Forensic mag summer 2015 by Federation of Forensic and Expert Witnesses

Forensic & Expert Witness E Mag Summer Special Issue 2015

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Ethos

Forensics Forensic Science: Reliability or Liability? Amidst revelations of serious forensic errors made over more than two decades by the FBI, tales of wrongful conviction due to faulty forensic evidence, and the continued fallout from closure of the UK Forensic Science Service, what is the current quality and reliability of forensic science? Sue Carney, Consultant Forensic Scientist, Ethos Forensics In April 2015, the FBI made a formal admission of errors in its forensic science. 26 out of the 28 examiners at its microscopic hair comparison unit had overstated the significance of evidence in favour of the prosecution over a period of more than 20 years. This revelation followed criticism of flawed bite mark comparison evidence, a heated discussion that continues amongst the US forensic community, and subsequent investigation. The National Association of Criminal Defence Lawyers and the Innocence Project are currently assisting the US government in the largest post-conviction review of forensic evidence; investigation of thousands of cases. Of those cases so far reviewed, 32 of the defendants were sentenced to death of which, 14 have been executed or died in prison.

The National Academy of Sciences 2009 Report, Strengthening Forensic Science In The United States: A Path Forward, is particularly critical of those evidence types, such as bite marks analysis, comprising subjective comparisons. Of such evidence types, it states that there is continuing dispute over their value and scientific validity. The report also highlights that in such experience-based methods there exists the potential for bias, particularly in the absence of blind comparisons. The report, amounting to more that 300 pages, is comprehensive in its recommendations. Whilst it could be argued these universally relate to the standards and quality requirements of forensic science the world over, a simple comparison of the US with the UK is not straightforward. The US is a vast country comprising a variety of jurisdictions at both state and federal level. Uniting the practices of this collection of agencies and implementing accreditation and best practice is an unenviable task.

In assessing the state of UK forensic science one must view both its past and possible future. The UK has a long history of forensic innovation. It was at the University of Leicester in the 1980s that Sir Alec Jeffreys developed DNA fingerprinting, the precursor of the DNA profiling techniques used today by forensic agencies worldwide. The former Forensic Science Service had a reputation as the UKâ&#x20AC;&#x2122;s foremost forensic research body, establishing the guidelines for many forensic evidence types including landmark publications ranging from the persistence of biological evidence in sexual assaults to the implementation of frameworks for the interpretation of forensic evidence. The FSS closed in 2012 under pressure from the UK government in its deregulation of the forensic market. The ripples are still being felt across the forensic community. The new competitive forensic market brought with it a culture of faster and cheaper forensic science. Todayâ&#x20AC;&#x2122;s main UK forensic providers (LGC, Cellmark and Key Forensic Services) are under increasing pressure to deliver more for less, as are their customers, the 43 police forces of England and Wales, whose forensic budgets have been slashed. The effects on forensic science are palpable. Forensic science is a painstaking process where accuracy and attention to detail are critical. Yet reporting scientists find themselves under increasing time pressures diametrically opposed to quality. Rushing any forensic analysis risks evidence being missed.

What remains for the smaller consultancies operating within the UK forensic market? Unlike many of the US forensic laboratories, the big 3 UK forensic providers hold accreditation to international quality standards (ISO 17025), as do some of the smaller organisations providing forensic services to the defence. Accreditation ensures that quality of work is comparable to that of other accredited organisations offering the same products and services. It is an assurance of capability and competence. In short, it demonstrates excellence. However, the accreditation process is currently cost-prohibitive for independent consultants working as sole traders. Further, they lack the infrastructure required for objective selfassessment.

In addition to the inevitable loss of expertise from UK forensic science, as many time-served scientists chose retirement or alternative careers, this new culture also brought about reluctance on behalf of police forces to use particular evidence types due to perceived cost. Fibre comparison is a case in point. The big three forensic providers deliver relatively few fibre comparison services directly, since customers are loath to authorise such time-consuming analyses. Yet time and again, fibres have provided crucial evidence in casework. Notable examples include the murders of Holly Wells and Jessica Chapman and the eventual prosecution of Norris and Dobson for the murder of Stephen Lawrence. Despite continued campaigns for change in UK forensic science, the announcement on 24 July that Contact Traces, possibly the only specialist forensic fibre consultancy in the UK, was to withdraw from the forensic market was a bitter blow and is symptomatic of the current state of UK forensic science.

The closure of the Council for the Registration of Forensic Practitioners in 2009 meant that there were no longer clear criteria, other than accreditation status, upon which the criminal justice system could assess the credentials of an expert witness. Within the next five years, it is thought that accreditation will be a legal requirement for all forensic practitioners to operate within the UK criminal justice system. Whilst this is to be commended, there is, as yet, no clear framework under which independent consultants can demonstrate competence. The Forensic and Policing Services Association, in conjunction with the Chartered Society of Forensic Sciences are exploring the options for small businesses and consultants via their quality standards working group. It is hoped that the Society, as the industryâ&#x20AC;&#x2122;s professional body, will be able to fulfil some of the independent monitoring functions on behalf of independent consultants.

The NAS report recommended that the control and operation of US forensic provision be removed from police forces, in order that forensic experts maintain true impartiality. The new cost-focused UK forensic market has prompted increased numbers of UK police forces to form their own in-house forensic services. Many of these have not yet achieved accreditation, such that they too are not yet able to evidence quality and capability. This increase in police in-house forensic activity has given rise to a fragmented approach in some cases. Rather than a set of exhibits being submitted for examination by the forensic science provider, some forces carry out their own examination and submit swabbed or cut out stains to an FSP for DNA profiling, accompanied by little contextual information. The FSP and police experts each compose their own evidential statement in the case and there is a risk that on some occasions, issues of how the tested biological material came to be deposited on the exhibit may not be addressed in either statement. Furthermore, the mutual trust built up over years of collaboration between forensic science providers and police forensic submissions units in jointly agreeing the most appropriate forensic strategy for the case may suffer. It seems that decisions are now made based on perceived cost rather than forensic potential and the true needs of an investigation. If cost and time are the main opponents to quality, can we be sure that UK forensic science is protected from such serious errors as those admitted by the FBI? Whilst comprehensive checking procedures are in place to minimise error within UK forensic laboratories, it is the follow up of errors — what is learnt — that is most important. A significant portion of the requirements for ISO 17025 accreditation deal with managing the risk of error, but it must be accepted that any forensic service run by people can never be completely error free. People get tired, they have erratic moods, they have off days. They are not machines. This principle relates to all types of forensic science but is particularly pertinent to those more subjective forensic methods involving marks comparisons. Anyone who thinks that we are free of cognitive bias in forensic marks comparisons on this side of the Atlantic need only refer to the Scottish Fingerprint Inquiry to realise their misconception. The fact is, almost all forensic opinion contains some degree of subjectivity.

Even the most analytical test results have context within a case, and if we are to address the more complex, and arguably more useful, issues of how a questioned substance came to be present in or on an exhibit, then we may need to infer from previous casework experience in addition to published scientific data. The good news is that we are a few steps ahead of the US in our awareness of cognitive bias. It is an issue familiar to all forensic practitioners and awareness, whilst not prevention, means that we know the warning signs. Blind comparison is more routinely part of the peer review process and practitioners try not to be swayed by the nature of any particular case. Of course, this does not guarantee complete irradiation of bias and error, but the framework is in place. The most recently appointed (from November 2014) Forensic Science Regulator, with an overall responsibility for identifying and developing quality standards, is herself an experienced forensic scientist. This can only be an advantage, along with the recent agreement that the regulator will be given statutory powers to regulate the quality of forensic evidence. As a final point, it’s important to consider the UK’s status as a world leader in forensic science. Whilst this was considered to be true in the hey day of the FSS, it could now be argued that research is rarely conducive to profit and therefore, may not be the first priority of the existing forensic science providers. Having said that, a recent (April 2015) Chartered Society of Forensic Sciences conference showcased some innovative research being undertaken at many of the UK’s fine academic institutions and by dedicated forensic practitioners within the FSPs. Perhaps, whilst vocal forensic practitioners continue to wield some influence, all is not lost.

www.ethosforensics.com

How do you find a business valuer?

by Chris Makin

henever a client asks “What’s my business worth?” the reply should be “To whom, and for what purpose?” As with any commodity, supply and demand come into play, but with a business it’s far more complicated. Supply and demand of capital, general economic conditions, even fashion – why was so much paid for dot.com companies, Amazon, twitter, which had never made a profit? And why does their value disappear when the bubble bursts? And what about the special purchaser?

To take an extreme example, in one of my family cases I was expert adviser to the wife’s legal team led by the then Nicholas Mostyn QC. The husband had an IT company in London which had but one product, a program for international currency dealing. It was in a desperate state: losing £1million a year, rent arrears of £½million, and the Revenue had a walking possession order for PAYE arrears of £¼million; yet the husband was in negotiation with a US company which had a whole suite of software for international banking but for this particular program. They needed it to complete their suite, and the husband negotiated a multi-million $ sale of the company and a very well paid position for himself. My task was to advise the lady’s lawyers on the parameters of the husband’s negotiations without spoiling her position – she was a 50% shareholder – and the tax consequences. The outcome was highly satisfactory for all concerned. One would have expected the value of the company to be £nil, but with the ultimate special purchaser a very high value was achieved.

Let’s talk about more mundane matters. Your client is getting divorced, and the family business forms a significant part of the matrimonial estate. Or your client is a director of a company and has been excluded from management decisions, probably coupled with a claim for constructive dismissal. Or your client (or you?) has for many years been a partner in a professional firm, is coming up to retirement, and suspects that the continuing partners are not prepared to pay his entitlement. What do you do? In all such cases, and others, the value of the business, and your client’s part of it, must be determined. I have acted frequently as a mediator and as an expert determiner in such matters, but today we are concerned with my work as expert valuer.

chris@chrismakin.co.uk www.chrismakin.co.uk

n family cases the expert is usually instructed to value each spouse’s shareholding, estimate the tax which would be payable on disposal of the shares, and say how much cash may be extracted from the company to aid a settlement. Traditionally there would be separate experts on each side, and I remember many happy experiences with Hildebrand documents and the like! These days, with judges’ preference for the SJE (so that they don’t have to strike a balance between opposing experts’ opinions of £15million as against £nil!) family valuations are less exciting, but no less worthwhile. And there are always the big cases where party experts are needed. A few months ago I was appointed expert by the husband to value his businesses in property development and construction services. Another expert, in my view bending all the rules for the benefit of the wife, had valued the enterprises at about £1million. My view was that, with negative equity in the properties and a slippery customer list, the value was £nil. Because of the husband’s strained finances my instructing solicitor was taking monthly fees on an IOU, and would not be responsible for my fees, so I had to do the same. During the hearing, the husband said he was applying for an IVA. It failed, and he went bankrupt. Good news: I was right with a value of nil. Bad news: I didn’t get paid! In the commercial field, so often one of the founders of a company is elbowed out by others, and has to mount a claim under Section 994 of the Companies Act for unfair prejudice. Normally a “fair” value is required, but what is fair? Is there for example a quasi partnership per Ebrahimi –v- Westbourne Galleries? Such matters need an experienced valuer.

There are two essential requirements for your choice of valuer: a person who has experience and a deep understanding of business, and a person who has in effect a second profession as expert; for there is no point in choosing someone who knows about business, but who doesn’t know CPR or FPR, who can’t write an expert report in acceptable format, and who can’t survive cross-examination at trial. On the first requirement, I have been managing partner in a series of firms, starting as a sole practitioner and eventually becoming head of litigation in a national firm. When in general practice I acted for a huge range of clients, from market traders to PLCs. And my chapter on Loss of Profits for the Self-employed, which appeared for many years in Kemp & Kemp, is available to you on request. I do understand business. On the second requirement, I was one of the first to be accredited as a forensic accountant and expert witness by the ICAEW, and I am fellow at The Academy of Experts, one of only 60 world-wide. And with over 100 court appearances, the witness box is a very familiar place! In this article I have said nothing about valuation techniques; about assets basis, dividend yield basis, earnings basis, P/Es, and so on. There isn’t space, and I wouldn’t want my readers to go glassy-eyed. I have just written a helpsheet on business valuations for the ICAEW Forensic Group, and the basic checklist of information needed runs to five pages! Can we just take it that after many, many such assignments I do understand how to do a valuation, and that we can share some of these matters if time allows and if you are really interested? In the meantime, please bear in mind that for your expert assignment, valuation or other, my terms include an initial review of any case, with no charge if the matter does not proceed. So it costs you nothing to find out if I can help you unravel some of these mysteries.

Andrew Geddes Financial legal reports in industry

Mr. Andrew Geddes is a Financial Expert Witness providing reports concerning fraud, misunderstandings, broken contracts and business valuations; many of which have saved clients thousands of pounds.

pecialising in the MATERIALS, METALS AND MINING INDUSTRY

Andrew's standing as an Expert Witness has been enhanced by his original technical background. In a recent interview, he explained: “I spent over 40 years on the commercial side of the metals business working with producers, traders and consumers doing billions of dollars’ worth of business.” “I became a member of the Expert Witness Institute and have passed the Bond Solon/Cardiff University Law School accreditation for Expert Witnesses,” Andrew continued. “While not all disputes will end up in court, it helps to be able to show the lawyers that I have successfully given evidence in court a number of times in London, Geneva, Zurich and Stockholm.”

Continuing to divulge into his experiences in the courtroom, Mr. Geddes went on to say:

“In the sort of disputes in which I am involved there would always be an Expert Witness appointed by each side.” “I have worked for both the Prosecution and for the Defence in different cases. In some circumstances I find I may be appointed by a party with whom I crossed swords a few years beforehand when they were on the other side but that is the value of being independent and being valued for my own independent opinion.” Discussing the importance of instructing an Expert Witness at the beginning of a legal case, opposed to asking for an opinion at a later stage of the proceedings, Andrew explained: “I wish lawyers would appreciate how much better they could pursue their case and how much more efficient it might be for their client if they were to make an earlier appointment of an Expert.”

In addition to this, Andrew holds an MA from Oxford and is a member of the Institute of Directors, he is “When there are very complicated cases with 600also a member of the Expert Witness Institute and 1,000 different documents for hundreds of millions of dollars I am sure an Expert Witness would be able to the Institute of Materials, Metals and Mining. do a better job if there is plenty of time to work out what The cases for which Andrew Geddes is instructed should have happened in the series of contracts and are usually very large, meaning that the Expert can to then make an easily understandable presentation manage just one or two in a year with the time that he to the lawyers and client,” he continued. “This does has available. “This means that I might be in court on not necessarily mean more time (and therefore cost) two cases in one year or, if they both get settled out- being spent by the Expert but it does mean that some of-court I might not attend court at all in a year. It just of the potentially important minutiae are less likely to depends how things work out,” he explained. “While be overlooked in the rush to put a Report together and, many lawyers tell me that it is unusual for a dispute to it does mean that there is time for the lawyers to better go to court, I find that for the cases I am working on appreciate the trade implications of the dispute and act there are about 30-50% that eventually go to court.” accordingly.”

Many of the cases on which Andrew has been appointed have been arbitrations and must comply to the strictest of confidentiality rules. In some cases these have involved disputes in the range of $30 million to $300 million â&#x20AC;&#x201C; examples include:

FRAUD:

between parties in USA, Europe and the Middle East and Far East. The commodities have been alumina and aluminium metal. Sometimes it is a matter of under- or over-pricing the metal in return for a hidden commission but that is unlikely to be spotted by an accountant or even by auditors. It needs a trader to know the real value. Sometimes it has been a matter where one party just walks away with the money or the stock of metal and there is nothing to be found. This will then involve not only the loss of the funds or valuation of the metal but also the implications of any LME hedge against the metal.

