Forensic & Exert witness Magazine Medico Legal Issue 2019

Don't Miss The Bond Solon Conference 2019 And Our Special Issue

RSW medico-legal

Richard Scott Watson launches new website for 2019-2020 see inside for interview with Richard. rswmedicolegal.forensicandexpertwitness.co.uk

Award-winning RSW Medicolegal Ltd Outlines The Advantages Of Instruct Direct

Federation of

Forensic & Expert witnesses

Since its inception, Stourbridge-based RSW Medicolegal Ltd has achieved an enviable reputation for the provision of high quality Medico Legal Reports in the field of orthopaedic related personal injury cases.

A highly experienced Trauma and Orthopaedic Surgeon, Founder and Managing Director of the Company, Richard Scott-Watson has been the Director and sole Medical Examiner at RSW (incorporating in 2001) for over 28 years.

Able to draw on over 28 years’ experience, Mr. Scott-Watson is a single expert with a particular interest and expertise in general orthopaedics, fractures and trauma; musculoskeletal injuries and all aspects of bone and soft tissue injury including limb and spinal injuries. He is particularly interested in the disability aspect of cases, an as this is what matters most to the claimant.

As you would expect from such a consummate professional, Mr. Scott-Watson is a member of the Oxford Medical and Legal Society, as well as attending industry-led conferences each year, depending on the relevance of the subject matter.

Richard Scott Watson

In a recent interview Mr. Scott-Watson outlined the advantages in an Expert Witness being instructed directly, as opposed to using the services of an agency/intermediary: “To begin with the solicitor gets to choose the expert. Some solicitors ask agencies only for the shortest waiting list but many solicitors prefer the direct contact once they have tried it. As it is far more efficient and cheaper.

Some solicitors give the impression that agencies indicate that they can only get the expert through the agency and are surprised that direct instructions can be given. It is never the case that an agency owns an expert and direct instructions can always be sent.

Another key advantage to instructing an Expert Witness directly would be that Agencies normally take around 50% or more of the fee the expert would normally charge. Therefore, unless the fee is regulated, the solicitor ends up being charged considerably more than the expert would charge direct in every case that they have (accidentally) revealed their charges – usually another 10 – 30%. The value to the expert is next to nothing, in fact frequently agencies obstruct the smooth running of a case. Of course, the practicality is that the expert accepts end of case payment with direct instruction, but for nearly twice the fee for the same work, that seems reasonable. Many claimant solicitors still seem to be unaware that when liability is admitted, the expert’s fee becomes a disbursement and there is no need to wait to end of case It is no coincidence that what used to be independent agencies have largely been bought out by big companies – they make a lot of money for the work they do.”

When asked if clients using an Agency always have access to the correct expert, who has experience in their particular niche, Mr. Scott-Watson told us: “No. The agencies rarely know or use the expert’s particular areas of specialisation. Some do not even get the speciality correct, and in the last year I have been sent two hernias and a head injury, neither of which are Orthopaedic cases.

The criteria agencies use are usually things like speed of return of report but agencies often collect such data incorrectly and so fail to instruct the most efficient experts. I recently had an agency tell me that 25% of my cases were on time. In fact it was over 95% but their figures were skewed by them failing to correctly record when they were sent reports – resulting in the reports looking late and them asking for repeated duplicates – in one case seven times. The agencies also are first point of contact for many claimants – which many find a very tiresome process.

In my experience, the benefits a client receives from instructing an expert directly in terms of cost, service and ease of liaising with the expert speak for themselves. In terms of cost, they get what they are paying for as opposed to the agency taking half of it or more. If there is a problem with a late set of documents or adjustment to a report this can be done quickly but through an agency, three weeks or more for every alteration is common. Some agencies hold reports for weeks before sending them on – the record I have seen is ten months. Needless to say the expert was blamed for the delay when it was entirely the fault of the agency.

I have also had instructions to agencies being mis-interpreted, so one case recently where the agency had failed to send to correct notes, even though they had them, resulted in a significant delay in sending the report. Eventually the solicitor had to send the notes direct after I had been threatened with non-payment for the report due to delays: Delays entirely caused by the agency that passed on the threat.

The Solicitor was very happy once the problem was sorted out direct, which probably would never have been possible if the agency had continued to be in the middle.”

In what cases, can the use of an agency be a useful course of action, if any?

“Agencies can be useful to experts as they provide volume, but they need to because of the very low fees they pay. They also provide diary systems (cost, but no value) and electronic transmission of records (cost, but no value).”

When asked if there were any legal developments or incoming Government legislative changes that will affect the use of agencies and/or experts in the future, Mr. Scott-Watson explained: “I think MedCo really missed a trick in stopping fraud. The initial GP reports are almost valueless and entirely subjective as they do not insist on the contemporaneous notes, which are vital in every case. Equally, with agencies taking most of the fee in these cases, the time taken to complete a case is about a third of what is required to do the job properly in most cases. They actually encourage fraud, as all the claimant has to do is either say they are already recovered (so nothing to find and contradict) or that the symptoms were severe, but no longer are. This means that a high level of disability is recorded for part of the period prior to the report being written, which had by that time partially recovered. In almost every case where I see the claimant later, the contemporaneous notes contradict all or most of any period of severe disability.

As the Government changes the scenery, we currently have little or no idea what the future holds, but the recent increase in fees for agencies will probably lead only one way – agencies taking an even greater percentage of the fee for the small percentage of the work they do.”

Partnering with FORESIGHT

Drawing on almost 15 years’ experience, Foresight brings the UK’s most comprehensive panel of expert witnesses to support family and criminal law cases. As an industryleading nationwide provider, we help legal professionals save time and work smarter by sourcing the most qualified and experienced expert to support their case.

We work with the very best experts in the industry, taking the time to get to know our panel’s unique strengths, skills and expertise to make sure we can match them to the most suitable case types.

From Psychologists and Psychiatrists to Paediatricians, Toxicologist and Forensic Scientists, our esteemed panel is as far-reaching as it is qualified, experienced and renowned.

With an ever-expanding network of eminent professionals, Foresight proudly offers one of the most comprehensive, distinguished expert panels in the industry – some of whom have been with us for many years.

By joining our Expert Panel, you’ll become a valued extension of our renowned team, delivering vital support and evidence to legal professionals across a broad range of disciplines. Our dedicated Account Managers will be on-hand to support you throughout the case lifecycle, ensuring all appropriate documents are received and chasing any outstanding documents on your behalf. As your trusted partner, we deliver a swift, regular payment process for your complete peace of mind.

Are you an expert witness looking to join a leading multi-disciplinary panel?

When you join the Foresight expert panel, you benefit from becoming an extension of our team with a varied and interesting workload.

If you’re interested in joining, please register your interest with our Expert Liaison Executive, Chris Riches Chris.Riches@foresight.expert or call one of the team on 0330 088 9000 or visit www.foresight.expert

Dr B David Cohen Specialist Endodontist and Accredited Expert Witness

PhD MSc BDS MFGDP LDSRCS CUEW MEWI CertMR

I have now been preparing expert witness reports for over 20 years, having prepared over 1000 of them. Most of these have been completed in the last 7-10 years since the Woolf reforms, and following my formal training on the Cardiff University Expert Witness Certification course.

I am trained to be involved in acting as an expert witness on behalf of the court, appointed by either claimant or defendant, and as a single joint expert. My training and experience also include court/ tribunal procedures, and cross examination.

Endodontics clinical negligence My specific area of expertise in clinical negligence cases is that of endodontics (root canal treatment/ therapy). I have prepared reports for both claimants and defendants

Personal Injury Cases

Dr Cohen prepares condition and prognosis reports for facial and dental injuries caused by:

• Accidents • Slip and trips • Road traffic accidents • Accidents at work • Sports accidents • Endodontic problems inc. clinical negligence DENTO-LEGAL SERVICES 122 Hilton Lane Prestwich Manchester M25 9QX dento-legal@endodontistmanchester.co.uk www.endodontistmanchester.co.uk Phone: 07000 665277

Mr Philip Coleridge Smith

DM MA BM FRCS Emeritus Reader in Surgery, UCL Medical School

Areas of expertise • • • • • • •

Peripheral vascular disease Deep vein thrombosis Spider veins Thrombosis Varicose veins Venous insufficiency Venous ulcer

Mr Philip Coleridge Smith is one of London's leading vascular surgeons. Operating at the British Vein Institute he is an expert in the treatment of varicose veins. He lectures at University College London and has been the editor of the medical journals, ‘Phlebology’ and ‘The European Journal of Vascular and Endovascular Surgery’. He is currently President of the British Association of Sclerotherapists and is acknowledged as an international authority and expert in venous disease, including the management of vein problems using ultrasound-guided sclerotherapy and other modern methods of vein ablation.

