical Implications?
   
   The life care planner is obligated to share his/her knowledge and expertise with the referral source. Recognizing the ethical obligation to the subject of the Life Care Plan (the client), it behooves the life care planner to educate the referral source so that no harm is done to the client. If the life care planner does NOT take these steps and allows harm to be done to the client, this could have serious consequences.
   
   Very often, the referral source, typically an attorney or insurance company claims professional, will not have much experience in working with life care planners and understanding how Life Care Plans are developed. Just as we are not attorneys and are not, therefore, held to the highest standards as an attorney when it comes to understanding the law, the attorney cannot be expected to understand the profession of life care planning and make the most-informed decisions that will impact on the life care plan and the role of the life care planner.
   
   Life care planners are educators to their clients, attorneys, judges and other triers of fact, such as juries, mediators and arbitrators. To merely follow the "marching orders" of the referral source can result in the compromise of professional ethics and credibility, problems that can be harmful to the client, the subject of the Life Care Plan. We must avoid these problems whenever possible.
   

1. Preparing a document that provides for categories of medical and non-medical services and equipment as discussed in the life care planning literature;
   
2. Using current cost information;
   
3. Relying upon multiple sources for cost data to avoid the appearance of providing inflated, deflated or otherwise inappropriate costs for the items contained in the Life Care Plan;
   
4. Using geographic-specific resources and cost data;
   
5. Preparing the Life Care Plan in both narrative and table format so the Life Care Plan can be easily understood;
   
6. Documenting informational and foundational data sources;
   
7. Not including items or services for which there is no support;
   
8. Carefully considering funding sources and avoiding the use of inappropriate collateral sources which may not only be precluded by case law or statute, but the availability of such funds may not be predictable from year to year, let alone over the period of time set forth in the Life Care Plan.
   

1. Case Examples:
   
   
   1. You receive a referral to develop a Life Care Plan from a defense attorney in a case involving claims of medical malpractice. The subject of the Life Care Plan is a child with a brain injury. The attorney requests that you develop a Life Care Plan using only collateral sources. These collateral sources would provide for the cost of medical office visits, diagnostic studies, therapies, equipment, supplies, etc. Due to limitations in family income, the child qualifies for services through the State that provide for all long term medical care and many of the above services, equipment and supplies.
      
   2. You receive a referral to develop a Life Care Plan and the facts are the same as above, except that the family has excellent group medical insurance that is paying for the majority of the child's needs at present.
      

1. I will be happy to do as you ask;
   
2. I cannot simply do as you ask. I have an ethical obligation to the subject of the Life Care Plan and will consider those collateral sources that are appropriate and include those in the Life Care Plan;
   
3. I need more information regarding the available potential collateral sources, such as whether they have rights of subrogation. If they have such lien rights, it would be inappropriate to consider these as appropriate collateral sources as they would expect reimbursement for what they have paid from any settlement or jury verdict and my Life Care Plan, therefore, would not adequately include the funds to provide for the child's future care needs as set forth in the Life Care Plan. To include these collateral sources would, therefore, create a situation where I could be accused of committing a breach of ethics as I have willfully underfunded the Life Care Plan;
   
4. I will be happy to develop a Life Care Plan in this case as I am qualified to perform this task, but I can only do so in a manner consistent with how my profession, certifications (and/or licenses) literature and standards of practice dictate how the Life Care Plan should be developed.