MISUNDERSTANDINGS:

where each party within Europe was convinced they were in the right but one side had misunderstood the implications of what he was contracting. In another case on a swap, one party had made a hedge in the wrong direction (for example had bought an LME hedge when he should have sold) but this usually happens on the FX hedge rather than the metal hedge. This error should show up when they do a mark-to-market valuation at the end of the day or end of the month but sometimes it doesnâ&#x20AC;&#x2122;t or sometimes a party maybe running a system where their mark-to-market discipline is insufficiently precise so an error is unlikely to show.

BROKEN CONTRACTS:

Andrew has worked on cases for broken contracts in the tolling of alumina into metal and for deliveries of aluminium. These usually occur because one party looks at the massive volatility that may have occurred between the time of making the contract and the due time for delivery so, for example, a supplier might think he can make a lot more money in a rising market by breaking the contract and selling at the new, higher, value. This then leaves the buyer to have to cover-in at the higher price which will end up making a loss since the reason he had the fixed price on the contract in the first place was because he had a fixed price commitment for the sale of his fabricated product.

VALUATION:

Andrew worked on one case a few years ago where a Lloyds Syndicate was asking him to establish the true value of losses of insured metal which had been paid for but not delivered. The Lloyds Syndicate was not actually a party in the litigation but might have had to pay out depending on the result of the court case. Andrew is not able to divulge the result of the court case but the Lloyds Syndicate was satisfied with his valuation.

For further information, please contact Mr Andrew Geddes on T:07768 274 499 or email enquiries to awgeddes@btinternet.com

GBRW's Headquarters in Old Broad Street, City of London

GBRW Expert Witness is an affiliate of GBRW Limited, a consulting company based in the City of London which provides advice on banking, insurance, financial sector and enterprise development issues. In 2015, GBRW Expert Witness celebrates its twentieth anniversary of expert work in banking, investment management, insurance, stockbroking, derivatives and related litigation. With three active experts among its Directors, GBRW Expert Witness also draws on a pool of experienced associates – the widest in the UK for financial sector cases. Over the past eight years, GBRW Expert Witness has been engaged in over 400 cases involving civil and criminal court proceedings, arbitrations and mediations, working with clients from the UK, Asia, Australia and New Zealand, Middle East, North America and Europe. When law firms are looking for expert witnesses or advisers in financial sector litigation, they face a number of challenges, including identifying potential experts in a specialised discipline discreetly; avoiding individual experts ‘shoehorning’ themselves into roles for which they are not properly equipped; and assessing individual experts’ strengths and weaknesses and prior track records.

GBRW Expert Witness’s Directors’ experience enables the firm to propose one or more candidates whom they consider the best equipped to address the specific issues on which expert evidence is required. On occasions, they may suggest using more than one expert where requirements of the case cannot be covered by a single individual. GBRW Expert Witness has now been engaged by more than 70% of the Legal Week Top 50 firms as well as many overseas practices. The company provides Briefing Papers on its website to assist lawyers on a number of areas which are frequent subjects of litigation. Two of these are investment and insurance related disputes.

GBRW Expert Witness’s ofﬁces in Old Broad Street, London EC2

Investment Litigation Investment losses are often followed by lawsuits and requests for expert support. Investment disputes have been a major area of litigation since the global ﬁnancial crisis in 2008/2009 and have formed one of GBRW Expert Witness’s most active areas of work. Each case will have its own characteristics, which may include: • • • • •

A mismatch of investments with the investor's requirements. The investor’s risk appetite being misunderstood, incorrectly recorded or ignored. The investment adviser misunderstanding the risk characteristics of the investment, which has resulted in mis-selling. Unprofessional behaviour, typically exhibited in practices such as selling inappropriate investments to inexperienced investors or misrepresentation of the nature of the investment product. Fraud, ranging from outright theft of assets to churning, self-dealing and front running.

However, it is important to understand that poor investment performance is not automatically a basis for a claim. The points that an expert should consider prior to providing advice include: • • •

Were the investments appropriate, in terms of risk appetite and stated investment objectives? Were proper procedures followed in fact-ﬁnding and record-keeping? Was the timing correct for speciﬁc investment decisions?

Only when these questions have been answered to a satisfactory level can a claim be supported.

Insurance disputes GBRW Expert Witness acquired Associated Insurance Experts in 2009, adding a group of experts in a wide range of insurance disciplines with an extensive background of knowledge and industry contacts . The majority of its engagements involve allegations of broker negligence or the contesting of decisions by insurers to “avoid” liability under the policy which they have issued. In many cases, the insured party may have potential claims against both its insurer and the broker which placed its insurance. Given the specialised characteristics of the insurance market, with which many lawyers are not familiar, early discussion with an expert is highly advisable. If an expert is engaged late in proceedings, assumptions about insurance contracts by the legal team may prove ill founded or incorrect and a basic error in the interpretation of an insurance policy can badly weaken the client's position in a disputed claim. GBRW Expert Witness now offers a scheme which provides an initial overview of the strengths and weaknesses of a case for a ﬁxed fee. The company’s experts have dealt with a wide range of cases involving property, business interruption, motor and marine insurance, as well as more specialised areas such as reinsurance broking and underwriting and excess loss layers of cover. Further information on GBRW Expert Witness can be found in the 2015 editions of the Sweet & Maxwell Expert Witness Directory (including Legal Hub), the UK Register of Expert Witnesses and the Expert Witness Directory.

Level 17, Dashwood House 69 Old Broad Street London EC2M 1QS

T:020 7562 8390 E:experts@gbrwexpertwitness.com W:www.gbrwexpertwitness.com

www.acc

LEADING THE WAY IN FORENSIC ACCOUNTANCY ON PROCEEDS OF CRIME Under the leadership of Director David Winch B.Com., F.C.A., Accounting Evidence Ltd has gained an excellent reputation as a technically expert firm of Forensic Accountants acting as Expert Witnesses in relation to Crown Court proceedings concerning crime and proceeds of crime. A nationally recognised Expert Witness, David's particular strength is in criminal litigation, acting as the key expert, at different times, for both prosecution and defence teams in relation to criminal investigations, including allegations under the Theft Act, Fraud Act, Proceeds of Crime Act, Companies Act and Insolvency Act as well as tax evasion, drug trafficking, money laundering, conspiracy and common law offences; and related proceeds of crime and confiscation proceedings. In addition to producing numerous Expert Witness reports on instruction from solicitors (usually under legal aid funding arrangements) or prosecutors, David has given oral evidence as an Expert Witness in the Crown Court, the High Court and the First Tier Tribunal (Tax Chamber).

David has been a contributor to AccountingWeb, Criminal Solicitor Dot Net and various professional journals, including the Solicitors Journal and the New Law Journal, as well as being a nationally recognised expert on confiscation, proceeds of crime and money laundering. A sought after conference and course speaker, David imparts a refreshing sense of humour and relevance to his material. He has that rare combination of technical excellence - in fact a passion for the subject matter - and practical experience, that offers the listener entertaining and informed commentary. The high regard in which Davidâ&#x20AC;&#x2122;s expertise is held is underlined by the invitations he receives to appear on national TV and Radio and his contributions to training videos for The Accountancy Channel, The Law Channel and Tax TV on issues related to financial scandals, money laundering, crime and proceeds of crime. David is also a director of MLRO Support Ltd, a company which offers guidance to money laundering reporting officers in accountancy and legal practices, and joint author (with Janet Bazley, Barrister of Lincoln's Inn) of 'Money Laundering for Lawyers: the new requirements and their practical implications' published by Butterworths (2004).

countingevidence.com

Below is a Case Study undertaken by the Company (please note the names & locations have been changed to maintain confidentiality). Thefts of cash by an employee - Theft Act 1968 Brian was offered a job as manager of a public house in Liverpool. He had many years experience in the pub trade but had never managed a pub before. He explained to the pub owner that he would need some help with book-keeping. The owner explained a system of record keeping and banking which he had himself devised. When the quarterly VAT return was due in July the owner checked the records and found the there appeared to be a substantial shortfall in the bankings. He complained to the police and Brian was charged with theft of the shortfall and false accounting. We were instructed to review the accounting records and bankings on behalf of the defence funded under a legal aid prior authority. We gave our opinion of the elements required in a properly designed accounting system for a pub and highlighted the many serious deficiencies in the system devised by the pub owner and the difficulties that Brian would have experienced in attempting to operate it...... We also pointed to a number of possible causes of the cash shortfall, other than theft by Brian. When the case came to the Crown Court many of the points in our report were put to the prosecution witnesses in cross-examination. At the close of the prosecution evidence the judge accepted a submission that Brian had no case to answer and he was acquitted.

Before David incorporated Accounting Evidence Ltd, he was a Partner and the Head of Forensic Services for a Manchester based firm of Chartered Accountants. David is also able to draw on the experience he gained during the many years he worked with accountancy practices of all sizes, ranging from Price Waterhouse & Co (with whom he qualified) to sole practitioners in general practice.

To discuss your specific needs for a forensic accountant expert witness contact: David Winch, B.Com., F.C.A. Accounting Evidence Ltd Well House Broughton in Furness Cumbria LA20 6HS T: 01229 716651 M: 07816 767154 E: d.winch@accountingevidence.com W:www.accountingevidence.com

Mr. Ian Forster

Due to the onset of whiplash symptoms not happening until the few days after the accident, most patients go the see their GP rather than go to A&E, this means that they are examined, given advice and sent home with pain relief.

• • • • R

As a lower limb and knee specialist, Mr. Forster has dealt with such cases before both involving whiplash and his specialist areas. Medical negligence and personal injury is also Mr. Forster’s forté, instructing in the particular areas of:

Mr. Ian Forster • Lower limb disorders • Sports injuries Lower Limb • Arthroscopy & • • Knee replacement surgery Knee surgery • Ligament reconstruction including Knee Specialist anterior cruciate ligament

Mr. Ian Forster, specialist in lower limb and knee injury retired from the NHS in Nottingham in 2007 but has continued to specialise in lower limb • knee Joint replacements surgery as well knee reconstruction within the r. Ian Forster, specialist in lower limband and knee injury retired from as the complex NHS For in Nottingham in 2007 but has further informat more private sector of medicine until 2013. Having graduated • Revision surgery (orthopaedic) the from continued to specialise in lower limb and knee surgery as well as complex knee reconstruction within more the 01332 880 824 or email University College London in 1968, MrLondon Forsterinhas had of private sector of medicine until 2013. Having graduated from the University College 1968, Mrmany Forsteryears has had experience within this field of medicine. Although it is not his specialist many years of experience within this field of medicine. Although it is not his specialist area, he has also dealt with cases of area, he has also dealt with cases of whiplash too. whiplash too.

The records of practitioners such as chiropractors and osteopaths can The records of practitioners such as be very useful in addition to the usual GP and Hospital notes, especially chiropractors and osteopaths can be if they contribute to an expert witness report. This is because they do very useful, especially if they a very detailed examination and an equally detailed report. This is the contribute to an expert witness report, same for people that have gone to their GPs with persistent symptoms; it this is because they do a very detailed can mean that their medical records have plenty of detailed information examination and an equally detailed about their symptoms and these can provide essential aides to anyone report. This is the same for people that writing an expert witness report. have gone to their GPs with persistent symptoms; it can mean that It is essential to see all the notes when providing an their medical records have plenty of expert report for a court case. detailed information about their symptoms ; these can provide essential For further information, please contact Mr Forster on As a lower aides to anyone writing anlimb expertand knee specialist, Mr. Forster has dealt with such cases 01332 880 824 or email enquiries to iwforster@aol.com before witness report. both involving whiplash and his specialist areas. Medical negligence and

personal injury is also Mr. Forster’s forté, instructing in the particular areas of:

This is also true for lower limb and knee injuries, the patient’s notes could • Lower limb disorders be essential when providing an expert • for a court Sports injuries report case.

• • • • • •

Arthroscopy Knee replacement surgery Knee surgery Ligament reconstruction including anterior cruciate ligament Joint replacements Revision surgery (orthopaedic)

For further information, please contact Mr Forster on 0

Knee surgery & Ligament reconstruction including Knee Specialist anterior cruciate ligament r. Ian Forster, specialist in lower limb and knee injury retired from the NHS in Nottingham in 2007 but has continued to specialise in lower limb and knee surgery as well as complex knee reconstruction within the more M Joint replacements private sector of medicine until 2013. Having graduated from the University College London in 1968, Mr Forster has had many years of experience within this field of medicine. Although it is not his specialist area, he has also dealt with cases of Revision surgery (orthopaedic)

Lower Limb & Knee Specialist whiplash too.

The records of practitioners such as chiropractors and osteopaths can be very useful, especially if they contribute to an expert witness report, this is because they do a very detailed examination and an equally detailed report. This is the same for people that have gone to their GPs with persistent symptoms; it can mean that their medical records have plenty of detailed information about their symptoms ; these can provide essential aides to anyone writing an expert witness report. This is also true for lower limb and knee injuries, the patientâ&#x20AC;&#x2122;s notes could be essential when providing an expert report for a court case.

Whiplash

tion, please contact Mr Forster on l enquiries to iwforster@aol.com In recent years many cases of whiplash have been suspected fraud. However, from a medical point of view fraud is very difficult to spot due to evidence being difficult for a physician to positively recognise. A classic whiplash injury occurs when the head is thrown directly back then forwards, usually in a car and the patient will have been wearing a seatbelt. However, sometimes a seatbelt may increase the whip of the neck by holding the body back. As a physician or expert the question as to whether or a not a seatbelt was being worn at the time of impact would be asked. Surveillance records can be very helpful, both close circuit TV for instance in a bus, or subsequent recording surreptitiously to see exactly what disability the claimant has. Due to the onset of whiplash symptoms not happening until the few days after the accident, most patients go the see their GP rather than go to A&E, this means that they are examined, given advice and sent home with pain relief and reviewed only later. Recent research on volunteers has shown that even for a whiplash some speed has to be generated. It has been shown that only a collision speed above 4mph can produce a whiplash injury.

01332 880 824 or email enquiries to iwforster@aol.com

I am extremely proud to have been selected by the team at the forensic & expert witness E magazine. The orthopaedic award recognizes the years of commitment and hard work that i have dedicated to the subject. Normally, i am happy to take enquiries from solicitors wishing to instruct my services and aim to provide high quality medico-legal reports which are highly regarded witin the legal sector

Mr. T. J. Duffy

Consultant Breast Surgeon & Expert Witness Mr. Terence Duffy holds thirty years’ experience as an NHS and private Consultant Surgeon. Throughout that time Mr Duffy’s had a special interest in breast diseases and disorders, working within and leading a multidisciplinary team of surgeons, radiologists, pathologists, oncologists and breast care nurses. He is a member of the Association for Breast Surgery and the British Association of Surgical Oncologists. To enhance his medico-legal practice Mr. Duffy has attended courses with Bond Solon and has gained qualifications related to the medico-legal aspects of breast surgery. He finds the annual Bond Solon Conference very useful in keeping abreast of developments in the medico-legal field. Mr. Duffy is a member of the Association of Surgeons of Great Britain & Ireland and is registered with the UK Register of Expert Witnesses. Working to an agreed agenda, Mr, Duffy provides reports for lawyers as an independent expert witness. He believes that a clear wellargued report often allows early settlement of a case, summarised as Duffy’s rule which states “a good report keeps it out of Court.” His work involves an even split of claimant and defence work; he also provides independent reports for the General Medical Council in cases of complaints against surgeons. Many cases relate to alleged avoidable delay in the diagnosis of breast cancer, with a resulting reduced prognosis, need for more extensive surgery or more aggressive chemotherapy and increased loss of life years. Whether or not the tumour was capable of being diagnosed at the earlier date frequently depends on the size that the tumour would have been at the earlier time.