Throughout his career he has treated several thousand patients using injection techniques.

T:0870 609 2389 E:p.coleridgesmith@adsum-healthcare.co.uk W:www.bvi.uk.com W:www.medical-expert-witness.co.uk

The British Vein Institute 24-28 The Broadway, Amersham HP7 0HP

Dr Julian Harriss MD, MSc, BSc

Consultant in Rehabilitation Medicine (PM&R, Physiatry)

Rehab Medicine Areas of Expertise:

Dr Harriss has served in many senior clinical and academic positions, including Clinical Lead in Rehabilitation Medicine at the Lane Fox Clinic, Guy’s and St Thomas Hospital and Frank Cooksey Rehabiliation Unit, KCH, and Honorary Senior Lecturer in Medicine at King’s College London. He is Director of IRMA: Independent Rehabilitation Medicine Assessment, and a trustee of UKABIF and the BSRM.

Areas include: * Rehabilitation medicine. * Neuro-rehabilitation. * MSK rehabilitation. * Paediatric rehabilitation. * Amputee rehabilitation. * Specialist orthotics. * Post polio syndrome. * Personal injury, clinical negligence and medical malpractice medical reports. * Spasticity management. * Brain injury rehabilitation.

Federation of

Forensic & Expert witnesses

10 Oakway, BROMLEY. Kent. BR2 0LJ 07533 149796 jharriss@doctors.org.uk

AWARD FOR HEALTHCARE EXPERT WITNESS PROVIDERS

2018/2019

The Award Winning Somek & Associates is one of the biggest providers of Expert Witnesses in the UK delivering highly professional trained experts in a range of health professions: Occupational Therapy / Care experts, Physiotherapy, Speech & Language Therapy, Nursing, Midwifery, and other key health professions

Alison Somek Alison is CEO of Somek & Associates, which has been established for over 20 years.

She a Consultant Occupational Therapist and specialises in orthopaedics, brachial plexus/ Erb’s Palsy, upper limb hand injuries and general medical and surgical cases.

‘An excellent reputation...’ www.somek.com

Somek & Associates is one of the largest providers of Expert Witness services in the UK, delivering highly professional trained experts in a range of health disciplines; the depth and breadth of experience covers all types of personal injury and clinical negligence matters, as well as other medico-legal and regulatory needs.

The consultancy was set up in 1997 by Alison Somek, CEO of Somek and Associates who as an occupational therapist / care expert, had previously worked in the National Health Service for over 20 years. Alison has seen the medico–legal environment change dramatically over this period, but has always been passionate about professionalism and independence in her role as an expert witness, continuing to ensure that the integrity of the expert witness is embodied in the work of the associates and company as a whole. This work is supported by a professional team led by Jessica Thurston, Chief Operations Officer (and also an occupational therapy / care expert with many years’ experience).

Somek & Associates now has over two hundred experts, which include, occupational therapists (care experts), nurses, midwives, physiotherapists, speech and language therapists, and other allied health professions. This is reflective of the growth in need for expert witnesses in a range of health care professions allied to medicine, as well as the high regard for Alison and the team at Somek and Associates.

Experts are selected following a robust recruitment process after which they are required to attend an extensive training programme, covering topics from the role of the expert witness (including CPR Part 35) to Courtroom skills. Somek works with leading expert training organisations to offer in house courses and an Annual Conference for all experts, with specialist speakers including solicitors and barristers.

All experts continue to undertake clinical practice in either statutory or independent settings, and importantly maintain their CPD. Reports for litigation (liability and quantum) are fully CPR compliant, or for advisory purposes. Reports are frequently commended; they are well written and presented and are relevant to the complexity and size of the case; they are clearly structured with robustly argued opinions and recommendations, summarised conclusions and costings, and above all, meet agreed deadlines.

Different report structures are available, according to the case need.

www.somek.com Somek & Associates offers competitive fees including deferred payment terms when required.

Fee estimates and guidance for costs budgeting is provided upon request.

Alison and the team are passionate about the integrity of the expert witness role, and as a company, they boast a balanced portfolio of claimant and defendant instructions in equal measure.

Professionalism, objectivity, independence and understanding of legal principles and tests as well as relevant procedure rules (especially CPR 35), are all key factors that Somek strives for and it is these core values that has led to Somek and Associates’ outstanding reputation in the field.

Somek welcomes feedback and responds with a ‘can do’ attitude to flourish in this ever-changing complex environment. The team members have extensive skills and knowledge and are happy to provide training sessions in their respective fields to lawyers and others, thus promoting the working relationships and building confidence.

Alison and the team at Somek & Associates have a goal to make Somek and Associates the organisation of choice for expert witness services in the UK.

Here is what our clients say: “I would like to take this opportunity to thank you most sincerely, once again, for your time and expertise, without which I know that such a favourable result could not have been achieved. Please also thank the rest of the team for being so helpful and super-efficient.”

— Claimant Solicitor’s feedback on Sunneva Thorpe

“The fine our Client received was £40,000, originally it was anticipated this could have been up to £1 million, and Sadia’s report was helpful in mitigation to try and reduce the fine as far as possible.”

— Defendant Solicitor’s feedback on Sadia Hussain

“This is an impressive report, and the narrative is wellreasoned. Reading the Claimant’s report, one might think that the Claimant was completely incapacitated – almost akin to an amputation type injury. However, Mr JuddCooper carefully analyses each of the features and, I think, gives a more balanced view of his condition.”

— Defendant Solicitor’s feedback on Mark Judd-Cooper

“I think Sarah did a great job on this Joint Statement.”

— Claimant Solicitor’s feedback on Sarah Walker.

Contact us for a discussion of your specific case needs.

Somek & Associates 9 Chess Business Park Moor Road Chesham HP5 1SD

T: 01494 792711 E: admin@somek.com W: www.somek.com

Mr Firas F Jamil

Consultant Orthopaedic Surgeon MB ChB, FRCS Ed, FRCS, MSc (Surgery)

Mr Firas F Jamil is a Consultant Orthopaedic Surgeon based in Leeds. Since qualifying in 1972 Mr Jamil has acquired a vast knowledge of Orthopaedics with specific interest in spinal disorders.

Mr Jamil provides care to spinal injured patients. 40% of them have unstable spine but no nerve damage. He also deals with consequences of spinal cord injuries such as; Implants for Nerve Pain Management of Movement Disorders Back Pain Carpal Tunnel Syndrome, Neuropathic Pain (Nerve Pain) Spinal Injury Trapped Nerve Whiplash Associated Disorder.

Mr Jamil is Honorary Senior Lecturer and Principal Visiting Research Fellow, University of Leeds, He is also involved in research on human motor function, including robotics.

He is fluent in English and Arabic.

Memberships: * Association of Minimally Invasive Surgeons of UK and Ireland * British Pain Society * British and International Neuromodulation Societies * Federation of Forensic and Expert Witnesses * British Society of Rehabilitation Medicine * British Association of Spinal Injuries Specialists * International Standards Organisation (Robotics) * British Standards Institute (Robotics)

The Old Vicarage Jacksons Lane Wentbridge Pontefract WF8 3HZ

Call or email Tel:07748 386 969 Email: Sbaran163@outlook.com

Joanne Caffrey

Expert Witness

I am an Expert Witness for ‘Safer Custody’ and the management of challenging behaviour & use of force. The main sectors I work with are the custody (prison and police) and education sectors. I have also experience of hospitals and security settings.

The use of force in custody, education, care and clinical settings varies greatly with many staff having limited, or no, knowledge of risk associated with certain demographics of service users. Too many injuries and deaths are avoidable in my opinion. I have trained several thousands of staff over the years concerning safer restraints and the managing down of physical interventions.

For Safer Custody, the use of force and the management of challenging behaviour

‘Safer Custody’ refers to the safeguarding of staff and detainees within the custodial system, from the moment of arrest to detention at police custody, court cells, prisons and all associated transport between.

I was a custody sergeant from 1996 to 2003 inclusive, then progressed to custody staff training and assessment, and joint police/prison custody planning. In 2012 I received a British Excellence in Performance Award for my contribution to ‘safer custody’ on a national basis.

The Criminal Justice System custody estate has progressed significantly since 1996 when custody was seen as a punishment for detainees.

Staffing was usually by newly appointed sergeants, as I was, or sergeants heading towards retirement, or being disciplined.

Safer Custody aims to prevent, or reduce to the minimum, deaths or injuries connected with self-harm, suicide, use of force, underlying medical conditions, head injuries, malicious or accidental incidents.

The whole custody process is holistically governed by the principles of ‘Safer Custody’, regardless of which institution, or agent, is providing the service to the detainee. Providing a common framework of understanding and care of the detainee and having the ability to share information via systems such as the PNC. (Police National Computer).