It is possible to make an estimate of the likely size at the earlier date by back-calculation based on the size of the cancer on the date of diagnosis. Estimates of the rate at which the tumour doubles in size are derived from published studies in the literature, but they are not without limitations. The fact that a breast cancer can be shown to have been present at an earlier date does not mean that it could have been detected then, something that claimants in particular find difficult to appreciate. Difficulties also arise as not all breast cancers are visible on mammograms or on ultrasound. One type of breast cancer, lobular carcinoma, can be particularly difficult to detect both on imaging and on clinical examination as it has the same texture as normal breast tissue.

Lobular carcinoma in situ

Not all cases relate to malignant breast disease when the issue is delay in diagnosis. A recent case of alleged failure to diagnose and initiate prompt treatment of a breast abscess highlights the problems that arise after routine surgery for benign disease. Unlike the management of suspected and proven breast cancer, there are few nationally agreed protocols which stand as points of reference to assist when considering breach of duty. Where such guidelines do exist it is important to remember that they are just that, and not a mandatory protocol. However, in practice it is usually not difficult to discern where management has fallen below the expected standard practiced by “a reasonable and responsible body of competent practitioners”. Cases where alleged unnecessary surgery has been carried out are uncommon but two recent cases are illustrative. The first relates to a failure of the surgeon to offer and carry out needle core biopsy of a breast lump thought (and subsequently shown) to be benign before proceeding to surgical removal. The claimant would have avoided operation, a general anaesthetic and the resulting scar. The second was a case of alleged unnecessary extensive axillary lymph node removal during a prophylactic mastectomy and was more contentious. Trauma to the breast at the time of a road traffic collision, and usually due to seat belt injury, causes traumatic fat necrosis which may result in permanent deformity. Loss of breast volume due to tissue destruction and the contraction of scar tissue results in changes which may require later cosmetic correction and will be included in quantum assessment. I do not deal with cases relating to cosmetic breast surgery, a minefield for potential litigation and a subject in itself.

Asked about the importance of instructing an expert clearly at the beginning of legal proceedings, Mr. Duffy explained: “Early clear instruction is very important to the outcome of a case. Lawyers are becoming specialised in areas of medical negligence and they are able to specify the key issues when instructing. As a result the clarity of instructions has improved. It makes the life of the expert a great deal easier when the lawyer is able to detail the issues at the outset.” “Preliminary and short form reports can be limited to a two or three page overview of the experts opinion. These are provided at a fixed fee”, he continued “and it gives the lawyers and claimant sound advice as to whether there is a case to answer or not, thus avoiding more costs. If the case does move on to a report for the Court, much of the background work has been done.” “The role of an agency can be an asset in finding the correct expert whilst avoiding inappropriate appointments,” he explained. “It helps smaller firms and takes away the leg work of the solicitors in finding an appropriate expert, whilst providing an efficient and cost effective service.” “Larger solicitors however, are more inclined to instruct directly and have their own specialised departments which are in touch with the relevant experts for each individual case that they have instructed” Mr. Duffy concluded.

Mr. T. J. Duffy T:01782 680 199 E:tjduffy@merrytree.net

Peter Alan Jones L.R.C.P., M.R.C.S., M.B. B.S., F.R.C.S. & M.S

For the past 10 years Peter Alan Jones has diversified from his career as a Senior Consultant General Surgeon at the BMI Somerfield Hospital, Maidstone, Kent, to offer his professional services as an independent Expert Witness for Medico-Legal cases covering a wide spectrum of topics including medical negligence in delayed diagnoses of breast cancer, medical damage resulting from poor quality surgery for hernias, together with abdominal and chest trauma, ruptured spleen and breast injuries brought about due to an accident. Mr. Jones has all the necessary credentials to act as an Expert Witness; being able to draw on his extensive academic training, which led to him achieving the following qualifications - L.R.C.P., M.R.C.S., M.B. B.S., F.R.C.S. & M.S, plus his many years of practical experience, which saw Mr. Jones undertake posts in a number of leading Hospitals in London and Sussex. Starting his career as a House Surgeon at St. Stephens Hospital, London through to his current position as Consultant General Surgeon at BMI Somerfield Hospital, Maidstone, which he has held for over a decade, Mr. Jones has gained a wealth of experience during his career covering a wide spectrum of medical conditions including Breast Cancer, Hernia, Urology, Thoracic and General Surgery. Mr. Jones added: "In my view it was the excellence of the Westminster Senior Registrar Rotation that allowed me, as Senior Registrar, to develop more specialized interests and yet achieve my aim to maintain and extend my familiarity in other branches of general surgery."

Mr. Jones was amongst the country’s pioneers in laparoscopic cholecystectomy and one of the first in the country to perform this operation.

A past National Committee member of the Pancreatic Society, Mr. Jones' interest in acute pancreatitis led to a two years research with Professor Hermon-Taylor: "Pancreatic disease remains an area of fascination for me but now on a more clinical basis. I am competent at all forms of pancreatectomy and have been performing laparoscopic cholecystectomies since 1991. As Mr. Jones' CV reflects, his career as a Consultant Surgeon has been far from static: "At the time of appointment I had to fulfill the rôle of one of three general surgeons, and took responsibility for patients with upper GI, lower GI, vascular, endocrine and breast problems as well as a broad range of urology. I enjoyed the challenge of these early days, but it was clear that general surgeons had to pursue a goal of greater subspecialization. I had excellent training in upper GI surgery as well as coloproctology and have retained a close interest in these areas. I am a founder member of the Associate Coloproctologists of Great Britain and Ireland and regularly attend both local and national meetings. I am a member and past committee member of the Pancreatic Society of Great Britain and Ireland and continue to attend the annual meetings. I keep up-to-date with other aspects of general surgery by attending the Annual Meeting of the Association of Surgeons of Great Britain and Ireland, the surgical and clinical sections of the Royal Society of Medicine and other meetings on specific topics."

Consultant General Surgeon & Expert Witness Over the years Mr. Jones has developed a particular interest in breast disease, as he explained: "It was whilst with Professor Harold Ellis that a special interest in breast disease began, although I had previously enjoyed my involvement in the very busy Breast Clinic at St. George’s Hospital." Adding: "The management of breast disease has steadily evolved during my years as a Consultant as my main special interest; with more of my continuing medical education and continuing personal development being centred around this field. I am a member and past national committee member of the British Association of Surgical Oncology and regularly attend the six monthly meetings. I also attend and participate in the regional and national breast screening audit programmes and meetings and the annual Brighton Breast Meetings. I have also in the past attended courses on breast reconstruction at the Royal College of Surgeons and Milan, as well as a multidisciplinary breast cancer educational course in Florida."

Mr. Jones' interest in breast disease is further highlighted by the fact that he established 'The Mid Kent Breast Cancer Appeal' charity, which raised £140,000 for Maidstone's first big purchase - a prone biopsy table and Biopsys vacuum assisted core biopsy device. In the following years many thousands of pounds have been raised to maintain the Hospital's Breast Clinic as the best equipped in the South East.

As you would expect from such a highly regarded professional, Mr. Jones is a member of a number of leading organisations within the medical sector including: • • • • • • • • •

Member of the British Medical Association (past Secretary and President of local division) Fellow of the Royal Society of Medicine Member of Clinical Section/Section of Coloproctology/Section of Surgery Member and past Committee Member of Pancreatic Society of Great Britain & Ireland Fellow of the Association of Surgeons Member and Past National Committee Member of BASO Member of Association of Breast Surgeons at BASO Past Committee Member of Association of Breast Surgeons at BASO

Therefore, it comes as no surprise to learn that Mr. Jones has achieved an enviable reputation as an Expert Witness. Having accepted commissions to act as an Expert Witness from Solicitors throughout the UK and Ireland, Mr. Jones is well versed in providing concise, independent Reports on medico-legal cases; the majority of which are settled out of court.

FOR FURTHER INFORMATION PLEASECONTACT:

MR. PETER ALAN JONES Consultant Surgeon & Expert Witness Tel: 01622 820840 Mobile: 07831 430674 Email: peter.a.jones69@btinternet.com

Dr. Norman Wallace Medico-legal Advisor

During recent years, primary care has evolved in many directions and in some senses is almost unrecognisable from what it was in previous years. The standard of medical negligence however remains the same. Whilst the emergence of guidelines has made it slightly easier to determine what is normal practice, it is often by no means easy to determine when a GP has fallen below that standard. Dr. Norman Wallace holds over 30 years experience in primary care and has been giving independent expert GP opinions since 1993. With 31 years experience as a principal in general practice, Dr. Wallace was also a trainer from 1984 to 2011. The expert also possesses a great deal of experience in court, having previously been a police surgeon for nine years. However, Dr. Wallace only attends court approximately three times a year – “most cases are settled before this stage,” he explained. A member of the Royal College of General Practitioners, Dr. Norman Wallace receives approximately 45 instructions per year, acting for pursuer and defender. He will also give opinions for public bodies like the Central Legal Ofﬁce and Procurator Fiscal Service, as well as receiving work from individual solicitors and medical defence organisations. Discussing the importance of early instruction, Dr. Wallace commented: “In order to give a balanced and truly independent opinion it is important to be instructed early on and have sight of all the relevant medical papers without the bias of seeing other reports.” “Over the years I have come to recognise that there are several patterns emerging in claims of medical negligence against GPs,” explained Dr.Wallace.

These risks of negligence associated with primary care include: Unrecognised Deterioration

Computer Algorithms

Sessional Work

Nurse Practitioners and Paramedics

This is best summarised in my experience by the phrase “second bite of the cherry”. Often a patient is reviewed, frequently by another clinician and their deterioration is unrecognised. I have always advised trainee GPs to try to avoid presuming that the previous diagnosis or course of action was correct and to review the case from the initial presentation. Modern general practice is largely delivered by doctors working a variety of sessional commitments. Continuity of care can be difﬁcult to establish. When the GP is unfamiliar with the patient or the case the risk of misdiagnosis is subsequently higher.

Out of Hours

Whilst out of hours care is now much more organised than previously it does mean that the service is not familiar with the patient and there are risks in the triage system which has now become a necessary part of the delivery of out of hours care.

Telephone Triage

Whilst telephone triage can be an effective tool, there is little doubt that this is a higher risk activity in terms of misdiagnosis or mismanagement than face to face consultation.

I have had the uncomfortable experience of listening to several tapes of patients who are clearly unwell asking for help which seems to have been largely ignored by the triage nurse who has been slavishly trying to follow a computer algorithm and appears to be oblivious to the anguish of the patient. This discomfort is exacerbated by knowing that the patient dies within a few hours. Whilst nurse practitioners and other paramedicals are invaluable in several sub-specialities, their training is essentially not one of diagnosis and can lead to signiﬁcant judgement errors. I suspect that this will also apply to “physician assistants” as it often takes many years of experience to develop the clinical acumen necessary to manage patients.

Failure to Visit or Consult

Whilst every patient contact does not merit a face to face consultation, the likelihood of a claim for medical negligence is greatly increased when the patient is not seen. An example of this might be the diagnosis of a leg swelling being due to cellulitis when in fact it was an underlying DVT. Such a misdiagnosis is understandable when a clinical examination has taken place but hard to defend when the patient has not actually been seen.

Failure to Refer

One of the most common complaints can be an alleged delay in referring to secondary care when the patient has repeatedly consulted. This of course is one of the burdens of general practice, having the wisdom to know when a referral for a specialist opinion is appropriate.

Record Keeping

Most GP records are now computer generated and whilst they are now entirely legible they are often necessarily quite brief and reliance is increasingly placed on what is normal practice with a lack of recording of negative ﬁndings. This can make it difﬁcult to defend a GPs assessment of a patient.

Language and Cultural Barriers

The likelihood of a claim of medical negligence is in my experience heightened by the patient and the doctor belonging to a different culture or having a different ﬁrst language.

System Failures

Modern general practice requires to develop relatively sophisticated systems. There are however several opportunities for significant error. This might be : the filing of abnormal results without notification to the patient, the loss of a specimen, the misdirection of a specimen e.g. testing a urine specimen for infection and not glucose in a suspected diabetic, the lack of monitoring of repeat prescriptions and appropriate medication review.

“In my experience,” Dr. Wallace explained; “cases can also become centred around delayed or wrong diagnosis of various conditions including:” • Peripheral vascular disease producing critical ischaemia • Meningococcal disease • Asthma • Difﬁculty swallowing • Ectopic pregnancy • Lung cancer diagnosed as chest infection • Learning difﬁculties masking serious underlying disease • Red eye being diagnosed only as conjunctivitis • Suicide risk not being adequately assessed • Sinister causes of rectal bleeding or haematuria not being considered

Unfortunately in primary care, relatively rare conditions can present and they can be difficult to recognise. Such conditions can include: • Haemolytic uraemic syndrome due to e-coli 0157 • HIV infection • Paediatric tumours such as neuro or nephroblastoma • Neurofibromatosis • Cystic fibrosis • Tuberculosis • Haemachromatosis • Epiglottitis • Toxic Shock syndrome • Leukaemia • Lyme’s Disease • Ruptured spleen

“In reviewing many of these cases my overwhelming sensation can be 'there but for the Grace of God go I,'” explained Dr. Wallace, “but there are occasions when I do certainly feel that the care offered to a patient has been below that of an ordinarily competent general practitioner acting with ordinary skill and care and will not hesitate to give that opinion. On the other hand there are occasions when I have been able to support a GP who has made an unfortunate but not negligent mistake or judgement,” he concluded. For further information, please call Dr. Norman Wallace on 0131 334 8833 / 07800 634 733 or email enquiries to normanwallace@btopenworld.com

Mr. Shahid Khan BM BCh, MA, FRCS, FRCS (Tr &, Orth) Consultant Orthopaedic and Spinal Surgeon

Ocean Physio & Rehab Clinic

Mr. Shahid Khan is a Consultant Orthopaedic and Spinal Surgeon and has completed a full orthopaedic and trauma training program and practices widely in all aspects of orthopaedic and trauma. This has given expert exposure to all orthopaedic injuries which he has treated for many years; Mr. Khan is therefore well positioned to advise on any orthopaedic trauma personal injury case. His specialist training has been in spinal surgery and today, Mr. Khan runs a dedicated spinal surgery practice in Exeter. Not only does this help him to provide expert opinions in personal injuries that involve spinal injury, it also positions Mr. Khan to offer expert opinions in negligence cases that involve spinal pathology, spinal surgery and spinal injury. A highly regarded expert witness, Mr. Khan also possesses a law degree which he has found invaluable in understanding the legal process and its relationship with the clinical world, thus aiding to optimise the specificity and quality of reports. Discussing his expert witness work, Mr. Khan explained: “Most cases are settled well before they reach court and I am only occasionally required to attend court. I provide many detailed joint reports each year which often removes the need for court attendance.” “When I do attend court it can be for claimant or defendant,” he continued. “More often on behalf of the claimant in personal injury cases, but more commonly on behalf of the defendant in negligence cases.” “In addition I attend ‘fitness to practice’ hearings for the General Medical Council, as I also provide ‘fitness to practice’ reports for the GMC. These are essentially specialist negligence reports,” he concluded.

The importance of instructing an expert witness at the beginning of an investigation/ legal case is that it can often save significant unnecessary costs. “Often at an early stage, an expert witness can identify a claim that is likely to prove unsuccessful, particularly in the clinical negligence setting,” Mr. Khan explained. “I am often asked to provide screening reports, initially on a pro bono basis, to root out such claims which ultimately may have no financial value.” As a case progresses, significant costs are often incurred, and the claimant’s hopes of a successful settlement are raised and, as Mr. Khan points out: “this could be avoided by early involvement of an expert.”

Case examples: In the personal injury setting, Mr. Khan’s cases vary throughout the full range of orthopaedic trauma. Recent legislation means that less and less of the cases that he sees are simple soft tissue “whiplash” injuries. As a specialist consultant spinal surgeon, a significant and increasing proportion of Mr. Khan’s workload relates to major spinal trauma and injury including spinal fractures and their sequelae including patients who have suffered severe neurological injury such as paralysis as a result. In the clinical negligence field, together with his work for the General Medical Council, Mr. Khan’s opinions relate only to the field of spinal injury and spinal surgery. Many cases on which he is instructed relate to the possible diagnosis of cauda equine syndrome and particularly to delays in diagnosis and management of this condition.

A significant proportion of Mr. Khan’s work as an expert witness relates to spinal fractures which are alleged to either have been “missed,” not diagnosed, or mistreated. Another, but smaller proportion of this work relates to lateral access surgery, a growing field in which only a few spinal surgeons in this country are suitably trained and experienced to provide such opinions.

Mr. Shahid Khan is a member of •The Royal College of Surgeons of England. •The British Association of Spinal Surgeons (BASS) •The Society of Lateral Access Surgeons (SOLAS) This is a group of Spinal Surgeons, most of whom are based in North America, who specialise in minimally invasive lateral access surgery to the lumbar spine.

For further information and for all medico legal enquiries, please call Mr. Shahid Khan at Ocean Physio & Rehab

T:01395 239 455 E:spinal@oceanphysio.com W:www.oceanphysio.com

An interview with MBA, MBBS, FRCS, FICS, Dip EurB (Plast) FRCS (Plast) Consultant Plastic, Reconstructive, Hand Surgeon & Expert Witness

Mr Atul Khanna is a consultant plastic surgeon and has been involved in medico legal work since 1997. In this period he has provided over 2,400 medical reports. These have been predominantly in the following areas of expertise

• Hand Surgery : Sequelae of hand injuries and surgery • Soft tissue injury: Sequelae of post traumatic scarring • Burns management: Sequelae of disability following burns injury, scarring and surgery • Medical negligence in Cosmetic surgery

How has your experience and various qualifications enhanced your standing as an Expert Witness? Experience, qualifications and an analytical approach have enhanced my status as an expert witness. I am an NHS consultant in Plastic surgery at Sandwell and West Birmingham NHS Trust and Walsall Manor Hospital NHS Trust since 1999. I have also been clinical director for plastic surgery services in the Trust. I graduated in 1983 and after completing my Plastic surgery training I have been in consultant practice since 1998 having being awarded the FRCS in 1989, FRCS(Plast) in 1997, Dip Eur B(EBOPRAS) in 1998 and MBA (Open University) in 1994 . I am on the GMCâ&#x20AC;&#x2122;s specialist register for plastic surgery and have a general plastic and cosmetic surgery practice with sub-speciality interests in body contouring surgery, facial rejuvenation and breast surgery, skin oncology, Paediatric Plastic Surgery and Hand Surgery. I have had many years clinical experience in the management of Hand injuries : (Sequelae of hand injuries and surgery), Soft tissue injury: (Sequelae of post traumatic scarring) and Burns management: (Sequelae of disability following burns injury, scarring and surgery). This experience has helped me prepare 2400 reports over the last ten years in these clinical areas and also provided reports in medical negligence. Experience and qualifications are indeed extremely important but it is also important for the expert witness to have a passion for his/her work and desire to analyse the issues in detail. I certainly enjoy the analytical side of being an expert witness.

How regularly do you attend court and who do you act on behalf of? (Prosecution, Defence, Single Joint Expert) It is not often that I attend court. It usually works out to be once every 2 years. The percentage of work I undertake for Claimants, Defendants and SJE would be in the region of 80:10:10. I have seen a significant increase in the number of joint conferences I have had with experts over the years to provided joint statements.

What is the importance of instructing an Expert Witness at the beginning of an investigation/legal case, opposed to asking for an opinion at a later stage of the proceedings? Many of the cases I deal with are those involving the management of scars. Since it can take upto a year for the scar to settle it is usually helpful in many cases to wait for 12 to 18 months till a final prognosis to be given at the time of the preparation of the report. In complex cases where the client has had several injuries and it is inevitable that there is a requirement for several experts to be involved it is helpful for a preliminary/ initial report to be prepared. This is helpful for the client and solicitor to establish the requirement for further treatment/surgery and the need for the involvement of other specialists. In some medical negligence cases it is helpful for the solicitor to instruct an expert witness at the beginning of an investigation/legal case. Over the last 4-5 years I have been providing short format screening reports for cases involving liability and causation. I also tend to discuss many of these cases with the instructing solicitors and I am aware that they find this very helpful.

Are you a member of any fellowships and/or societies? I am a member of the Society of Expert Witnesses and member of numerous professional bodies including the British Association of Plastic, Reconstructive and Aesthetic Plastic Surgeons (BAPRAS). I have been council member of the British Association of Aesthetic Plastic Surgeons and Chairman of the British Medical Association, Birmingham and Honorary Secretary of the West Midlands Regional Advisory Committee in Plastic Surgery. I am actively involved in teaching and training and have been College tutor for Surgery for my NHS Trust. I have several publications in scientific peer reviewed journals and I am a reviewer for the Journal of Plastic, Reconstructive and Aesthetic Surgery. I have also prepared a chapter for the Encyclopeadia of Forensic & Legal Medicine entitled “Medical Malpractice in Cosmetic and Plastic Surgery

Could you provide brief examples of cases that you have instructed on? Plastic and aesthetic/cosmetic surgery covers a wide range of surgical procedures. Cosmetic surgery is different from other surgical specialties as the benefits of surgery are mostly psychological rather than functional. There are certain issues that lead to malpractice claims against plastic and cosmetic surgeons. These include unexpected scarring, general dissatisfaction, and lack of adequate explanation or discussion that is not appropriate for the patient’s level of understanding, resulting in poor consent. The patient’s expectations may have been unrealistic. The patient’s expectations may not have been known preoperatively and subsequently not have been met, or the patient’s expectations may have been known preoperatively and were still not met. There are also patients who are more likely to pursue litigation claims in cosmetic surgery. These are patients with great expectations, excessively demanding patients, and those who may be indecisive, immature, and secretive. Patients who lack familial approval, those who have repeated cosmetic surgery procedures, and patients with psychological problems are also more preferable to trying to do as much as possible in one session.

It is important for the medical expert to understand the consent process for each individual case and be uptodate with all the relevant advances in the surgical techniques for various conditions.

T: 0121 507 3455 M: 07880 797 235 E: atulkhanna@doctors.org.uk W: www.atulkhanna.co.uk

Ajit Ambekar MCh.Orth., FRCS(Eng), EWI

Consultant Orthopaedic Surgeon

Cardiff University Law School Certificate as Medico-Legal Expert

APIL 1st Tier Expert

I am able to prepare expert witness reports and give evidence in court in my speacialist areas of: • •

Orthopaedics and bone joint trauma Muscle-tendons, peripheral nerves and soft tissue injuries

Extensive experience in management of fractures in adults and children - (Exception: certain types of pelvic and cervical spine fractures) I Will act for either claimant or defendant and also as a single joint expert (Exception:’Breach of Duty’ Report in Clinical Negligence arena.) As a member of the expert witness institute, London, my reports are in compliance of CPR 35, corresponding Practice Directions and the civil justice council protocol for Expert Witnesses. As a fellow of the American Academy of Orthopaedic Surgeons with expert witness AffirmationI am also able to provide percentage evaluation of Permanent impairment, ‘DASH’ Score and the judicial College Guidleines Category of Disability for international jurisdictions. I am prepared to undertake reasonable travel if necessary.

T:020 7467 8537 / 07922 607 948 E: aa@ortho-trauma.uk / ajit.ambekar@me.com 10 Harley St, London W1G 9PF

Prof Charles M Court-Brown Professor Of Orthopaedic Trauma MD, FRCS Ed (Orth)

Professor of Orthopaedic Trauma and Orthopaedic Surgeon with particular interests in the management of orthopaedic injuries encompassing Musculo-skeletal injuries and diseases, fractures, foot, ankle, wrist, hand and upper limb injuries (including whiplash injuries) and surgery in respect of all of these Surgery expertise also covers emergency and trauma surgery and intensive care for multiple injury patients of personal injury, Road Traffic Accidents and slipping, tripping, falling and other hazards. I have writen 8 books and over 100 papers on my specialities and have in depth medico-legal experience, averaging some 300 new instructions annually and including court appearances

Contact: Prof C M Court-Brown Craigesk House, Lothianbridge. EH22 4TP. Tel:0131 660 4227. Emailccb@courtbrown.com

DR. ANTHONY K. CLARKE B.Sc., M.B., B.S., F.R.C.P.

Throughout his illustrious career Dr. Clarke's extensive academic qualifications - B.Sc., M.B., B.S., F.R.C.P - have given him the necessary credentials to achieve a successful career, including carrying out the post of Civil Consultant in Rheumatology & Rehabilitation for the Royal Air Force. During his time working for the Air Force Dr. Clarke compiled at least 20 Reports as an Expert Witness - dealing with military personnel injured as a result of their work within the services.

Dr. Clarke's Areas Of Expertise Includes: • • • • • • • • • •

General Rheumatology. Ankylosing spondylitis. Soft tissue injury including repetitive stress injury & whiplash. Back pain. General rehabilitation, including traumatic brain injury. Stroke. Multiple injury. Chronic pain including complex regional pain. Fibromyalgia and chronic fatigue. Medical negligence.

Dr. Clarke's continual commitment to research and development, in order to extend and improve the range of services patients receive, is further highlighted by the fact that he played a key part in establishing: • • • • •

The Bath Pain Management Unit, The Bath Head Injury Unit, The Bath & Bristol Paediatric Rheumatology Service The Bath Sports Medicine Clinic The Bath & Wiltshire ME/Chronic Fatigue Service.

Expert Witness in Rheumatology & Rehabilitation 2007 saw Dr. Clarke retire from the NHS, at which point he was Senior Physician, Director of Rehabilitation & Medical Director of the Royal National Hospital for Rheumatic Diseases, Bath. Dr. Clarke now has the practising rights at the Hand to Elbow Clinic, Bath, and, holds a licence to practice from the General Medical Council and as a GMC affiliate, Dr. Clarke undertakes assessments for their Performance Panel. Therefore, it comes as no surprise to learn Dr. Clarke is affiliated to a number of leading organisations including: British Society for Rehabilitation Medicine - having been the President of this organisation in the past; British Society of Rheumatology; Fellow of the Royal College of Physicians of London and British Medical Association. With 45% of Dr. Clarke's time spent working for the Claimant, 50% for the Defendant 50% and 5% working as a Joint Expert Witness, Dr. Clarke is well versed in attending Court, having made 3 Court appearances in the last three years and writes some 30 or so Expert Witness Reports annually. Dr. Clarke is happy to visit clients in their home during the week and at weekends, both in the UK and abroad; having twice visited Poland for a case on which he was working.

DR. ANTHONY K. CLARKE Charcoal House, Market Place, Colerne, Chippenham, Wilts, SN14 8DF

T: 01225 838849 M; 07774 658522 F: 01225 832535/743215 E:akclarkefrcp@yahoo.co.uk

Whiplash - Rapid Whip like Action of Head & Neck Whiplash gets it’s name from how your head and neck move when someone crashes into you. Unfortunately, during the accident, your head is often powerfully snapped backwards and forwards so quickly you don’t even notice it happening. This fast whip like action of your head is what causes the strain and sprain in your muscles, tendons, ligaments and joints. In severe cases, this whip action can create disc injury in the spine. It is the result of this violent motion that causes your pain.

Symptoms of Whiplash can include: • • • • •

Neck pain and stiffness (often in the front of your neck too) Headaches, often at the base of the skull Dizziness Blurred vision Fatigue

This can result in difficulty concentrating; ringing in the ears; sleep disturbances; irritability; emotional upset- from fear, to crying to anger, unexpectedly. As well as speech changes; difficulty swallowing; memory problems and even concussion.

In recent years, many cases of whiplash have been suspected fraud. However, from a medical point of view fraud is very difficult to spot due to evidence being difficult for a physician to spot. A classic whiplash injury occurs when the head is thrown directly back then forwards, usually the patient will have been wearing a seatbelt. Occasionally a seatbelt may increase the whip of the neck by holding the body back. As a physician or expert, the question as to whether or a not a seatbelt was being worn at the time of impact, would be asked. As whiplash symptoms may not start until the few days after the accident, most patients go the see their GP rather than attend A&E, this means that they are not examined by specialists and may be given less than ideal advice and sent home with only pain relieving medication.

Mr. Jon Leigh of the Gillingham Clinic of Complimentary Medicine explained: “Osteopaths, being experts in spinal mechanics, understand the mechanics of how and why whiplash is caused and thus are more able to treat it. This is different from people who merely treat the symptoms without having fully studied spinal mechanics.” Whiplash injuries from a car accident may cause you pain immediately; but pain and other symptoms may take 10 to 14 days before they affect you. This makes diagnosing a whiplash very complicated. You might think you have not been injured after a car accident but two weeks later you wake up, can barely move your neck, or you find you are have constant headaches.

Three solid 'crash-related injury facts': 1. Most injuries occur at speeds below 12 MPH. 2. Rear-end impacts of 6 MPH to 12 MPH cause the most injuries. 3. Between 1 and 2 years post-injury, 22% of patient’s conditions have not returned to “Normal”.

Whiplash 'risk factors' 1.DEGENERATIVE DISEASE: Headaches and/or neck injury pain (for whatever reasons) prior to the crash. 2.PRE-EXISTING HEALTH PROBLEMS: These can result in even greater pain. (For example: an arthritic situation may lead to an increased severity of the injury and thus an increase in the level of the pain. 3.VEHICLE SIZE: Even if both vehicles are about the same size, an impact at 8MPH will cause the spine in general and the neck in particular being subject to a force twice that of gravity. If one differential in vehicle size is greater then the Gravity-Force effect is also further increased. 4.HEAD RESTRAINT POSITION: The injury becomes much worse if the head restraint is too far away. It must be close enough to prevent the head moving over too great an arc. Ideally, the centre of the head restraint needs to in line with the centre of the occupants head and no more than two inches from it.(Over 98% of head restraints are more than 2 inches from the head and therefore do not prevent the excessive head movement). 5.POSITION OF HEAD AT IMPACT: If not positively straight (it rarely is) all the G-Forces are localized to one side of the spine, substantially increasing the severity of injuries. If rotational forces are then taken into consideration, the injuries may be vastly increased. 6.AGE: How old one is plays a crucial role regarding a “Whiplash-Type” of injury. Why? Because as the body becomes older, ligaments become less pliable, muscles are weaker, joints less flexible, all resulting in a decreased range of normal movement. 7.WOMEN AND CHILDREN: They may be injured more seriously than men because they have smaller, weaker necks. Women may also be too close to the steering wheel, airbag and/or are wearing an improper fitting shoulder harness. Children sitting in correctly fitted car seats are at far less risk of injury because they are being restrained by a five strap seat belt system and are far less likely to experience a whiplash type injury. 8.NON-USE OF: The motor vehicle’s shoulder harness. 9.FAILURE TO WEAR A SEATBELT!

www.gillinghamclinic.co.uk

Dr. Bernard Leddy

B. Pharm (Hons) M.Sc., Ph.D. M.R.Pharm.S (GB) M.R.S.C., C. Chem, C.Sci, M.P.S.I. With several high level qualifications in Pharmacy, Pharmaceutical Science and Toxicology, Dr. Bernard Leddy has recently been accepted as a Member of the Expert Witness Institute in London which is regarded as one of the most prestigious and influential expert witness fellowships in the world.