The same principles of ‘safer custody’ can apply to children within the care and custody of the education system, who may also be suffering from special educational needs and disabilities.

Safer custody covers a wide variety of issues for safeguarding the staff, the service users and others, which are applicable for police and prison custody, court cells and contractor transport companies, such as:

• Custody staffing, training levels, and paperwork • Risk assessment processes for condition of detainee / prisoner • High risk issues e.g. head injuries, positional asphyxia, excited delirium • Building risk assessments e.g. ligature points, alarm systems, fire safety • Information sources e.g. PNC, PER, • Health conditions and use of the health care providers • Control & restraint techniques and use of • Transportation e.g. fleet management issues, PECs (prison escort and custody services), • Management & supervision e.g. visits and rousing • Equality & individual needs e.g. females, juveniles, disabilities, foreign nationals • Healthcare & medication needs • Cell occupancy • Out of cells – exercise, showers or interviews • Hygiene e.g. bedding, toilets, clothing & cleaning • Food safety – choking assessments, food hygiene • Dependencies – alcohol, drugs • Mental health – assessments, medical needs, adaptations • Technology – CCTV, audio recording • Deaths or injuries in custody procedures

Custody officers and staff should be familiar with the signs or behaviours of a detainee that may indicate an increased level of risk and/or requirement for a higher level of monitoring.

Custody officers need to be aware of the enhanced risk of suicide and self-harm during periods of detention.

Detainees who are deemed to be a high risk of suicide or selfharm must be seen by a healthcare professional (HCP) and kept under close proximity supervision. This allows officers and staff to engage with the detainee and intervene if required.

Deaths in custody increase disproportionately during the early days in custody, with younger male prisoners being at increased risk and the larger demographic, however although women prisoners account for only 5.5% of the prison population they account for half of all self-harm incidents.

The governance of the education system may be easier to understand, but there are currently no national restraint techniques or principles of practice for safeguarding children in the education system and use of force on them. The Department of Education leaves it to each school to decide their approach to training and what systems they will implement.

I work with over 200 schools and there is little common understanding or application of systems, unlike the criminal justice custody systems. Schools are under immense pressure to reduce costs and often sub standard training is introduced to a school which is not tailored to the demographics of the child or staff.

This makes it unsafe and unfit for purpose. For example a child with downs syndrome is highly likely to have heart disease, respiratory disorders and hyper mobility of joints. Even special schools who should be the most knowledgeable in dealing with these children lack the understanding of risk associated with restraint and conduct too many restraints.

The emphasis in many schools is the application of restraints rather than the avoidance of restraints.

A current issue I am concerned with is the increase in creation of ‘calming rooms’ within the care and education sectors. With little national guidance service providers are creating ‘calming rooms’ which are not therapeutic and contain many ligature points plus the adopted practices of such rooms is dubious and potentially abuse and false imprisonment.

The cases I have worked on in the last 12 months include: • Prison custody suicides and self harm where staff have failed to identify risk factors and control measures for prisoners; • Prisoners being assaulted by other prisoners despite risks being reported to staff; • Custody staff being injured in assaults from prisoners due to staff shortages and failure to communicate risk; • Injuries to staff and service users from hand cuffs and other equipment; • School staff injured by children due to lack of training in de escalation and inappropriate restraint techniques; • Children being injured by excessive use of force by staff without any pro active attempts to manage down cases of violence; • Failure to identify ligature points in custody areas which have allowed the opportunity for prisoners to then self harm; • Security staff in a hospital restraining a person who died during the restraint • Inappropriate use of calming rooms I have worked for coroner, civil and criminal cases and deliver training and consultancy on these topics.

www.joannecaffreyexpert.co.uk / www.totaltrain.co.uk

Mr John H Scurr Consultant General and Vascular Surgeon - Senior Lecturer MBBS (Hons), BSc (Hons 1st Class) FRCS

Vascular Expert Witness Reports

John Scurr Medico Legal

Whilst the majority of clinical interventions result in a very satisfactory outcome, a few cases do not. In the majority of cases where a patient is dissatisfied the reason for this dissatisfaction may simply be a failure to understand the procedure or the lack of appropriate advice. Very few people start a medico- legal claim with the sole purpose of obtaining large sums of money.

It has been possible to identify patients with a significant claim and in some cases claims where the patient has suffered a life altering experience.

The first step in conducting a medico-legal case may be to obtain advice from a solicitor. Many solicitors are now experts in this area and will know who to instruct.

We are approached on a regular basis by people who are concerned about the validity of a claim and we are in a position to advise both on the validity of the claim and on the solicitor who can manage the case.

We are in a position to provide a simple case analysis which will identify the merits of the case and point a solicitor in the right direction. More detailed reports can be provided which are suitable for solicitors issuing proceedings.

John Scurr has had considerable experience in the preparation of all forms of reports, both clinical negligence and personal injury. He has appeared in Court on many occasions and many cases have been seen as highly successful. In some instances a successful case may not involve the Court at all but will involve a satisfactory resolution at an early stage.

John Scurr trained as a mediator and has considerable expertise in the preparation of Medico Legal reports both in the field of clinical negligence and personal injury.

For Medico-Legal issues please contact us initially on +353 1 2937863 and medleg2@ eircom.net.

John Scurr continues to provide a clinical service. He works closely with Mr Philip Coleridge Smith (another of our Federation members and expert witness) re the management of varicose veins.

Lister Hospital, Chelsea Bridge Road, London, SW1W 8RH Unit 509/510, Q House, 76 Furze Road, Sandyford, Dublin 18 Ireland Area of work: United Kingdom & Ireland Tel: 020 7259 0692 & 00 353 1 293 7863 Email: jhsgroup@hotmail.co.uk; medleg2@eircom.net

Federation of

Forensic & Expert witnesses

Q & A With Luke Meleagros No.145 MAY 2016 $21 80 PAGES

Expert Witness –Surgery – Luke Meleagros The saying 'health is wealth' is ever prevalent and so we place our trust in our GPs to correctly diagnose us so our recovery can rapidly come around; nevertheless, this is not always the case and when a patient believes they are a victim of clinical negligence, they turn to the law.

We speak to Luke Meleagros, an expert witness in surgery, who outlines the effects of misdiagnosis and how he provides insight to try settle a case involving negligence.

In cases of professional negligence, how long can it commonly take to complete an investigation?

In my experience knowing the time it takes between the solicitors requesting medical records and the time that they issue a claim, it can take anything up to 6 months and a year, because the claimant solicitors will have to review the medical records and interview the clients.

They then usually instruct the expert to provide them with reports. It is likely in some cases, the solicitor will instruct counsel as well, before they issue legal proceedings they will hold a conference with councils, experts and claimants, and when that is completed, and the case is reviewed, they will then issue a length of claim. It is a lengthy process which takes several months.

I know that you deal with a range of cases in a way, but can you specify a common case you tend to deal with on a regular basis?

In general surgery, a common case I deal with in professional negligence are complications of laparoscopic cholecystectomy, delaying diagnosis of appendicitis, complications of appendicitis, delay of the diagnosis of bowel cancer, complications following surgery of bowel cancer and delaying the diagnosis of these complications.

Can you think of reasons to why there are delays with diagnosis?

There are many reasons why there is a delay with diagnosis; for bowel cancer, the patients' symptoms may not be typical. The patient maybe falsely reassured when they visit their GP, who does not appreciate their symptoms are significant and attribute the symptoms to minor ailments, such as piles; piles are very common in the general population and the symptoms, such as bleeding, are similar to the symptoms of bowel cancer. Therefore, it is not uncommon for the GP to not refer the patient to the specialist early enough.

Another reason is because the patient is not referred to the appropriate investigation. The statistics in misdiagnosis say that it is possible to misdiagnose up to 2% of colonoscopies. Based on a negligence investigation the patient will then go away, and feel reassured that they have had their definite investigation i.e., a colonoscopy which was negative; they will then treat the patient for a different condition, such as Irritable Bowel Syndrome (IBS), which causes similar symptoms as bowel cancer. Thus, a year or two later, the patient returns to the doctor, and reports the same or worse symptoms and the investigation is repeated; this time the cancer would have grown and is usually picked up.

No.145 How often is your critical analysis the MAY 2016 game-changer in a claim? $21 80 PAGES I would say the expert report is crucial to the entire process, but it is not usually the case that an expert provides such an earth-shattering report, that the defendant will immediately put their hands up and immediately accept it; the defendant will always come up with their own report to counterargue, so the aim is to read the settlement which limits the pay-out as much as possible. A game changer I think, is a joint expert discussion; in a situation whereby the claimant and defendant obtain expert reports and provide diametrically opposing opinions on most of the major issues, their solicitors require the experts to hold a conference in order to respond to the disputed area. The weakest argument made by one of the experts is made apparent. Any expert can provide a supporting report and an argument for their instructed solicitors, the problem experts will have will be defending the arguments during discussion.