Dr. Leddy's areas of expertise include: • The use and abuse of drugs legally or illegally obtained • Counterfeit medicines and POCA valuations • Plant drugs and drugs of natural origin • Separation and Spectroscopy of Drugs • Pharmacy practice regulation and management systems • Dispensing and prescribing errors and drug interaction • The effects of drugs and alcohol on driving • Fitness to practice issues, particularly in impaired practice, (due to health and addiction problems)

T:00353 5853 341 | E:info@leddyconsultancy.ie | W:www.leddyconsultancy.ie

In a recent interview, Dr. Leddy explained: “I have prepared many reports on all of the above topics for Criminal and Civil Proceedings in Courts of all levels up to and including the High Court and Crown Court.” “In addition, I have also written numerous articles on the issue of drug and alcohol abuse within the pharmacy profession and adjudicated in Health Committee decisions affecting pharmacists with impaired practice due to drug and alcohol.”

Dr. Leddy mainly prepares reports for defendants in Criminal and Fitness to Practice cases and for Plaintiffs in Civil actions. “I am not always called to appear but I usually have about two cases per month in preparation,” he explained. Asked about the importance of instructing an Expert Witness at the beginning of legal proceedings, opposed to asking for an opinion at a later stage of the proceedings; Dr. Leddy answered: “I would urge any Lawyer acting for a defendant or plaintiff to engage with an expert witness as early as possible in proceedings. This leads to a more efficient preparation of the cases and can save time, effort and money in the long run.”

Some of the cases which Dr. Leddy has been instructed on have made the national newspapers - acting for the defence in criminal cases and the plaintiff in civil cases. Examples of these cases include: 'A half naked woman became impaled on railings after jumping from a window when former security guard attacked her with a coat hanger after they had sex.' During a party at the man's third floor Kensington flat, a woman was forced to jump 20ft from a window on to railings below. Remarkably she survived – suffering fractures to her hip, pelvis, ribs and back in the fall. Her attacker was jailed for nine years for causing grievous bodily harm in July 2013. Toxicology reports found that guests at the party drank and had been smoking cannabis. After the couple had sexual intercourse, the attacker became angry, accusing the woman of stealing money from his pocket. What happened was fuelled by a high level of intoxication. 'Drink driver killed a mother-of-two after ploughing into her while speeding on a cocktail of cocaine, M-Cat and alcohol.' The car he was driving spun, mounted the pavement and slammed into a couple before stopping in the garden of a house nearby. A female died at the scene, whilst her husband was taken to hospital with a dislocated shoulder and cuts and bruises. After pleading guilty to causing death by dangerous driving, the driver of the car was jailed for five years and seven months and banned from driving for five years in February 2014. A urine test revealed that he was over the drink-drive limit and has been taking cocaine and mephedrone, known as M-Cat.

Dr. Bernard Leddy is a highly regarded expert in the field of Pharmaceuticals and Toxicology; he is a Member of: The Pharmaceutical Society of Ireland, The Royal Pharmaceutical Society of Great Britain, The Royal Chemical Society, The International Association of Forensic Toxicologists, The Medico Legal Society of Ireland and The Expert Witness Institute.

Saul Myerson

Cardiologist & Expert Witness MBChB, MD, FRCP, FESC

Prof. Myerson is a cardiologist specialising in diagnostic testing, particularly advanced cardiac imaging, and he has an international reputation for cardiac magnetic resonance imaging. He is often consulted about diagnosing particularly difficult cases, and asked to identify the causative processes involved. “These areas of expertise fit well with medico-legal cases in cardiology, which often revolve around correct diagnosis, particularly differentiating normal from abnormal findings; causation and the likely time frame; and the appropriate actions followed by the medical team.” he explained in a recent interview. Other areas of practice relevant to medicolegal work include:Assessing future risk/prognosis and the suitability of patients for cardiac surgery (e.g. viability studies, and assessing the severity of valve disease). Prof. Myerson has acted on behalf of both defence and prosecution in the Court of Law and is also happy acting as a single joint witness. His assessments and reports are always objective and focussed on best medical practice. However, most cases that Prof. Myerson has taken instruction on have avoided coming to court – detailed and objective reports allowing for an informed discussion between legal teams, so that a settlement can be reached, avoiding court costs. Discussing the role of a single joint expert. Prof. Myerson explained that: “The appointment of a single joint expert can add value to the judicial system. The Expert Witness will prepare a truthful, objective report and, in my own examples, detail how and which things were done well and which aspects were not managed so well and how these differences may have affected the outcome.”

A fair and objective report for both sides leads to a wholly accepted expert opinion and can improve the chances of an agreement being made without the expense of attending court in most cases,” he concluded.

Professor. Myerson is a member of

• The Royal College Of Physicians • The European Society Of Cardiology • The British Cardiovascular Society • The British Society For Echocardiography • The Society For Cardiovascular Magnetic Resonance • The British Society For Heart Valve Disease.

Case example: “I have been an expert witness on several cases involving sports screening,” Prof. Myerson explained. “A robust and accurate approach is required for the cardiologist undertaking an assessment (usually as a result of an initial screening test being abnormal); a recent case also highlighted the importance of good communication and appropriate handling in avoiding a legal challenge.” A professional footballer for a premier league club had an abnormal ECG but normal cardiac imaging. His likelihood of a cardiomyopathy was higher than the normal population but still low (<10%), and he was allowed to continue playing. However, an appropriate consultation with him did not occur and the abnormalities and potential risks were not discussed with him, denying him the opportunity to consider his options which included detraining for a period of time to see if the changes resolved. Unfortunately, the player suffered a cardiac arrest in his ﬁrst professional game and, although he was resuscitated, he suffered signiﬁcant neurological damage and required lifelong nursing care subsequently. The family won a High Court case for compensation and ongoing care costs, despite the normal imaging tests, due to the club’s failure to implement an appropriate process for assessment, and the failure of communication denying the player the opportunity of making an informed choice.

Asked about the importance of instructing an Expert Witness at the beginning of an investigation/legal case, opposed to asking for an opinion at a later stage of the proceedings, Prof. Myerson explained: “Knowing whether you have a strong case / can defend a case is crucial to avoiding unnecessary legal work, and being able to focus on the important aspects. This requires a good understanding of the medical issues, and an expert witness is best placed to provide that level of detailed advice, unless the legal team are particularly well informed in that specialist area. It can save much expense and effort if the correct path is identiﬁed at the start.” Prof. Myerson states that “although an initial assessment from the bare details is possible, it is not as beneﬁcial as an actual expert's opinion – this is surely a better option whilst remaining objective.”

Consultant Cardiologist, Associate Professor of Cardovascular Medicine and clinical lead for cardiac imaging in Oxford, with speciﬁc expertise in diagnostic testing, including all forms of cardiac imaging and functional cardiac assessment. Professor Myerson is based in the internationally renowned cardiac MRI department in Oxford and provides expert advice on all areas of cardiology including cardiomyopathy, coronary disease, heart valve disease and aortic disease. He has a signiﬁcant cardiac research portfolio including clinical trials and has over 70 peer-reviewed publications. He is an editor of three Oxford Handbooks in Cardiology.

T:01865 234 571 E:saul.myerson@cardiov.ox.ac.uk W:www.oxfordcardiologist.com

Dr. Raj Thaman MBBS FRCP.

Consultant Cardiologist & Physician Dr R Thaman provides a medico legal service specialising in all areas of cardiology. He has clinics based in Manchester, Warrington and Wrexham (North Wales). Dr Thaman is frequently instructed by solicitors, barristers and coroners throughout the UK to write expert reports and give evidence including complex high profile cases. Dr Thaman undertakes medico-legal work acting as an expert witness in various cases mainly cases of medical negligence, cases involving competence, causation, prognosis, drug errors, procedural complications/ errors, occupational assessment. Dr Thaman is also frequently instructed to produce life expectancy/ survivability reports Dr Thaman qualified from St Georgeâ&#x20AC;&#x2122;sHospitalMedicalSchool, London in 1994. He trained in general medicine initially and subsequently in cardiology from 1999. He spent three years as an Honorary Senior Lecturer and research fellow at St. Georgeâ&#x20AC;&#x2122;sHospitalMedicalSchool and The Heart hospital, London where he researched mechanisms of sudden cardiac death and heart failure. His cardiology training was initially at University College London and the LondonHeartHospital where he trained in cardiac intervention. Dr Thaman moved to Bristol in 2006 where he finished his training. In 2009 Dr Thaman was appointed as a full time Consultant Cardiologist and Physician at Wrexham MaelorHospital part of BCUUniversity health board. Dr Thaman is experienced in managing all aspects of general cardiology and his subspecialty areas are the management of patients with heart failure, arrhythmia, complex device therapy, adult congenital cardiac disease, pregnancy, cardiac CT/ CT angiography, and echocardiography. Dr Thaman is lead cardiologist for heart failure complex pacing/ devices, CT angiography, adult congenital cardiac services and pregnancy. He is also part of the local cardiac network and acute medicine working group. He sits on a number of working groups involved in safety in medicine prescribing and practices.

Dr Thaman is also involved in research and has published extensively

For further information, please call Dr. Raj Thaman on T:01978 725134 or 07739762995 or email medico legal enquiries to rajesh.thaman@wales.nhs.uk

Mr A J M Birnie

Consultant Orthopaedic Surgeon FRCS GMC

T: 0191 373 4457 F: 0191 373 4457 Alternative contact Mrs Davison (Sec) T: 0191 584 4614 F: 0191 565 5998 E: ajimb@ajmbirnie.com Eshwood House, Acton Road Esh Winning, Durham, DH7 9PL Rooms also at: 8 Grange Terrace, Stockton Road Sunderland SR2 7DF

Mr. R. A. Miller MS FRCS FRGS

Consultant Urological Surgeon

Consulting from his extensive medico-legal practice at Highgate Hospital, London with 29 years experience at Consultant level, Ron Miller is registered as an Expert Witness with the Law Society Register and The Expert Witness Directory. He acts on behalf of the defendant, claimant and as a single joint expert witness. Mr. Ron Miller qualiďŹ ed in 1974 and therefore holds unique experience of major open urological surgery, as well as extensive experience of endoscopic and minimally invasive techniques of endourology many of which he pioneered more than 20 years ago.

In the last 10 years and as his medico-legal practice has evolved, Mr. Miller has developed his interest in urological pain syndromes such as painful bladder syndrome, urethral syndrome, prostatitis, pelvic pain of a urological origin and chronic testicular pain.

During his time working in the NHS, Mr. Miller has also been interested in medico-legal work. He now attends court 3-4 times per year and currently writes over 100 reports a year mainly on clinical negligence but also in cases of major accidental injury. Aside from obvious urological cases resulting in a patient losing a testicle or kidney, Mr. Miller has a special interest in some cases that are not so obvious such as a hernia operation leading to the testicle being affected and the high value urology problems associated with spinal injury.

In the last three years, Ron Miller has restricted his NHS work to The Choose and Book System following his resignation from his position as Head of Department at The Whittington Hospital in 2012. He now divides his time between clinical and medico-legal practice in a 50:50 split; providing a more personalised service at the private hospitals where he works.

A BAUS approved and trained medico-legal expert, Ron Miller spent 25 years dealing with major surgical complications following gynaecological surgery â&#x20AC;&#x201C; including perforated bladder, ďŹ stulae, ureteric damage.

As well as his professional career, Mr. Miller has lectured on medico-legal urological practice as well as attended the relevant courses. He has an extensive academic history: 2 books, 140 papers, 2 journal supplements, and more than 300 national/international presentations, supervision of 8 post graduate degrees and the production of 27 book chapters.

Mr. Miller is a member of the British Association of Urological Surgeons and has been a supra-regional Urological Specialist for both open and endoscopic renal (kidney) surgery for many years, with a particular interest in stone disease, in which he holds an international reputation. Mr. Miller is also a member of the British, European, German, French and American Urological Associations. The Royal Society of Medicine, European Intra Renal Society, The Society of Minimal Invasive Therapy and The British Day Surgery Association. Discussing the importance of instructing an Expert early on in legal proceedings, Mr. Miller commented: “A provisional opinion on the likelihood of success of any case is usually most useful. It frequently determines the justiﬁcation for breach of duty/causation and condition and prognosis reports. We are able to arrange all conﬁrmatory urological investigations in London.” “A urology opinion is often decisive in determining substantial damages in cases involving injury due to gynaecological surgical complications, cauda equine cases and pelvic fractures as well as the more obvious urological cases:

• Incontinence • Erectile Dysfunction • Mismanagement And Late Diagnosis Of Kidney, Bladder And Prostate Cancer • Loss Of Testicle From Hernia Operations • Vasectomy • Torsion • Hydrocele/Varicocele Operations • Complications Of Stone Disease. My long experience and up to date clinical knowledge of urological practice provides an excellent perspective for lawyers in particular when dealing with Bolam Defence and causation issues,” he concluded.

For further information, please contact Mr. Miller's secretary, Linda

T:0203 539 6712 E: linda@ronaldmiller.com

PROFESSOR C.H.RAINE MBE Ch.M. FRCS

Consultant Oto-Rhino-Laryngologist & Medico-Legal Expert Witness Despite a series of regulations governing exposure to ‘noise at work’, there continues to be a steady flow of cases regarding noise-induced hearing loss caused by ‘noise at work’.

oise induced hearing loss is usually described as ‘damage to the inner ear structures due to repeated exposure to loud noise over a period of time.’ It occurs when the sensitive hair cells inside the cochlea become damaged, resulting in a permanent sensorineural hearing loss. Problems usually develop gradually but are most severe following exposure to high frequency sound. The resulting hearing loss, centred mostly at the frequencies of 3, 4,and 6 KHz, tends to be similar in each ear unless there is a clear history of noise primarily affecting one ear. Inevitably hearing will get worse if the individual continues to be exposed to the noise without appropriate hearing protection.

For for nearly 30 years Professor Chris Raine has been offering his professional services as an Expert Witness for cases involving Oto-RhinoLaryngology, and Head & Neck problems ; receiving instructions from both Claimants and Defence. Having prepared a great many MedicoLegal Reports over the years, dealing with issues such as malpractice cases both for the patient and medical attendant, as well as independent cases for NHS tribunals. Prof. Chris Raine is able to give his professional opinion on the case in question via an independent, concise Medico Legal Report, in accordance with Civil Procedure Rules.

Individuals can also experience sudden hearing loss due to exceptionally loud noise, such as an explosion, which is known as acoustic trauma. Exposure to sudden and continuous noise can cause tinnitus, which results in the individual hearing sounds such as ringing, buzzing or whistling - the common link being that the sounds perceived do not have an external source.

Although he has formally given evidence in court as an Expert Witness, Prof. Chris Raine explained that the majority of cases are more often than not settled amicably out of court. Currently completing about 90 cases per year, Prof. Chris Raine is happy to undertake single or joint reports if required and would welcome an opportunity to discuss cases with counsel and solicitors alike.