I have been involved in cases where a conference is held with the other experts to discuss the issues; the conference is held within a month of the trial and based on the issues and discussions that arise, the claimant eventually discontinues the case as they realise that the argument that they have provided will not allow

What makes you the go-to expert witness in this field?

It is important to appreciate that the solicitors do not have the expert scientific knowledge but are expected to draw conclusions on what happened; the expert has to provide a report that details and explains medical and scientific matters which can be quite complicated in layman's language. More importantly, solicitors need to understand the issues involved so they can ask appropriate questions to explore the issue further and clarify matters for them.

I have found that my value as an expert, the reason why I am instructed very frequently is because I can provide a summary of scientific and medical matters in language that can be understood by the solicitor. The other reason I think why I am a go-to expert is because I research this subject and refer to recent literature and quote relevant articles to support the arguments that I provide in my report.

Contact Details Call: 020 8527 0977

l.meleagros@btinternet.com jawdobson@gmail.com

Medical Expert Report Writing Emma Ferriman has been a Consultant Obstetrician since 2001. She graduated from Liverpool University in 1990 and is dually accredited in both Obstetrics and Gynaecology and is subspecialty trained in Fetal and Maternal Medicine. Emma Ferriman worked at The Leeds Teaching Hospitals NHS Trust as a Consultant Obstetrician and Fetal Medicine specialist from 2001 to 2015.

In November 2015 she was appointed as a Consultant Obstetrician with a special interest in Fetal Medicine at The Jessop Wing, The Royal Hallamshire Hospital, Sheffield. Emma Ferriman has a private practice in antenatal ultrasound and first trimester screening at Thisismy Health and Ultrasound Screening Centre in Leeds.

Emma Ferriman is a member of the British Maternal and Fetal Medicine Society (BMFMS), British Association of Perinatal Medicine (BAPM) The British Medical Ultrasound Society (BMUS) . She is listed on the UK register of expert witnesses and is a member of The Society of Expert Witnesses (SEW).

Emma Ferriman undertakes medical negligence and personal injury reporting within the United Kingdom. Currently cases are split approximately 50/50 between plaintiff and defendant. Areas of special interest include prenatal diagnosis, first trimester screening, multiple pregnancy and high risk obstetrics including intra partum complications and asphyxia.

Fees are charged at ÂŁ200 per hour or part hour of medical time, ÂŁ500 for a screening/desktop report and six hours work for a full report.

Electronic records accepted. Simple reports vary from 2 to 4 hours work whereas more complex reports may be 7 to 8 hours work.

The time for completed reports is usually four to six weeks from the date of receipt of the full medical records.

To enquire about instructing Emma Ferriman, solicitors and medico-legal agencies should first contact emmaferriman@doctors.org.uk or call on 0113 262 1675 to request a copy of the Terms and Conditions.

Please note that all fees are payable within 56 days of receipt of the completed report.

Mr Richard Matthews

MB BS(London) FRCS(Eng) FRCS(Edin)MAE Consultant Cosmetic & Reconstructive Plastic Surgeon

Member of The Academy of Experts and a founder member and former President of the Warwickshire Medico-Legal Society, Mr Matthews has great experience in preparing Medical Reports for Solicitors for clients who have suffered personal injury, frequently taking instruction on a Single Joint Medical Expert basis. He also provides professional advice in cases of alleged medical negligence within his sphere of medical expertise.

Personal Injury

Issues associated with:

All soft tissue injuries of the upper limb and hand Soft tissue injuries of the face Soft tissue injuries of the body Scarring Burns, scalds and thermal injuries Clinical Negligence Issues associated with: Soft tissue damage from trauma, including burns, scalds & thermal injuries Soft tissue damage from disease Tissue loss &/or scarring arising from medical or surgical actions Skin Cancer Surgery General Plastic & Reconstructive Surgery Cosmetic Surgery

Professional Memberships, Fellowships & Registrations The Academy of Experts UK Register of Expert Witnesses The Federation of Forensic & Expert Witnesses British Association of Plastic, Reconstructive & Aesthetic Surgeons (BAPRAS) British Association of Aesthetic Surgeons (BAAPS) British Society for Surgery of The Hand (BSSH) British Burn Association (BBA) Royal College of Surgeons of England Royal College of Surgeons of Edinburgh General Medical Council (GMC) Specialty Register for Plastic Surgery Professional Indemnity: The Academy of Experts

Mr Richard Matthews is a highly experienced Consultant Cosmetic & Reconstructive Plastic Surgeon. After qualifying as a Doctor at St Thomas Hospital Medical School in London, Mr Matthews trained widely in General Surgery, Orthopaedics, Urology and Paediatric Surgery before commencing his career in Plastic Surgery, progressing through five Regional Centres for Burns & Plastic Surgery, absorbing the art and craft of cosmetic and reconstructive plastic surgery. This included two years as Burns Research Fellow at the renowned Queen Victoria Hospital and Blond-McIndoe Research Centre at East Grinstead, during which he had notable papers published on the management of burns in pregnancy and the use of amniotic membranes for wound healing.

He became fully accredited in Plastic Surgery, including Cosmetic and Reconstructive aspects, in 1984, was European Travelling Scholar of The British Association of Plastic Surgeons (now called BAPRAS) in 1985 and was appointed Consultant Plastic Surgeon in the National Health Service for Coventry & Warwickshire (catchment: 1 million) in 1986.

From 1986 to 2006, when, as Head of the Unit, he effected its transfer to the new University Hospital for Coventry & Warwickshire, he radically modernised and expanded the Plastic Surgery Unit, introducing modern techniques and services for congenital abnormalities, such as cleft lip & palate and abnormal hands, for soft tissue diseases of the hand, such as Dupuytren’s contracture, for Breast Reconstruction and Head and Neck Reconstruction in cancer cases, including microsurgical procedures, and worked hard to improve standards of care for skin cancer.

He served for four years as the first Chair of the Skin Cancer Site Specific Group of the Arden Cancer Network.

Mr Matthews has been West Midlands Regional Chair for Burns & Plastic Surgery and Regional Specialty Advisor to the Royal College of Surgeons of England and has served variously as Clinical and Medical Director within the NHS. Mr Matthews has over 30 years’ experience as an Expert Witness in his specialist field, preparing on average 60 Medical Reports a year, 40% instructed by the Claimant’s solicitor, 40% instructed by the Defendant’s solicitor and 20% as a Single Joint Expert.

Mr Matthews keeps up to date by attending Professional Association meetings and other CPD events, such as The Academy of Experts one day Seminars, as well as reading relevant Journals and the ‘Your Witness’ newsletter of the UK Register of Expert Witnesses. His election to The Academy of Experts recognised his wealth of experience and expertise.

T:: 01926 436341 fax: 01926-422659 E: Sally.Bates@nuffieldhealth.com W:www.richardmatthewsplasticsurgeon.co.uk

Mr Simon Bramhall MD FRCS Consultant HPB Surgeon While working at the Queen Elizabeth Hospital in Birmingham in 2010, leading liver expert Simon Bramhall was involved in the dramatic transplantation of a liver that had been on board a private jet that crashed in fog at Birmingham International Airport en route to the hospital.

According to Mr Bramhall, the recipient would ‘certainly have died’ without the liver, which mercifully survived the crash unscathed.

With around 10-15 instructions per year as an expert witness in his specialist area, which covers the whole spectrum of liver, biliary and pancreatic surgical matters, Mr Bramhall carries out medicolegal work in criminal cases in addition to medical negligence work. His client base is reasonably evenly split between claimant and defendant.

Mr Bramhall was a consultant surgeon at the liver unit of Queen Elizabeth Hospital between 2002 and 2014, performing liver transplantation, pancreatic cancer surgery and liver surgery. He is now a consultant general/upper GI (HPB) surgeon.

In addition to his surgical duties, Mr Bramhall has been involved in tutoring and examining medical students and supervising postgraduate students in higher degrees, management and research.

He has published peer review papers, abstracts and book chapters and also has given presentations and invited lectures nationally and internationally.

He is a member of the West Midlands Surgical Society, the Midland Gastroenterological Society, the Association of Surgeons of Great Britain and Ireland and the Association of Upper GI Surgeons.

Mr Simon Bramhall T: 07976 278549 E: bramhalls933@icloud.com

Dawn Cragg

MBE - BABTAC, CIDESCO, CPCP, BASC, Expert Witness.

Dawn was appointed a Member of the Order of the British Empire (MBE) in the New Year’s 2010 Honours List for her outstanding work in developing Medical Tattooing as a service to healthcare.