Tinnitus can occur suddenly or very gradually. For some, the condition can be temporary, for example after a music concert, however, continued exposure to loud noise may make it permanent. Although symptoms can take several years to develop, legal action should be taken swiftly once a problem has occurred as individuals will have limited time to make a claim (3 years to the date of knowledge that hearing problems are linked to an industrial career in noise).

In order to provide his services as an Expert Witness Prof. Chris Raine is able to draw not only on his extensive academic achievements - which includes achieving a B.Sc. (Hons) Anatomy, an MB.BS, FRCS (Otol) and Master of Surgery Ch.M. - but also the wealth of practical experience he has gained throughout his career. Prof. Chris Raine currently holds the position of Consultant OtoRhino-Laryngologist at Bradford Royal Infirmary, a post he has held since 1986.

Solicitors will conduct checks to ensure a claim is genuine and that the defendant company or insurance policy still exists. Medical records are then checked and, if no previous issues are raised and there is a reasonable likelihood of success in the case, an Expert in noise-induced hearing loss is instructed to act as an Expert Witness in the case.

In a recent interview Prof. Chris Raine told us: “I have a general interest in all aspects of Oto-RhinoLaryngology Head and Neck surgery and prepare Medico Reports accordingly. I am recognised as having an area of specialism in Paediatrics, Rhinology & Otology, dealing with issues related to trauma, industrial noise induced and profound hearing loss.”

• Prof. Raine holds Professional Membership to the following: British Medical Association • General Medical Council • Medical Defence Union • Royal College of Surgeons of England • British Association of Oto-Rhino-Laryngologists • Royal Society of Medicine • British Association of Paediatric Otolaryngologists • European Society of Pediatric Otolaryngologists • British Cochlear Implant Group • British Society of Otology • British Rhinological Society • Member of The Expert Witness Institute • Registered Expert Witness for The Law Society Some cases may involve personal injury claims as the result of an accident, for instance, car accidents where an individual has resulting deafness, nasal facial injuries or whiplash, which can lead to other ear problems such as tinnitus (noises in the ears and/or head). Prof. Chris Raine added: “I won’t undertake a case until I have full background information on the claimant’s previous medical conditions etc. Whilst there are a number of general ailments that are known to be associated with hearing loss, many defendants are now bringing into the equation illnesses the claimant may have such as hypertension, high cholesterol and diabetes. However, if the claimant is being treated for these type of illnesses there is no proven evidence that they will significantly effect hearing.” Prof. Raine’s commitment to widen the opportunity to offer specialist treatment to patients with hearing problems is further highlighted by the fact that in 1990 he established Cochlear Implantation for treating profound to severely deaf children and adults. With the advent of newer otological implants for other forms of deafness the supra-regional Yorkshire Auditory Implant Service (YAIS) has been established at the Bradford Royal Infirmary.

Professor Christopher Raine The Yorkshire Clinic, Bradford Road Bingley, West Yorkshire BD16 1TW

“YCIS has developed nationally recognised programmes for assessing children and adults with severe to profound hearing loss. To date we have successfully completed nearly 900 adult and paediatric cochlear implants.”

T: 01274 550600 / 07768 372748 F: 01274 565349 E: chraine@btinternet.com E: Chris.Raine@bthft.nhs.uk W: www.profchrisraine.co.uk

Mr. Emanuel Rosen Expert Ophthalmologist Having gained medical qualification as an MD from Manchester University. Mr. Emanuel Rosen has also achieved three fellowships – the Royal College of Surgeons Edinburgh (FRCSEd) and Royal College of Ophthalmologists (FRCOphth), as well as the Fellowship of the Royal Photographic society (FRPS). A member of Expert Witness Institute and the Academy of Experts, Mr. Rosen is an independent Ophthalmologist Expert Witness invited to report on cases involving claimants, defence organisations and lawyers, but with a responsibility primarily to the Court. Mr. Rosen has 35 years of medico-legal experience in a wide variety of Ophthalmological cases. He led a very busy NHS and Private Ophthalmological practice as a consultant Ophthalmologist from 1972 to 2001. Each position has provided great insights into the effects of personal injuries and their effect on the victim. NHS Consultants generally stop operating at the age of 65 however, Mr. Rosen ceased his NHS work at the age of 60 to focus on his private medico-legal practice. Through this, he continues to provide expert advice on behalf of complainants and defence organisations as an independent ophthalmology expert with a duty to provide expert reports to the Courts. The UK civil litigation system usually achieves settlements of claims based on expert evidence and joint reports by experts for litigant and defence organisations. However, when experts for both sides are unable to agree and the matter has to be decided by a judge based on court delivered evidence. Discussing his medico-legal work in a recent interview, Mr. Rosen explained: “I am regularly instructed by both the defence and the claimant. In most cases, settlements are agreed before the case arrives in court with the expert on each side agreeing to the outcome. If, however, their findings are not compatible, the experts will meet and, if they still disagree and expense is worth the risk, the case will go to court.”

“I have also taken instruction as a joint expert witness although this is very rare unless the case is relatively straightforward such as an accident causing damage to the eyes,” added Mr. Rosen. Mr. Rosen will be speaking at a conference in Germany later in 2015 where he will outline the benefits of the English system; how the system works well and is designed not to go to court with experts working together to work on an agreeable outcome. In the same interview, Mr. Rosen was asked the importance of instructing an Expert Witness at the beginning of an investigation/ legal case, opposed to asking for an opinion at a later stage of the proceedings? He replied: “Today, short screening reports are increasingly being used by lawyers to judge the issues raised in a case. This is deemed the most economic way to proceed by providing lawyers with expert advice on strengths and weaknesses of the claims and their defence.” “Screening of these cases provides an overview and highlights if indeed there is a case to answer,” he continued. “If the case is then deemed as ongoing; prognosis can be investigated as well as assessments made on the patient to reach a conclusion.”

Cases:

Cataract Surgery:

t is often the case that surgery is simply incomplete and rather than suing the surgeon or the hospital, surgery options need to be taken to reach a satisfactory visual outcome. A second opinion can lead to resolution of the complaint before litigation is initiated. The expert has to decide on the available evidence whether the problem is the result of a known non-negligent complication, for complications simply do occur and may be unfortunate but not negligently caused. One example case that Mr. Rosen has taken instruction on involved the defence of a man with very poor vision who was accused of shooting and killing a man at night. However after Mr Rosen’s expert opinion the evidence convinced the jury that that was highly improbable and he was found not guilty The victim was standing 30 metres away from the suspect when the trigger was pressed prompting Dr. Rosen to suggest the accuracy was ‘more luck than judgement’. Asked to explain this idiom, Dr. Rosen discussed an experiment which he undertook with a friend. He asked the friend to stand 30 metres away from him, under a street light and defocused his eyes to the level of the defendant – giving him blurred vision. He could not see the friend clearly. The friend could not even be found successfully using a laser pointer with a red beam target as it was alleged that the defendant had a laser sight fitted to the gun he was holding. Following the experiment, Mr. Rosen could speak with authority in court and the defendant was cleared of all the charges against him.

For further information, please contact Mr. Emanuel Rosen Tel: 0161 832 8778 or Email:erosen9850@aol.com

Dr Andrew St. Clair Logan (MB B Ch B FRCA FFPMRCA)

Fellow of the Faculty of Pain Medicine of the Royal College of Anaesthetists (FFPMRCA) Dr. Andrew St. Clair Logan (BA Hons (Cantab) MBChB FRCA FFPMRCA) provides services as a Pain Management Consultant at the Countess of Chester NHS Trust, Nuffield Health Chester; the Grosvenor Hospital Chester and the Spire Hospital Warrington. Throughout his illustrious career Dr. Logan has also achieved an impressive reputation for the services he provides as an Expert Witness in cases involving 'pain' relating to injuries received in an accident. In a recent interview Dr. Logan explained that the definition of pain and the differences between acute pain and chronic pain were fundamental to an understanding of the problem of persisting pain. "Pain is an unpleasant sensory and emotional experience association with actual or potential tissue damage, or described in terms of such damage (http://www.iasp-pain.org). The above definition leads to the conclusion that pain is always subjective. Another way of putting this would be to say 'pain is what the person says it is existing when and where the person says it does' It can also be readily deduced from this definition that there does not actually have to be any tissue damage for there to be pain. Pain can exist without an obvious medical cause. Expounding on this theory on pain, Dr. Logan outlined more about the definition of pain in general and persisting pain caused as a result of an accident :

Consultant in Pain Management & Expert Witness "We have all experienced short term or 'acute pain'. This is a warning sign that prevents us from injury and helps heal or reverse injury. Acute pain can be extremely useful in alerting us to avoid touching hot or sharp objectives, as well as the abdominal pain of appendicitis. In both cases the experience of pain leads to behavioural changes that are useful and adaptive. Acute pain usually has a straightforward cause and is easy to diagnose and cure. Whereas 'chronic pain' can be defined as 'pain that extends beyond the expected period of healing'. This can be arbitrarily determined as 3 months, 6 months, 12 months or left simply as it is. It is not as easily understood as acute pain and leads to, or is associated with, other issues such as psychological and social problems. Pain is subjective, there is no objective way of measuring it. You have to ask the patient/claimant so exaggeration and malingering is not easily detectable due to the subjective nature of pain and its assessment. There are many simple ways of assessing pain. One way would be a numerical rating, where you would ask the patient to rate it from zero to 10. This is quite useful for the assessment and treatment of acute pain but too simplistic with regards to chronic pain which requires more detailed assessment."

"Treatments for pain vary from medications and interventions to pain management programmes and psychological treatments such as cognitive behavioural pain therapy," added Dr. Logan, "As a Pain Management Consultant I am often asked about prognosis and recommendations for further treatment. There is a broad palate of treatments to apply to the canvas of pain management. Treatments of different modalities are often recommended as part of the patient's pain management programme, with physiotherapy, medication trials, interventional techniques and psychological techniques often forming part of a treatment plan." On the subject of video surveillance being provided as evidence, Dr. Logan went on to say: "Although the pain management expert has a duty to the court to provide an unbiased report it follows that, as a result of the subjectivity of pain, such reports will often be broadly in favour of the claimant. The pain management expert is trained to believe the 'patient' when that person describes and scores their pain. When called upon as an Expert Witness, Dr. Logan is able to draw on his vast experience to make an overall assessment of the patient from the pain management prospective. As there is much overlap between pain management and psychology, Dr. Logan may consider it necessary in some cases to seek the opinion of an expert in psychology or psychiatry, who may have already been consulted, (e.g. in cases where post traumatic stress disorder may be suspected).

However, it is not uncommon for pain specialists to be sent video surveillance records on which they are asked to comment. In many cases no firm conclusions can be made about pain as it can't be measured or deduced from a video though it can help with some aspects of exaggeration of disability.

There are occasions, of course, where the evidence will result in a change of opinion, in cases where a claimant who claims to be permanently wheel chair bound is observed Depending on the severity of the injuries sustained in an running for a bus or taxi!" accident or personal injury, persistent pain can be a real problem. There may be a continuing cause for this or the original precipitating factor may have caused injuries that have already healed and the general perception is that there should be no further problems. It is also possible that the injury may have exacerbated a pre-existing condition or may have been endured by a person who, for some reason, is more likely to develop chronic pain. The pain may also be associated with functional difficulties, disability, psychological problems such as depression and anxiety and social problems. All these factors are likely to exacerbate the pain and lead to one or more vicious circles. There exist different types of pain after an injury, therefore it's important to differentiate between these as the treatments for them are totally different," Dr. Logan explained, "Nociceptive pain is the pain we all know about which is caused by a noxious stimulus or at least described in those terms. Whereas Neuropathic or nerve pain is caused by a defect or problem in the nervous system. It is usually more difficult to describe than Nociceptive pain and often remote to the site of injury.

Dr Andrew St. Clair Logan MB BChB FRCA FFPMRCA Nuffield Health The Grosvenor Hospital, Wrexham Road, Chester CH4 7QP Tel Mobile: 07791681278 Secretary Sharon: 07763783601 Fax: 01244 851 278

Professor

Michael A. Patton

Patton Consulting Ltd Since retiring from the NHS, Professor Michael Patton uses his Surrey-based company, Patton Consulting Ltd for medico legal work. Working closely with paediatric neurologists and obstetricians, Professor Patton has been instructed on a variety of cases in the last twenty five years but has now focused his workload on more complex cases with genetic disability. Professor Patton takes instruction on 20-30 cases each year and acts on behalf of both parties in medical negligence cases. Most of the recent cases that he has been involved in concerned children born with a disability, but Professor Patton has been involved in a wide variety of other cases. He is trained as a Joint Expert Witness. A founder member of the Expert Witness Institute, Professor Patton is also involved academically as a lecturer on medicolegal matters. Although assisting large claim cases involving birth trauma and pre-existing genetic disorders, he has provided medico legal reports for cases such as asbestos and its relation to the pre-existing genetic disease issue of Marfan Syndrome and the assessment of mental handicap where it proceeds a brain injury – deciphering what proportion of the damage was a result of the accident or what proportion is the result of pre-existing illness . Commenting on his previous instructions, Professor Patton added: “One of my most unusual cases was a libel case in which a model was accused of being a man rather than a woman by a tabloid paper. My brief looked at the legal and genetic definitions of gender and if the case had not been settled out of court would have provided the case law on the first use of molecular genetic testing for gender determination in English Law.”

“I have also had a number of cases where legal action has been brought against IVF clinics providing sperm,” he continued. “In these cases no medical negligence was proven and the cases were brought under the trade description law as the sperm had produced a disabled child and it was argued that the sperm hadn’t ‘done what it said on the tin’. These cases were defended as there is a background rate of handicap which even the best clinic cannot prevent absolutely.” Most of Professor Patton’s current work is looking for genetic causation in birth trauma cases or advising the Courts about the prognosis of rare genetic disorders where there has also been a personal injury claim. During his time working for the NHS, Professor Patton was instructed and provided evidence on some high profile cases which attracted a great deal of press coverage.

Cases that Professor Patton has instructed on and also shows a special interest in, include: • • • • • • • • •

Prenatal diagnosis of genetic or chromosome abnormalities Screening for cystic fibrosis Prenatal diagnosis of metabolic disease Causation of mental handicap Huntington’s disease as cause of criminal behaviour Determination of sex / gender Failure to provide genetic counselling Teratogenic effects of anticonvulsants Exclusion of genetic causes in deafness

“My most prominent cases were the Angela Cannings and Trupti Patel cases where these mothers were accused of murdering their children,” Professor Patton explained. “My evidence showed that an inherited form of sudden infant death was more likely and led to their acquittal.” The cases received national media attention and led to a judicial review of similar cases and Professor Patton has combined some of his thoughts into a talk entitled “Is Murder Genetic?” which has been given to a wide variety of audiences. Professor Patton does stress that he is NOT involved in DNA identification. In a recent interview, he outlines that “there is a lot more to genetics than simply DNA for personal identification. Genetics can be used to identify and analyse a variety of rare conditions which have become of great importance in medicine.” “Pre-existing mental disability can be exacerbated as a result of an accident in personal injury cases or a child that is left disabled from birth may have been the subject of a prenatal medical condition rather than medical negligence in the delivery room,” he explained.

Professor Patton receives mainly direct instructions and has built a good relationship with law firms who rely on his expert opinion in this specialist area. Whilst personal Injury cases often use agencies to get leads, Professor Patton believes that it is

“better to instruct at the beginning.”