Micropigmentation treatments provide cosmetic enhancement of the eyebrows, eyeline and lipline by the subdermal implantation of tattoo pigments. It is also used to provide post-surgical treatments to re-define areole, to camouflage scar tissue, for hair re-placement treatments and to provide eyebrows and eyeline for sufferers of Alopecia.

Micropigmentation Training Initial micropigmentation training in Paris - 1983 Society of Permanent Cosmetic Professionals (S.P.C.P). Qualified Practitioner Member, Subject Matter Expert, C.P.C.P. Subject Matter Expert & Accredited Teacher since 1996.

British Association of Skin Camouflage. (BASC) Diploma awarded 2003 Bond Solon/University of Cardiff Expert Witness Training completed 2004 Since 1996 Dawn has achieved a recorded history of continuing education and training in micropigmentation, having attended various conferences.

History of Tattooing Tattooing has been practiced across the globe since at least Neolithic times, as evidenced by mummified preserved skin, ancient art, and the archaeological record. It was Captain James Cook, a British explorer, who first coined the word ‘tattoo’ when describing a Polynesian practice of inlaying black pigments under the skin. Traditionally associated with sailors and convicts, artistic tattoos are widespread in today’s society.

History of Permanent Make-Up In the early years Queen Cleopatra in ancient Egypt and some women in India and Africa had sought permanent eye enhancement with various substances . They used plant and nut pigments or ground coals (carbon) to color eyeliners or eye shadows and inserted them through the skin around their eyes with any sharp implements, usually flint that had been filed to a sharp point. This is where permanent make-up, as we know it today, originated.

What Is Permanent Make-Up? In modern times permanent make-up (micropigmentation) is the implantation of colored pigments under the surface of the skin, using a very fine needle or group of needles, via a hand-held manual device or an electrically driven handpiece. This is a cosmetic procedure personally chosen by the technician and the client to enhance facial features such as eye-brows, eyes, and lips on normal skin.

What is Medical Tattooing?

As far as the author is aware there is no historical evidence that attempts were made to cover scars in the early days. However in modern times the awareness of medical tattooing to aesthetically improve the appearance of any part of the skin is rapidly gaining acceptance from medical practitioners,

permanent makeup technicians and patients. Medical tattooing is used to reconstruct features such as lips (possibly due to cleft lip or mouth cancer) or eyebrows (due to hair loss or alopecia) and to replace the areola following mastectomy. Many people will have heard of nipple reconstruction although it is quite disappointing just how many patients who would have benefited from this procedure were not offered medical tattooing. An example would be if a patient’s nipple could not be grafted onto the new breast mound. This applies to all genders.

Non-infectious skin conditions and scarring have many causes including hereditary and congenital (present from birth). Medical tattooing can cosmetically improve scars that are not darker than the surrounding area of skin e.g. following accident trauma, violence, disease, or interventions such as plastic and cosmetic surgery, radiation therapy, and endoscopic surgery. In cases where the scar is darker than the surrounding area then camouflage creams that are specifically manufactured to cover skin blemishes can be applied.

The age of the scar, type, color, condition, and the health of the skin surrounding the area to be treated, as well as the underlying health and age of the patient will affect the pigment color and technique used. All will influence the outcome, as would patient compliance with aftercare. The composition of scarred skin, different types of scars, and how the scars themselves react to medical tattooing are further considerations.

For example, scar tissue due to burn injury will absorb more pigment and may require several medical tattoo sessions to achieve an acceptable outcome. After the initial treatment, the pigment will fade over time. In fair skin (Fitzpatrick skin type I and II) once the pigment has faded, the residual color will tend to be even lighter because of the need for titanium dioxide (white) to mix the color. Consequently, frequent retouches will be necessary, possibly on an annual basis. Variegation in the skin caused by freckles and capillaries, for example, should be added on the final visit; the skin must have fully healed between appointments.

Healing will take approximately 1 month on young and healthy skin. On mature skin, approximately 2 months should be allowed between treatments. Healing affects the ultimate color as it requires a layer of skin to grow over the tattooed area; therefore, the pigment will appear lighter over time.

Application Techniques Scratch-tests and Patch-tests.Scars are very unpredictable and different areas of the same scar can respond differently to the pigment.When using both glycerin-based and water-based colored pigments on several areas of a scar a skin test is essential to determine the reaction to the pigment. A scratch-test is applied underneath the skin to establish which shade of pigment will heal to the color required.

This method should be used 4 – 6 weeks prior to the first procedure. Only a very small area should be tested.Patch-tests procedures are used at the consultation prior to the procedure to check for any allergic reaction. A small drop of pigment should be applied topically, covered with an adhesive dressing, (assuming the client has no allergy to plasters) and left in place for 24 hours. The patch test should also include the anaesthetic that will be used during the procedure. If the area becomes irritated, the dressing should be removed immediately and the skin cleansed. In this case tattooing should not proceed. This method of testing is normally used for cosmetic tattooing, e.g. eyebrows, eyeliner, and lips, where the client can discuss with the technician which color to choose.Medical tattooing is a process not a procedure, therefore frequent re-touches will normally be required, sometimes but not always, on an annual basis.

This is most likely for lighter skin-tones (Fitzpatrick skin-types I & II).The technician requires skill, artistry, and color experience to match the area to be treated. In order for the tattooing to naturally blend in with the surrounding skin the illusion of variations must be added. For example freckles, moles, capillaries and small red Campbell de Morgan spots, which are small benign tumours containing an excess of blood vessels (sometimes referred to as Cherry Angiomas). The quantity of the spots can increase as the patient ages, therefore the skill of re-creating them is essential for a medical tattooist. Pigment is applied using a circular, back and forth, or hair stroke motion, depending on the area worked. Shading is applied using a flat needle configuration and working through a very thin layer of petroleum jelly. Stippling is the application of small dots with a fine round needle. Working in natural daylight is important. If this is not possible, then daylight bulbs may be used. Work should never be attempted under artificial light. Color application should be conservative initially, and can be adjusted on subsequent visits. This is because one cannot be sure how the pigment is going to heal into the skin, and it is easier to add more color at the second appointment.

Who Can Perform Medical Tattooing and Where Although medical tattooing will use the same products and techniques as micropigmentation, the technician will require additional training because of the nature of working on scar tissue, rather than normal skin.A Medical tattooist should firstly should have had thorough training, subsequent on-going experience in cosmetic tattooing, and have a background in beauty therapy or relevant medical experience. A knowledge of the formation and causes of the various types of scar tissue is essential. If it is not possible to attend classes on this subject there are now many very good on-line courses in dermatology available. It is essential that technicians are highly skilled and qualified in medical tattooing before they accept clients or patients.

Because of lack of understanding and tattoo techniques, inexperienced and undertrained practitioners can cause damage to the scar, including permanent hypopigmentation. In addition, post-treatment hyperpigmentation can occur when tattooing patients with Fitzpatrick skin types IV, V, and VI. In many countries the cosmetic tattooing industry is unregulated and without thorough training to a high standard (i.e., from a recognized training authority). Therefore expertise is potentially highly variable and insurance is difficult to obtain. A patient seeking treatment in any country can contact the SPCP (Society of Permanent Cosmetic Professions) via their website spcp.org. They have a list of trained technicians worldwide who meet the very high standards in cosmetic and medical tattooing as required for membership.

Medical tattooing can be applied to all areas of the body, apart from the genitalia. This is because if a patient were to claim they had lost physical sensation, or if infection developed in that area, it would be nearly impossible to prove this was not caused by medical tattooing. Therefore it is unlikely to be covered on a technician’s insurance. Technicians generally work from hospitals and clinics, though they may work from other premises provided that they have been inspected and licensed by their local authority.

Products Used Although medical tattooing will use the same products and techniques as micropigmentation, the technician will require additional training because of the nature of working on scar tissue, rather than normal skin.Good quality pigments must always be used and safety data sheets should be obtained from the distributors.

Pigments used to camouflage scars to a natural skin tone for Fitzpatrick skin types I to IV are mainly highquality medical-grade products based on titanium dioxide. This is in contrast to pigments used in cosmetic micropigmentation, where the darker colors are more likely to have an iron oxide base. Color washes (diluted pigments) are a very important part of medical camouflage as well for blending the edges of scars or areolae.A digital machine is preferable because the power source is stable. Battery-operated machines are not recommended because battery power is affected by temperature and humidity and the speed would not be constant. The machine must conform to the regulations of the relevant country. For example, in the United Kingdom all machines should conform to European Union regulations. The CE mark (Conformité Européene) indicates the manufacturer’s declaration that the product meets the requirements of the EC (European Community) directives. Needles must be sterile, disposable (single use), pre-packaged, color coded for easier size identification, packaged with plastic needle guard tubes, and compliant with health authority requirements.

Single needle - should be used with great caution because of their sharpness and fineness. It is easy for an inexperienced technician to penetrate the skin too deeply as the skin will feel no resistance. This may cause the pigment to migrate. This migration may not be visible immediately, but may be evident after a few months.

Double needle - two single needles close together and therefore, as with the single needles, not recommended for general use.

Triple needle - a cluster of three; the most useful needle for creating the outline for lips and freckles.

Flat needles - a row of needles in a line varying upwards from four needles. They are the perfect choice for eyebrow hair strokes, if used correctly, at right angles to the skin. When used this way with a sweeping motion, they are ideal for camouflaging larger areas of skin.

Round needles - five or more are best used to treat a large area of skin approximately 2 cm2 & above.

Magnums - used for shading, blending, and colouring large areas and are therefore very suitable for medical tattooing. Because of the amount of pigment that flows through, less passes are required, limiting skin damage.

Anaesthetics Used in Permanent Make-Up and Medical Tattooing Most countries have regulations regarding the use of topical anaesthetics used in tattooing. Technicians should only use products that are licenced and legally available in their country and read the instructions for each product before use.

When is Medical Tattooing Considered Appropriate?

Medical tattooing offers a long-lasting alternative to the daily chore of applying camouflage products. The professional judgment of the client’s dermatologist, or medical practitioner is required to evaluate whether the use of laser, acids, or hydroquinone will lighten hyperpigmentation, or if medical tattooing is warranted.

Tattooing is useful for cases where conventional methods are not indicated; e.g. when nipple surgical reconstruction is not achievable, or when a scar is healthy and without erythema and therefore would improve with additional laser treatment. Scars that will not benefit from surgical revision because of potential uneven color distribution often present a good outcome when tattooed. Hypopigmented scars generally look better with color, even if not a perfect match. Medical tattooing can disguise scarring resulting from the donor site of hair transplant surgery, also small scars following an accident or surgical procedure. The client must agree to the selected color before proceeding with the treatment. This is achieved by placing the pigment next to the area requiring the tattoo. Clients must be advised that initially the tattooed area will appear darker but should settle to the selected color in approximately 4 weeks. The design and shape of the tattoo must also be agreed before proceeding. This is most important for eyebrow and lip replacement as fashions frequently change and the tattoo could become ‘dated’ (compare the 1940’s thin arched eyebrow line to the modern thicker and fuller shapes of today).

Contraindications • • • • • • • • • • • • •

Either a patch (on top of the skin) or scratch (under the skin) test must be undertaken 24 hours before the planned tattooing. A 28-day patch test may be required for organic pigments.

Failure to do so may invalidate insurance.

People who are prone to hypertrophic or keloid scarring.

Scars from burns need to be mature and completely healed prior to medical tattooing. The physician’s written consent must be obtained to proceed.

Any area of skin that has a suspicious lesion, especially indicating potential skin cancer.

Skin types IV, V, and VI (Fitzpatrick scale) can result in hyperpigmentation.

Scars less than 6 to 12 months old.

Patients who are pregnant or breast-feeding.

Patients with skin grafts, without prior written consent from the doctor Patients with insulin-dependent diabetes, without prior written consent from the doctor.

Patients with abnormal heart conditions, without prior written consent from the doctor.

Patients with body dysmorphia are likely to have unrealistic expectations.

Suntan (fake or natural).

Some drugs may change the color of the skin; the person is advised to wait until the course of medication is completed and the physician gives permission for medical tattooing to proceed.

dawncragg.net

Cancer A cancer patient is not contraindicated, neither is chemotherapy as long as there is written medical consent from the doctor.

Vitiligo patients are not contraindicated providing written consent is obtained by a Dermatologist or Doctor Risks The following potential risks must be fully explained to the person before they agree to any medical tattooing.

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Hyperpigmentation can occur when tattooing Fitzpatrick skin-types IV – VI. Hypopigmentation can be caused by incorrect needle insertion.

Successful results cannot be guaranteed.

Allergy to pigments.

Allergy to the aftercare product used immediately post-procedure.

Allergic reaction to topically applied anaesthetic products such as lidocaine, prilocaine, and tetracaine.

Swelling, bleeding, crusting, nipple flattening and infection.

Skin changes color according to many internal and external factors (e.g. medication and sun).

Pigments will remain in the skin indefinitely, but will break down and fade with time.

Tattoos that are frequently exposed to ultraviolet light will fade more quickly than those hidden by clothing.

Reactions to any type of tattoo can occur many years after the procedure was carried out.

Needles inserted too deeply can cause bleeding, migration of pigment, and damage to hair follicles.

Overworking the area can result in scarring.

Results are not instantaneous.

Scarred skin is unpredictable and reacts differently than undamaged skin. Results can be inconsistent across the scarred area.

Unrealistic expectations; scars can only be disguised, not removed.

Patients with body dysmorphia may have unrealistic expectations.

Hyperpigmentation is not resolved by tattooing a lighter color over the area, as the needle may cause further hyperpigmentation.

Natural excessive melanin distribution, such as freckles and lentigines, will respond differently when tattooed.

Micropigmentation and medical tattooing is not an exact science, therefore results cannot be guaranteed

Before and After Photographs of Medical Tattooing

Web toes before Micropigmentation treatment.

Vertical pigment line using micropigmentation gives appearance of shadow.

Before and After Photographs of Medical Tattooing Scar From Eyebrow Lift

Scar on the front of client’s forehead.

A series of dots applied in a dark brown exactly matches his hair.

Scar Camouglaged And Eyebrow Reshaped

This high-profile lady had a brow lift which resulted in a scar through her eyebrow.

The scar was camouflaged by “raising” the eyebrows using medical tattooing.

This patient had harmed herself with a razor blade, having many scars up her arm. The first photo shows the result of a skin-scrape assuming the scars would be removed and the skin would grow back unblemished.

Unfortunately it did not work. The second photo is the healed skin after the surrounding area has been matched using different shades of brown to create freckles of various sizes.

An EXCELLENT example of looking ‘outside-the-box’!

MALE LIPS - SKIN TRAUMA Before

POST-MASTECTOMY

Befoere treatment

After Micropigmentation

(Note artistic touch - Veins)

After

This gentleman had a habit of biting and picking the skin on his lips, resulting in pigment loss caused by scarring. Pigment was tattooed in to match the surrounding unaffected skin

Artificial nipple was created during reconstructive plastic surgery.

This client had veins showing on the breast that had not been operated on, so the other was tattooed to match.

Copyright photographs by Dawn Cragg MBE. All tattooing and makeup applied by Dawn Cragg MBE.

London Spine & Pain Centre • 83a Bexley Road • Erith • London • DA8 3SW

DR NORMAN KUFAKWARO MB CHB, FRCA, FFPMRCA CONSULTANT IN PAIN MEDICINE & NEUROMODULATION

07761 487443 • norman@spineandpaincentre.com • www.spineandpaincentre.com Dr Norman Kufakwaro is a pain consultant who trained at Barts and the London School of Anaesthesia and Guys & St Thomas’ Hospital. His training included complex pain procedures including spinal cord stimulation, dorsal root ganglion stimulation, intrathecal pumps as well as procedures for disc pain.

His main interests are spinal pain, sciatica, nerve pain, cancer pain, chronic headache, abdominal and pelvic pain. He specialises in management of a wide array of chronic pain conditions using latest techniques in pain management.

Areas of expertise include: • Pain Management • Diagnosis of painful conditions.

• Treatment of painful conditions.

• Establishing causality and prognosis of chronic pain conditions (including complex regional pain syndrome.)

• Effects of injury on ability to work.

• Physical symptoms following trauma.

• Recommendations for treatment to facilitate rehabilitation.

• Regular clinics for difficult pain conditions.

• Complex regional pain syndrome.

• Persistent post surgical pain.

• Low back pain.

• Neck pain.

• Whiplash.

• Persistent post injury pain.

MR. ATUL KHANNA MBA, MBBS, FRCS, FICS, Dip EurB (Plast) FRCS (Plast)

Consultant Plastic, Reconstruction & Hand Surgeon & Expert Witness MR ATUL KHANA trained in general surgery from l983, when he qualified, to 1989. After which he decided to undertake specialist training in plastic, reconstructive and hand surgery, as he explained in a recent interview: “I have been in Consultant practice since 1998 and have been a Consultant Plastic Surgeon at Sandwell General Hospital since June 1999. My work involves the treatment of all types of hand injuries, burns, facial and soft tissue injuries, elective hand surgery, breast surgery, scars and deformities, skin cancer and cosmetic surgery.