Although he has retired from the NHS, Professor Patton currently still undertakes private practice at the Portland Hospital. He is Emeritus Professor at St Georges Hospital in London, where he ran the genetic service and academic department for 25 years. Professor Patton is also Honorary Professor of Medical Genetics at University of Exeter and University College London and an Honorary Fellow at Green Templeton College in University of Oxford. He is also Medical Director and a Founder of the Newlife Foundation for the Disabled Child, which supports equipment provision and research for childhood disability.

Patton Consulting Ltd T:01372 456 327 E:mpatton@sgul.ac.uk W:www.geneticconsultant.co.uk

Ability Matters Expert Witness services & Medico Legal reports

Ability Matters Clinic is part of Ability Matters Group; an international group of companies whose principal activity is to supply products and services that enhance the lives of those who require devices to improve their mobility and accessibility. With over 30 years experience in providing enablement products and services throughout the UK and Ireland, Ability Matters is a fast growing company with an international profile. In 2014; Ability Matters featured ranked 22nd on the Sunday Times HSBC International Track 200 and, with continued growth, today employs more than 450 staff. The company enjoys extensive partnership arrangements with the NHS for the provision of Prosthetics, Orthotics and Wheelchair services and also has a strong reputation as a product supplier under the Ortho Europe brand.

Ability Matters Prosthetics

Ability Matters enjoys excellent working relationships with all major component manufacturers and suppliers. The company offer a complete range of prosthetic care for both upper and lower limb loss and, with a team of experts, are able to select the most appropriate prosthesis to match the clients' requirements and enhance their ability. â&#x20AC;&#x153;The value of prosthesis is directly related to the way in which the prosthetist develops an understanding of the client's needs and is able to provide the time, care and equipment to satisfy the client's requirements,â&#x20AC;? explained Werner Herbst, Ability Matters' Clinical Director. â&#x20AC;&#x153;Equally important to the function of a prosthesis is the comfort and the ability to use it to enhance

Ability Matters Orthotics

Ability Matters' experienced team of Orthotists use the latest in technology and biomechanical assessment equipment to assist in the prescription of specialist orthotics such as knee braces, orthopaedic footwear, insoles, sport orthotics and other support products. With a growing number of clients with complex, short or long term conditions and rehabilitative needs, these individuals rely on services to enhance their mobility and improve their quality of life. Ability Matters Clinics Ability Matters Clinic have been formed over the past ten years due to the company's rapid growth and offer fast access to a team of highly experienced clinicians, all proven experts in their fields, who specialise in a range of private

Proven experts in their fields and covering a multitude of disciplines, Ability Matters' experts acting on behalf of defendants and claimant's solicitors; ensuring a highly professional, timely and cost effective service is adhered to throughout the process. Reports include: • • •

Expert Witness reports Quantum Reports – cost of treatment over a fixed period. Immediate Needs Assessment Reports – in line with BICMA code of practice.

Highly qualified and experienced Prosthetists and Orthotists work in conjunction with an affiliated panel of healthcare professionals, including consultants, physiotherapists, podiatrists, occupational therapists and counsellors. The Clinics regularly accept referrals from consultants, doctors, physiotherapists and occupational therapists as well as direct referrals. The clinics are located in five locations – Abingdon, Belfast, Dublin, Manchester, and Wimbledon – although, appointments can be arranged at Ability Matters' satellite clinics which are held throughout the UK and Ireland. Each of Ability Matters Clinic's experts are fully trained by Bond Solon and attend regular training sessions to ensure best practice and continually developing in their role. However, due largely to the consistency of medico legal reporting and the high regard in which Ability Matters experts are held in, a case managed by the company has never actually reached court stages as a settlement has always been agreed before a court hearing due to the extent of evidence and expert opinion. In a recent interview, Ability Matters' Clinical Director, Werner Herbst explained: “I have over 14 years experience in prosthetic and orthotic services; dealing with the practical day-to-day treatment of patients which, has ultimately enhanced my knowledge and experience of the area.” “I have been involved in several cases for prosthetics and orthotics,” Werner continued. “Most of the cases were the result of clinical negligence, road traffic accidents or accidents at work; clients normally require several orthoses and prostheses for each case whilst both prosthetic and orthotic cases will normally require lifelong treatment.”

Discussing the court process, Werner went on to say: â&#x20AC;&#x153;Normally, there would be an Expert Witness acting on behalf of the prosecution and defence for prosthetics and orthotics. Often it would be asked to compile a joint-report once the initial report from both experts has been provided. The aim of the joint-report would be to agree on a prescription, pricing and replacement cycles of products and treatments going into the future.â&#x20AC;?

Werner Herbst, Clinical Director

Werner Herbst is a member of the Health Professional Council and has also undertaken training on the Dominic Hannett, Bond Solon Course for Expert Witnesses. The Ability Clinical Services Director Matters Group is also a member of the British Healthcare Trade Association (BHTA). Ability Matters opened a brand new state-of-theart clinic in Manchester in 2014. As well as housing he company's experts, the new site boasts an excellent retail outlet giving high quality access to a comprehensive range of orthotic products, specialist seating, wheelchairs, mobility scooters, daily living products and specialist footwear.

Laura Nicholls, Orthotist

Geraint Collins, Silicone Technician

For further information please call Ability Matters on 0800 0723 122, email medico legal enquiries to info@abilitymatters.co.uk or visit the company's website at www.abilitymatters.

EXPERT WITNESS SERVICES & MEDICO - LEGAL REPORTS FROM ABILITY MATTERS

Prosthetics Experts Ability matters has 30 years experience in providing enablement product and services throughout the UK and Ireland We have highly experienced clinicians, proven experts in their fields, who can formulate medicolegal reports in relation to prosthetic treatment and the prescriprtion of prosthetic devices following personal injury, We also provide expert medicolegal services in relation to orthotics

clinic • All experts trained by Bond Solon • Cost- effective reports with quick turnaround • Experts in all areas of prosthetics

For information about our experts or to book a consultation, contact us today. Telephone: 0800 0723 122 Email:info@abilitymatters.co.uk

ABILITY MATTERS CLINICS ABINGDON | BELFAST | DUBLIN | MANCHESTER | WIMBLEDON

www.abilitymatters.co.uk

MIKE MARTIN Independent Consultant, Trainer, Researcher, Practitioner, Independent Report Writer & Expert Witness

Mike Martin formed his own company Mike Martin Associates Ltd (MMA) in 2003 to provide professional services as an Independent Consultant, Trainer, Researcher and Practitioner, as well as undertaking commissions as an Independent Report Writer & Expert Witness. Mike maintains a practitioner base to his work including occasional shifts in a mental health service in West Lothian and a permanent part-time commitment as a service co-ordinator to Perth and Kinross Council’s Out of Hours Social Work service; having acted as a consultant in establishing the latter in April 2010. In developing MMA Mike works approximately a third of his time as a singleton worker, a third when he brings in specialists to form a team, and a third where he joins with others in their teams. Specialising in Social and Health Care, Social Inclusion and Quality, Mike has provided his services as an Independent Report Writer & Expert Witness for cases dealing with the following issues:

• • • • • • • • • • • • • • • • • •

Mental Health Tribunal Welfare Guardianship Personal Injury Contested Adoption Contested Care Plan Dementia Planning Appeal Local Authority Complaints Appeal Care Commission Deregistration Appeal Carer Representation Adult Support and Protection Risk of Sexual Harm Risk Assessment Negligence Independent Advocacy Judicial Review Mediation/Complaint Resolution School placement Tribunal

Solicitors have valued the experience and insight Mike can bring not only to his contact with client and family, but also through his familiarity with statutory, private and voluntary organisations as providers of services, and as agencies with duties to assess need and plan for, commission and purchase services.

In the past 7 years Mike has worked with solicitors from 28 firms, mostly in Scotland but also in England and Northern Ireland, including Morgan Law, Cheshire Legal Services, Hughes Walker, Innes Johnston & Co and Ross & Connel to name but a few, dealing with a wide range of issues, as he explained in a recent interview: “Many cases have been linked to mental health tribunal and contested welfare guardianship issues, with reference to clients with either learning disabilities, mental health issues or both.” Mike has also undertaken work in relation to: contested local authority response to care assessment; adoption proceedings; personal injury (clients and staff); planning application; appeal against Care Commission revocation of registration; complaint resolution; Risk Assessment; Social Work Department Complaints Appeal; and, Education Department school placement appeal. “In most mental health tribunal cases reports are instructed in relation to the subject of the tribunal, though work has also been undertaken with a focus on the Named Person,” Mike added, “Typically an independent report is written having met with the individual, with family members if relevant, making contact with the range of professionals involved in a case, and having reviewed case papers. Commissions often extend to include attendance at Tribunal or Court, and research on potential alternative placements.”

Mike Martin Mike Martin Associates Ltd T: 01738 633948 M: 07904 060 013 E: mike@mikemartinassociates.co.uk W:www.mikemartinassociates.co.uk Mike has particular interest and expertise in the areas of transitions in life stages and between one service and another, in the interactions between services, and in advocacy for people with impaired capacity. He has skills in service inspection, auditing and monitoring, and for three years his portfolio included work as a part-time locum Officer for the Care Commission (now Care Inspectorate). An Associate Lecturer with the Open University and amongst other courses Mike teaches law to social work students, and leadership to NHS employees through the NHS Leadership Academy. An SVQ Assessor, Mike specialising in work with people undertaking the Registered Managers Award; with recent independent training commissions he has undertaken having focused primarily on dementia awareness and adult support and protection legislation. Mike is able to draw on an extensive network of associates, covering a range of professional disciplines, thereby enabling solicitors for whom he is acting to find the right individual to provide independent reports for the case in question. This can operate on the basis of engaging people through Mike Martin Associates, or MMA acting as a broker to identify a contact.

Mike’s impressive academic qualifications include achieving an MA (Hons) in Philosophy and English (Dundee), an MSC in Public and Social Policy (Edinburgh), with his research dissertation on user perspective on service quality, and Diplomas in Social Administration (Dundee) and Social Work (CQSW) (Stirling). As well as undertaking training as a Scottish Mental Health First Aid trainer, Mike has also achieved a Certificate in Management from the Open University. Combine this with the wealth of practical experience he has gained during his illustrious career and it’s easy to see why so many leading Solicitors are seeking Mike’s professional support as an independent Report Writer and Expert Witness.

Mike holds Membership of a number of professional bodies, including:

• The British Association of Social Workers (since October 1978);

• Social Care Association

(since March 1983 to 2012 - went into receivership late 2012) as well as being registered with

• Scottish Social Services Council (since August 2005)

Grifﬁn Forensics eForensics and Data Recovery

Handling Digital Evidence Are there computers, mobile phones or other digital devices involved in your latest case? Many cases now contain multiple digital exhibits and with this comes a wealth of data which may help your client but how should you handle it, who should examine it and what can you expect to get IT departments are primarily responsible for supporting a business’s infrastructure and computer stores ﬁx and sell computers. They will usually not have staff who are forensically trained and they will not have the technical capability, hardware or software to deal with the forensic examination of digital media. There is a very real danger, due to the fragile nature of data, that by using non-trained staff you will lose valuable evidence either because it is accidentally deleted or overwritten, missed completely or ruled inadmissible by the court owing to procedural failings. All digital examinations should be conducted in ccordance with the principles within the Association of Chief Police Ofﬁcers Good Practice Guide for Digital Evidence.

On computer media such as hard drives digital forensic examiners can view active (or live) files, deleted files, slack space and free space. You may be familiar with these terms but if not: � Active files – live data which has not been deleted and is generally accessible and visible to a user; � Deleted files – If a subject knows there are incriminating or sensitive files on the computer media they may delete them and many computer users think that this actually irretrievably 'deletes' that information. Depending on how the files are deleted a forensic examiner may be able to recover all or part of the original data. � Slack space - The areas of disk between the end of the live data and the end of its’ allocated area on disk; � Free space - File clusters that are not currently used for the storage of live files but which may contain data which has been 'deleted'. Free space may contain complete files or fragments of files.

www.griffinforensics.com Data that may be identified or recovered from digital media can include documents, log files detailing usage, registry records, Internet history, pictures, videos, dates and times, e-mails and temporary files. The data available from mobile phones is similar to that from other digital media. Cases rarely have CDs in investigations now however one CD holds in excess of 100000 A4 pages of single sided raw text (numbers and letters); six CDs (640 megabytes (MB)) will fit on to a DVD (4.7 gigabytes (GB)) and USB flash drives can store 1000 GB / 1 terabyte (TB). With these quantities of data you will need the support of a digital examiner who can conduct searches for specific words or phrases to relatively quickly identify relevant files or data. If you are handed digital media by a client protect it from heat, moisture and physical damage; do not be tempted to switch them on as this will irretrievably alter data and may over-write the very evidence you are seeking and contact a digital forensic examiner for advice.

Grifﬁn Forensics carry out digital investigations for law ﬁrms, law enforcement agencies, commercial organisations and private individuals. Investigations that we have conducted include fraud, e-mail abuse, intellectual property theft, terrorism, murder, rape, computer misuse, child abuse images and grooming. We prepare technical reports and statements for se in court and give opinion on reports submitted by other experts

Griffin Forensics Ltd, 5 Oxford Court, St James Road, Brackley, Northamptonshire, NN13 7XY

T: +44 (0)1280 707190 E: info@griffinforensics.com F: +44 (0)1280 707199 DX:16982 Brackley W:www.griffinforensics.com

FORENSICS INDUSTRY E-MAGAZINE

For TOMORROW’s Genomic Technology.... TODAY Since it first entered the criminal legal practice, DNA has become an indispensable tool in fighting crime, allowing both unambiguous identification of the criminal by traces of biological material left at the crime scene, as well as acquitting innocent suspects. Understanding how DNA evidence is obtained and evaluated allows the defence to find pitfalls in the evidence and in data interpretation.

was obtained, whether it can be interpreted in a way different form that of the prosecution expert, explain what is the significance and the probative value of the evidence and how it can be successfully challenged in court in order to minimize its impact or even dismiss it completely. We will also provide Expert Witness testimony in court should this be required”

A match between the defendant and a biological sample recovered from the crime scene does not and should not automatically mean conviction, even if it is a complete match. DNA is a means of identification and, as other means of identification, it is prone to errors, uncertainties and conflicting interpretations.

The company has published extensively in legal press on the use of DNA in legal practice including the book “Dealing with DNA evidence: A Legal Guide”, which, as the first of its kind, treats DNA evidence within the framework of English Law.