Mr Khanna holds membership to a number of leading organisations including being a member of the Society of Expert Witnesses, the British Association of Plastic Surgeons, the British Association of Aesthetic Plastic Surgeons and the British Burns Association. Mr. Khanna has also written a chapter for the Encyclopeadia of Forensic & Legal Medicine entitled “Medical Malpractice in Cosmetic and Plastic Surgery”

Mr Khanna’s qualifications are as follows: M.B.B.S Osmania University July 1983 F.R.C.S. Royal College of Physicians and Surgeons of Glasgow November 1989 F.I.C.S. International College of Surgeons June 1994 M.B.A. Open Business School, Open University December 1994 F.R.C.S. (Plast) Intercollegiate Board in Plastic Surgery March 1997 Dip. Eur. B( Plast) European Board of Plastic Reconstructive and Aesthetic Surgery (EBOPRAS) November 1998 For more than a decade now Mr Atul Khanna has combined his work as a Consultant Plastic Surgeon with the professional services he provides as an Expert Witness working on Medicolegal cases for which he has provided Solicitors with over 2100 medical reports over the last 10 years. Cases undertaken by Mr. Khanna have predominantly dealt with 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

“When acting as an Expert Witness I understand that my duty to the Court is to provide independent assistance to help the Court on the matters within my expertise. I appreciate that this duty overrides any obligations to those by whom I have been instructed or by whom I am paid. In preparing medical reports I strive to be accurate and complete, having mentioned all matters which I regard as relevant to the opinions I have expressed; all of which lie within my field of expertise.”

T: 0121 507 3455 - M: 07880 797 235 - E: atulkha

The Case Study below is a typical example of the work undertaken by Mr. Khanna as an Expert Witness: This report is entirely independent and has been prepared for the court on the instructions provided by Solicitors following an injury sustained by Mr Smith on the 23.1.2000 and details his treatment, condition and prognosis.

Mr Smith was 45 years old at the time of the injury and now is 46 years old. His occupation at the time of the injury was that of an extrusion operator. His occupation now remains the same. His hobbies at the time of the injury were playing golf. His hobbies remain the same. Mr Smith is right handed.

This report is based on an interview and examination of Mr Smith carried out on 7.5.2002 at Sandwell Healthcare NHS Trust, Lyndon, West Bromwich, West Midlands B71 4HJ. No one was present at the time of the interview.

SUMMARY OF INSTRUCTIONS I have been asked to examine Mr Smith and prepare a full and detailed written report, dealing with relevant pre accident medical history, the injury sustained, treatment received and the present condition, in particular with the capacity for work and giving a definitive prognosis.

EXAMINATION The examination I carried out was specifically for this report and was confined to an assessment of the scars and deformity that Mr Smith has following the injury he sustained on the 23.1.2000.

COMMENTS AND PROGNOSIS Summary One year four months ago Mr Smith sustained an injury to his left middle finger while at work. This was a crush communited injury affecting the distal phalanx and the nail bed. This was treated with dressings for four weeks following the injury. He was off work for five weeks following the injury. He required regular analgesia for six weeks following the injury and not partake in his hobbies for two months following the injury. Currently he has problems with pins and needs while in the cold. He is concerned about the appearance of his left middle finger and has hyper extension of his left middle finger.

Comments Regarding injury to left middle finger and treatment recommendations Mr Smith sustained a significant crush injury to his left middle finger. This resulted in a communited fractured of the distal phalanx and an injury to the nail bed as well. This was treated with dressings.

Regarding employment prospects and hobbies Mr Smith was unable to return to work for five weeks following the injury. He currently manages in the same capacity. If he were to lose his current job he would not be at a disadvantage on the labour market unless he had early progression of arthritis in his finger. Mr Smith is an avid golfer. He manages to play golf but following a game has pain in his left middle finger. He does however manage to soldier on and this injury has not yet affected his handicap.

At the time of signing the report I consider it to be complete and accurate. I will notify those instructing me if, for any reason, I subsequently consider that the report requires any correction or qualification.

I believe that the facts within my own knowledge which I have stated in this report are true and that the opinions I have expressed are correct.

anna@doctors.org.uk - W: www.atulkhanna.co.uk

Mr Aidan Fitzgerald Consultant Plastic Surgeon, Reconstructive & Aesthetic Surgeon & Expert Witness

Based in Sheffield at the Royal Hallamshire Hospital, Mr. Aidan Fitzgerald MB ChB M Plastic, Reconstructive & Aesthetic Surgeon, but also as an Expert Witness in case Aidan’s area of expertise for his Private Practice lies in Breast and Body contouring surgery, Aesthetic Facial Rejuvenation, Skin cancer. Added to this Aidan’s NHS patients are able to take advantage of his skill in Head & Neck Surgery, Facial Reanimation Microsurgical Reconstruction, Body Contouring (post weight loss), as well as Skin Cancer.

Aidan boasts a wealth of practical experience, together with academic qualifications; including gaining an MB., Ch.B. (University of Liverpool) 1988 M.Phil. (University of Bradford) 1998 FRCS (Edinburgh.) 1993; FRCS (Glasgow.) 1993 ; FRCS (plastic surgery) 2001 Professional bodies Full member of the British Association of Plastic Reconstructive and Aesthetic Surgeons General medical council no. 3352580 Aidan took a higher research degree, going on to obtain an M.Phil. from the University of Bradford in 1998. After which he undertook higher surgical Training in Scotland involving placements in Edinburgh and Glasgow, following which he obtained FRCS (Plastic Surgery) in 2001, as he explained in a recent interview: “Subsequent to this I spent a year each in Melbourne - Australia and Toronto - Canada gaining further experience in Reconstructive and Cosmetic Surgery of the Breast and Head and Neck, before returning in 2003 to Sheffield with my wife and children.”

In his present post as a Consultant Plastic Surgeon at the Sheffield Teaching Hospitals NHS Trust, Aidan is able to draw on his experience and skill in the field of reconstructive microsurgery, facial reanimation and the treatment of skin cancers.

“I would be delighted to be consulted on any question of cosmetic surgery in the areas of breast surgery such as augmentation, reduction or uplift; body recountouring. Together with other areas such as liposuction or abdominoplasty and facial rejuvenation including blepharoplasty or facelift. I would also be delighted to be consulted concerning minor skin blemishes such as moles or cysts, as well as skin cancers that may require excision.”

MPhil FRCS(Plast.) has achieved an impressive reputation not only as a Consultant es of Personal Injury Claims & Clinical Negligence in Plastic & Cosmetic Surgery.

A Full Member of the British Association of Plastic, Reconstructive & Aesthetic Surgeons, as well as being on the GMC Specialist Register for Plastic Surgery No: 3325803, Aidan undertakes medicolegal reports both in the areas of Personal Injury and Medical Negligence; with his medical negligence work being split 50:50 between claimant and defendant.

Aidan has the facility to see clients both adults and children for medico-legal work in Sheffield, Doncaster, Nottingham, Leeds London and Manchester at the following venues: • 10 Harley Street, London • Sheffield – Claremont Hospital • Doncaster – Park Hill Hospital • Nottingham – Russell Square Consulting Suites • Leeds – Nuffield Hospital • Manchester – Calderbank Medical Chambers “For those clients unable to attend hospital I am happy to arrange a ‘home’ visit which would usually take place within a few weeks of receiving instruction and I would expect to complete a report for the client within 2-3 weeks.”

Mr Aidan Fitzgerald Consultant Plastic Surgeon MB, ChB, M.Phil, FRCS (Ed), FRCS (Glas), FRCS (Plast) Please contact via E mail E: ampfitzgerald@hotmail.com

Mr Fortune Iwuagwu

Consultant Plastic, Reconstructive and Hand Surgeon.

On finishing his basic surgical training, Mr Iwuagwu embarked on training in all aspects of Plastic and Reconstructive surgery in various internationally recognised units in the country including Billericay (now Chelmsford), Manchester, Nottingham and Bristol.

He furthered his training in his chosen subspecialty (Hand Surgery) as the British Society of Surgery of the Hand Fellow in the highly reputable Hand Unit in Chelmsford.

He later undertook a Hand and Microsurgery Fellowship in the world recognised Kleinert and Kutz Hand Surgery Centre, Louisville , Kentucky USA where he trained under Dr Harold Kleinert recognised as one of the fathers and pioneers of modern hand surgery.

Mr Iwuagwu was appointed a Consultant Plastic, Reconstructive and Hand Surgeon at the St Andrews Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford and the Whipps Cross University Hospital, London in 2002. St Andrew’s centre is the regional centre for plastic surgery and has one of the busiest hand trauma units in the country dealing with all aspect of hand trauma and post trauma sequelae.

His main interests are: * Hand trauma * Post hand trauma reconstruction * Breast reconstruction and scars

Special interests: * * * * *

Scars Burn scars Hand injuries Soft tissue reconstruction Cosmetic surgery

He also performs a significant amount of general plastic surgery.