As a trusted and ethical provider of genetic testing services within the UK and Europe, Medical Genomics has been at the front line of genetic research, as founder of the company Andrei Semikhodskii explained in a recent interview:

Medical Genomics provides expert witness services not only in England but in other countries, like India, Libya, Russia and others. As DNA experts for the defense we took pat in the most notorious murder case in India - Noida double murder case which became the subject of the recent book "Aarushi" and the film "Talvar"

“At Medical Genomics we will guide you through DNA evidence in your particular case, help you to understand how DNA evidence

2013

Boasting vast experience in providing DNA Expert Witness Services for the defence, the company expertise covers the whole range of DNA evidence: • • • • •

STR genotyping: NGM SElect, SGM, SGM+, Y-STR, LCN testing Analysis of mixed DNA profiles mtDNA Analysis RFLP genotyping; SLP & MLP

• DNA data interpretation The company’s most notable resent cases include: R v Hart (2015) Snarsbrook Crown Court (unreported) – sexual assault, GBH

• R v Baffoe (2014) Croydon Crown Court (unreported) – firearms offenses, drug offenses

• R v Festus (2014) Wood Green Crown Court (unreported) – sexual assault • R v Chambers (2013) Woolwich Crown Court (unreported) - burglary • R v Helal (2013) Wood Green Crown Court (unreported) – GBH • R v Wozniak (2012) Exeter Crown Court (unreported) – firearms offenses • R v Santos (2012) Blackfriars Crown Court (unreported) – rape of a child • R v Jeyarejan (2012) Harrow Crown Court (unreported) - burglary • R v Wilson (2012) Exeter Crown Court (unreported) – armed burglary • R v Rafiq (2012) Cardiff Crown Court (unreported) - murder • R v Folley (2011&2012) Croydon Crown Court (unreported) - murder • R v Smith (2011) Reading Crown Court (unreported) - sexual activity with a child

• R v Roberts (2010) Southwark Crown Court (unreported) – triple rape • irregularities

With genetic testing technology constantly evolving, the company strives to provide its’ clients with the best available service by testing each DNA sample twice; using state of the art DNA testing equipment to ensure unparalleled accuracy of results “The turnaround of 10-12 working days guarantees that our clients do not need to wait long for results of a paternity test or any other DNA test they ordered. Added to this our competitive prices make the tests affordable to anyone who requires them.” “At Medical Genomics we acknowledge the unalienable right of every individual to privacy and confidentiality and see it our duty to use genetic information ethically and respectfully,” Andrei added, “We remain committed to stand by this pledge and to abide by national and international legislation with regard to genetic and medical research and information. We feel responsible to prevent misuse of genetic and other information obtained in the course of our services.” If you would like to get expert opinion on DNA evidence in your case or obtain a quotation please contact: MEDICAL GENONOMICS Tel: 0844 567 1071 Email: dnatesting@medicalgenomics.co.uk Website: www.medicalgenomics.co.uk

Where Students Thrive under an Ethos of Excellence CALLING ALL EXPERT WITNESSES! Most Expert Witnesses will admit to being very nervous about their first courtroom appearance and an inability to perform well in these circumstances is likely to result in the Expert being dropped by the commissioning solicitors. Having to give evidence and be cross examined by a Barrister is not for the faint-hearted, but Barristers are far less likely to challenge a well written expert statement in court, as opposed to one hastily stitched together by someone lacking the necessary skills.

forward-thinking training establishment, backed by a highly experienced Team and the latest in modern support services, Talking Life has achieved an excellent reputation, since its inception in 1990, for providing high quality seminars, training days and programmes covering a wide spectrum of subjects including a number of Court Skills Courses: Court & Expert Witness Skills; Court Skills in a Day and Advanced Statement Writing. Talking Life also offer a diverse range of Legal Courses including: Social Work Law; Healthcare Ethics, Family Liaison; Understanding Section 47; The Law & The Health Professional; The Law and the Nurse; Child Protection & The Law; Family Law in a Day; Reporting & Documentation for Nurses; Court Skills for Doctors; Advanced Statement Writing & Court Skills; Court Skills for Social Workers; Advanced Report Writing; Child Care Legislation; Current Legal Policy in Family Law; Public Law and Writing Section 7 and 37 Reports.

Talking Life is also able to respond to any request to provide a bespoke course around any aspect of Court work.

Wendy Bennett Managing Director of Talking Life went on to say: “Talking Life has developed a high quality range of Legal Courses in recent years which has attracted outstanding feedback across our client database. Our Achieving Best Evidence (ABE) Course uses highly innovative techniques, including the use of actors and our Court Skills trainingOur Court Skills training has been praised as being ‘outstanding’. Our Court Skills and Expert Witness Training Team is led by a senior practising Barrister and our ABE course is led by a former senior specialist police officer.” When asked who would benefit from undertaking one of these courses Wendy replied: “Our Court Skills courses are suitable for anyone who needs to appear in Court to give evidence, whatever the topic. This applies to Criminal, Civil and Family Courts. One of the courses we have delivered most regularly over the past 5 years is for Social Workers (either Children or Adult Social Workers) and others for Doctors, most recently Psychiatrists at their Post Graduate Medical Centre in Lancashire. The course is suitable for any expert witness, whatever their speciality (Accountants, Engineers and other professionals).”

alking Life’s Advanced Statement Writing course has been delivered on many occasions for the Department of Transport (DVLA) where the quality of statement writing has improved to such an extent that appearances in court have been drastically reduced by 90%. “The course was inspired by the fact that many professionals were appearing in court without understanding the court system and the importance of giving cogent and relevant evidence,” Wendy explained, “The aim of tour Court training is to take the ‘fear’ out of the experience by taking away the mystique of the Justice system and giving participants the confidence to make an effective appearance in the Courtroom. This is achieved by giving them the chance to ‘give evidence’ and then be put through a series of mock cross examinations. The course is a mix of theory and practical, delivered in a highly entertaining style and making use of extensive participation by the audience. Theoretical aspects take the participant through how the court works, what the roles of the respective officials is and what is, and is not, expected of them. Participants are asked to prepare a short five minute talk about anything they wish and they are cross examined on this. They then go on to improve technique, using case studies of particular relevance to their field of interest. They also get to learn how to write an effective statement. Its all very informal but highly effective in giving participants the confidence they need, together with the key skills to give a good account of themselves in Court.”

You only have to browse the Company’s website www.talkinglife.co.uk to see the positive feedback it receives from students., who are already reaping the benefits of attending a Talking Life course.

“This has been the most interesting course I have been on and the tutor was fantastic. She made it very worthwhile and I have gained so much information, it made me think in so much depth” Key to the company’s success is the fact that it can draw on the natural ability and expertise of Talking Life’s leading barrister-trainer, Andrei Szerard, a very experienced barrister with an entertaining, funny and friendly presentation style, who immediately puts participants at their ease.

“We pride ourselves in not only meeting but exceeding our clients’ expectations. Through our training courses we believe that we can make a positive difference in today’s workplace,” Wendy concluded. Therefore, it comes as no surprise to learn that Talking Life is the No. 1 choice for high quality Court Room & Legal Training within the Public, Private and Voluntary sectors.

For a bespoke quotation to meet your specific training needs please contact the team at Talking Life T: 0151 632 0662 36 Birkenhead Road, E: sales@talkinglife.co.uk Hoylake, Wirral W: www.talkinglife.co.uk CH47 3BW

CEDARWOOD TREE CARE Consisting of a team of professional Arborists, headed by founder of the company Mark Chester, Cedarwood Tree Care has achieved an excellent reputation for providing highly professional Consultancy work and Expert Witness Reports, as Mark outlined in a recent interview: “We provide help and support with planning permission applications, BS5837:2012 tree reports, tree Expert Witness services and Tree Preservation Order disputes. We also provide a large number of additional services for people encountering tree problems or in need of tree advice, including mortgage reports and insurance reports for trees and site development surveys for building sites with trees.” By drawing on his academic training, which led to him achieving the Cardiff University Law School Bond Solon Civil Expert Certificate, together with his vast practical experience as a lead Arborist, Mark holds all the credentials necessary for him to provide Expert Witness support for court cases and tree disputes, including Tree Preservation Order breaches and compensation for tree damage. A recent case summary described Mark as "a very impressive and authoritative witness".

Tree Preservation Orders:

Avoiding Costly Mistakes These documents have been part of the planning framework since 1947. They protect trees in the interests of the local amenity. They are a valuable tool. Care is needed to avoid costly mistakes. When a new TPO is served, affected parties have a limited time to raise any queries or objections. Errors and omissions can occur. This is an important opportunity to ensure accuracy before the document is confirmed and made formal. One client we helped had a garden backing on to woodland. There was no concern when a TPO was served on the neighbouring land, with a reassurance from the tree officer that the garden would be unaffected. Our client didn’t check the document for accuracy and it was subsequently confirmed without any change. It was only later, when restoring the garden, it arose that the boundary of the woodland had erroneously been marked to up to a brook running through the garden. Consequently, the self-set trees which now colonised half of the garden were protected.

As you would expect from such a quality-conscious organisation Cedarwood Tree Care has achieved the following

Trees and Development: Trees can be an asset to many developments, with careful management. Indeed, they can often enhance developments. However, the sooner we can visit a site and assess the trees the better. Correct identification is important; with one development, the site layout had been designed around a tree of local importance. The problem was that the tree was in a different position which required a redesign. There are a range of solutions to enable trees to be retained. However, we do need to be involved in the design of the site as early as possible. It helps to be informed. With one site, working with non-specialist planning officers, the possible presence of veteran trees, which are afforded more space within a development, was cited as a reason to refuse permission to develop the property. Using our technical knowledge, we were able to demonstrate that best practice was being applied and the trees in question were not veterans. With specialist guidance on how to develop around trees being retained, permission was soon granted. Finally, a case where good intentions nearly back-fired. We were working with a client seeking to regenerate an abandoned site. The site is within a national park, and so subject to greater scrutiny than would normally be the case. An avenue of Alder, a quick growing tree which can tolerate quite harsh conditions, had been proposed for the main thoroughfare to the site, also fronting a row of apartments. These trees are excellent for impact, but their dense foliage, causing shade, makes them unsuitable for settings near to residences. This was a case of right tree wrong place. Fortunately, we were quickly able to reassure the planning professionals that this proposal would not be in the final submission, and Alders were selected for other parts of the site.. TO DISCUSS YOUR INDIVIDUAL NEEDS FOR A TREE EXPERT WITNESS CONTACT:

Mark Chester CEDARWOOD TREE CARE

T: 01981 570 420 M; 07888 838 360 E: mark@cedarwoodtreecare.co.uk W: www.cedarwoodtreecare.co.uk

Dr Christopher R Plowman BSc MSc Clin Psych D CPsychol AFBSsS

Consultant Neuropsychologist I specialise in the neuropyschological assessment of the cognitive, emotional and behavioural consequences of acquired Brain Injury in adults following road traffic accidents, assaults, anorexia, or exposure to toxic substances.I have experience in the assessment of disorders of mood, neurotoxicology, epilepsy, drug and alcohol misuse, tumours. HIV, and in the areas of Personal Injury, Occupational Health and Clinical Negligence. I am a recognised expert by Cardiff University Law School and Bond Solon and I am trained in the legal aspects of report writing, giving evidence in court and the responsabilities of a single joint expert. I have provided medico-legal reports in Personal Injury cases for over ten years and in the past three years have provided around 120 reports for defence and claimant solicitors as well as joint instructions.

Consulting rooms can be found in:

Coventry, Solihull, Manchester, Leeds and Sheffield Domicillary visits are available throughout England and Wales For expert advice please contact Dr Plowman: PO Box 15858, Solihull B91 9RN Tel:0121 707 0482. Fax:0121 706 2822 Email:drplowman@inbox.com

Forensic Scientific is the brainchild of founder, Philip Boyce BSc, MSc a leading world expert in Firearms, Gunshot Residue (GSR) and Tool Marks, who is able to draw on his extensive experience within the military arena and firearms sector to provide his services as a leading independent Defence Consultancy and Forensic/Scientific Expert Witness. It was after working as a Forensic Scientist for over 30 years that Philip decided to take a 'leap of faith' and form his own company, Forensic Scientific, enabling him to work as an independent Consultant concentrating on defence cases, appeals and training. Since then the company has grown and gathered momentum and today Philip remains a world expert in his field, dealing with continual casework covering the following areas of expertise:

• • • • • • •

UK Gun Expert; Ballistics Expert; Gunshot Residue Expert; Firearms Expert Witness; Firearms Law Expert; Firearms Defence Expert and Ammunition Expert.

Philip gained an immeasurable amount of aptitude and fundamental knowledge of firearms whilst serving in the Territorial Army from 1977; with his 18 years of service during the Northern Ireland troubles providing him with an unrivalled level of Firearms/Ballistics/Gunshot Residue/ Tool Marks and scene expertise within the UK. Philip has also found the training he received with the Metropolitan Police in the use of the IBIS system both in cartridges and 3D bullet acquisition invaluable for complex casework. This practical experience, combined with the extensive experience he gained over the 30 years he worked as a Forensic Scientists, dealing with medical examinations, post mortems and exhumations, enable him to provide a professional, efficient service as an Expert Witness, as he explained in a recent interview: "We receive instructions from Solicitors, Barristers, Police Forces, Companies and Private Individuals and offer a single point of contact to provide essential continuity throughout each case.

FORENSIC SCIENTIFIC 30 Dereham Road, Shipham, Thetford, Norfolk IP25 7NA T : +44 (0)1362 820974 M: +44 (0)7759 004512 F: +44 (0)1362 820974 E: info@forensicscientific.com W: www.forensicscientific.com

We provide a quality focused, value for money and unrivalled expertise approach to each of our clients. Continually seeking to offer our services in a cost effective manner and realising the importance of high customer satisfaction." In his capacity as an Expert Witness Philip has provided thousands of Reports, both for the prosecution and defence, as well as giving Expert Witness testimony for many Courts, both in the UK and internationally, including: Juvenile, Magistrates, Crown Courts, High Courts, Courts of Appeal and Military Court Martials. A sign of the high regard in which Philips expertise is held within the industry is highlighted by the fact that he has been a participating member of a great many leading organisations including the European Network of Forensic Science Institutes (ENSFI) and the Association of Firearm and Tool Mark Examiners (AFTE). As a Expert Advisor for the Serious Organised Crime Agency (SOCA), in the past Philip was also, part of the NFFID (National Forensic Firearms Intelligence Database) Service Providers Group and contributed to the NABIS (National Ballistics Intelligence Service) program as a Senior Associate; NABIS is now live across the UK. Headed by Philip, the company's team of internationally recognised scientists is charged with the responsibility for providing an exclusive analysis and advisory service to Stealth Mark Europe, including any additional analysis of the Crimestoppers Property Protector™; with part of the company's remit being to issue independent Section 9 statements for acceptance by the Courts. Taking pride in being a 'commercial service' that supports National, International, local Forensic and Industry initiatives Forensic Scientific provides a unique combination and correlation of techniques and applications used in both ‘Forensic’ and ‘Scientific’ disciplines, as well as being committed to research and development. Currently undertaking the position of Ballistic Specialist for UNDP (United Nations Development Program) Kosovo, Philip concluded: "We are able to travel to any location within the UK, Ireland and worldwide to visit scenes, laboratories, police stations, courts and any other premises if required."

Case Studies: David Bain found not guilty on five counts of murder after 13 years in prison

David Cullen Bain (born 27 March 1972) is a New Zealander who featured in one of the country's most notable murder cases. He was convicted in May 1995 of the murders of his parents and three siblings in Dunedin on 20 June the previous year. After 13 years in prison, David Bain was found not guilty at his retrial. After months of painstaking scientific experimentations and calculations, Philip Boyce was able to support the defence theory that Robin Bain, the defendants father, could have gunned down his family, before turning the gun on himself. Philip carried out a courtroom demonstration to show that Robin Bain could indeed have shot himself.

This evidence was crucial for the defence as part of the prosecutions case rested on the supposition that Robin Bain could not have shot himself. Scientist Proves Rifle Shot Schoolboy

This controversial case examined by a Forensic Service Provider in 2005, was the wounding of a child in his school playground. This case involved 14 different Firearms, none of which could be excluded from the incident by the Forensic provider. Philip Boyce, with the use of the IBIS system, 3D analysis and by intensive comparison macroscopy, provided a conclusive link to one of the questioned Firearms and excluded the others. He also reconstructed the scene and the injuries to the child for court demonstration purposes.

He was awarded a commendation for this work in 2009.