Qualifications MBBS University of Nigeria 1986 MSc University College London 1996 FRCS Royal College of Surgeons of Edinburgh 1993 FRCS Royal College of Physicians and Surgeons of Glasgow 1993 FRCS (Plast Surgery) Royal College of Surgeons of Edinburgh 2000

Medico-legal Experience: Mr Iwuagwu has been preparing medico-legal reports for medico-legal agencies and solicitors for more than 14 years. He prepares approximately 100 medical reports a year. The distribution is approximately claimant (80%) to defendant (20%). From instruction to completion of report is approximately three weeks if the client and medical records are available for examination/review.

Mr Iwuagwu has undertaken specialist expert witness training.

Mr Iwuagwu has attended the Bond Solon course - Excellence in Report writing Written Evidence in June 2011 and, the Premex annual Clinical Negligence seminar in June 2016.

Essex, London and Nationwide

Membership * * * * * *

British Society for Surgery of the Hand, British Association of Plastic,Reconstructive and Aesthetic Surgeons, Expert Witness Institute, Society of Expert witnesses, Association of Personal Injury Lawyers (APIL), The Federation of Forensic and Expert Witnesses

Please contact Lisa for further information T: 01277 219752 | M: 07508 824858 | F:01277 219752 Email: austingracesuk@aol.com | Website: www.austingraces.com

MR. WILLIAM STUART HISLOP

BDS MBChB FRCSEd FFSTEd FDSRCSEd FDSRCPS Not only has Mr. William Stuart Hislop BDS MBChB FRCSEd FFSTEd FDSRCSEd FDSRCPS built-up an impressive reputation over the past 20 years working as a Consultant Oral and Maxillofacial Surgeon at Crosshouse Hospital, Kilmarnock and now at the Queen Elizebeth University Hospital in Glasgow but he is also fast becoming acknowledged as a highly experienced, reliable Expert Witness; carrying out around thirty reports per year for both defence and prosecution, as well as producing reports for injury and negligence cases.

Having gained a Medical Degree from Bristol University in 1987 and a Dental Degree from Dundee University in 1978, Mr. Hislop is able to combine his extensive academic training with the practical experience he has gained working at the cutting-edge of surgery in Scotland.

Specialising in head and neck ablative and reconstructive surgery for malignancy, salivary gland surgery, together with facial aesthetic and cancer surgery, Mr. Hislop is highly experienced in dealing with facial trauma; having carried out over 500 microvasular cases in his career.

Mr. Hislop added: "Within the west of Scotland I also carry out surgical dermatology for skin cancer and deal with facial trauma, as well as dental implants and dento alveolar surgery. I also have previous experience in orthognathic and tempopro mandibular joint surgery."

The diagnosis of skin cancer and its corresponding treatment has recently come under new guidelines. Individuals must now be seen within two weeks of the identification of a suspicious ulcer. Keeping up to date with changes in legislation and medical procedures, Mr. Hislop is aware that this may represent a fresh challenge to the medico-legal work of expert witnesses.

A Member of the British Medical Association; British Association of Oral & Maxillofacial Surgeons and the British Association of Head & Neck Oncologists, Dr. Hislop has undertaken the position of Honorary Clinical Senior Lecturer at the University of Glasgow for more than two decades.

In a recent interview Dr Hislop outlined what it takes, in his opinion, to provide the very best service as an Expert Witness: "When being called upon to act as an Expert Witness there is no substitute for experience and obtaining extra qualifications. Experience allows work place gathering of information over a career lifetime that informs decision making.

This can be used in the clinic operating room or courtroom. Extra qualifications show that reading and gathering of knowledge in the specialist area has been undertaken. This means that all clinical; and legal decisions are underpinned by a thorough knowledge of the specialist area."

Medico-legal Practice

"It's vital to instruct an Expert Witness at the beginning of an investigation/legal case, as this allows the expert to be available for advice from the start. There are numerous cases that are unlikely to be successful and having the expertise initially may save clients time and money."

"I currently carry out approximately thirty MedicoLegal Reports per year for both defence and prosecution, attending court once a year on average. It is important when being instructed that you do not forget that you act for the court and giving a balanced report reduces the need for court attendance. I work for the prosecution and defence equally."

"Being involved before the case has been submitted to the courts has proved to be very helpful.

One of the common problems I see is the uncertainty as to whether the matter is a failure in the duty of care by lack of consent or by negligence."

Case Study: "I was asked to see a lady who had a weak lower lip following a facelift. This can happen and she was warned about it. The surgeon them offered her a muscle transposition operation to try and get function into her lip. The operation did not go well and she was left with a weak tongue and slurred speech. She wished to make a claim on the grounds of lack of consent when in fact the complication was so rare it would have not been reasonable to mention it. However the injury should not have happened and there was a failure in the duty of care whilst carrying out the procedure. The expert intervention meant that the case was submitted under the correct terms and was settled without a court case."

Having published over 30 publications in peer reviewed journals throughout his career, Dr. Hislop would like to further develop the Medico-Legal side of his practice and would be pleased to discuss your individual requirements for an Expert Witness.

For further information, please call Mr. William Stuart Hislop on 01563 827 488 or email medico-legal enquiries to: stuarthislop@supanet.com

Mr Sarwat Sadek MBBCh FRCSI FRCS(ORL-HNS) FRCS

Mr Sarwat Sadek has been practising as an ENT Consultant for over 35 years and is currently Consultant Otolaryngologist and Head & Neck Surgeon at Musgrove Park Hospital and the Nuffield Hospital, Taunton.

He has a wide range of experience in all aspects of adult and paediatric ENT and Head & Neck Surgery and can act as an expert witness, including appearing in court, in all cases relating to these areas.

His specialist areas of interest include: • Industrial deafness • Occupational rhinitis • Facial & neck trauma • Traumatic loss of sense of smell & taste • Deafness, tinnitus and vertigo as a result of road traffic accidents

Please Contact Katie Popham (secretary) E:sadekmedsec@gmail.com T: 07495606762.

Somerset Nuffield Hospital, Staplegrove Elm, Taunton TA2 6AN

Dr B David Cohen Specialist Endodontist and Accredited Expert Witness

PhD MSc BDS MFGDP LDSRCS CUEW MEWI CertMR

I have now been preparing expert witness reports for over 20 years, having prepared over 1000 of them. Most of these have been completed in the last 7-10 years since the Woolf reforms, and following my formal training on the Cardiff University Expert Witness Certification course.

I am trained to be involved in acting as an expert witness on behalf of the court, appointed by either claimant or defendant, and as a single joint expert. My training and experience also include court/ tribunal procedures, and cross examination.

Endodontics clinical negligence My specific area of expertise in clinical negligence cases is that of endodontics (root canal treatment/ therapy). I have prepared reports for both claimants and defendants

Personal Injury Cases

Dr Cohen prepares condition and prognosis reports for facial and dental injuries caused by:

• Accidents • Slip and trips • Road traffic accidents • Accidents at work • Sports accidents • Endodontic problems inc. clinical negligence DENTO-LEGAL SERVICES 122 Hilton Lane Prestwich Manchester M25 9QX dento-legal@endodontistmanchester.co.uk www.endodontistmanchester.co.uk Phone: 07000 665277

Professor Paul Tipton B.D.S., M.Sc., D.G.D.P., UK Specialist in Prosthodontics & Expert Witness London | Manchester

Professor Paul Tipton is a leading authority in UK Dentistry.

Regularly featured in the Dentistry’s Top 50 Most Influential People in Dentistry, he has been a pioneering figure in the industry. In addition to being a specialist in Prosthodontics since 1999, he has been in private practice for over 30 years and is currently Clinical Director of T Clinics in Manchester and London. A keynote speaker at dental conferences around the world, Professor Tipton has lectured at home and abroad throughout his professional life including Australia, the US, Dubai, South Africa, Singapore and India. He is the founder of Tipton Training Ltd which has seen over 3500 UK dentists pass through many of his one year courses in Restorative, Aesthetic and Implant Dentistry.

Professor Tipton has assembled a team of dental expert witnesses who work with him at T Clinics nationwide. All areas of Dentistry are covered including General Dentistry, NHS and Private, Cosmetic and Restorative Dentistry, Implantology, Oral Surgery, Orthodontics, Periodontics and Endodontics. Experts range from experienced Private Practitioners to those with Masters degrees that limit their practice to special areas of Dentistry, to Specialists, Consultants and Professors and span across the whole of the UK. All experts write the highest quality of reports in all fields ranging from Personal Injury to Road Traffic Accidents to Clinical Negligence.

07786327978 | becky@drpaultipton.co.uk www.drpaultipton.com | www.tclinic.co.uk 1.

Throughout your years of experience as an expert, what common mistakes do other dental professionals make which does have the potential to lead to losses: Most of the common negligence cases that we see in dentistry are to do with periodontal disease and lack of diagnosis and lack of treatments which has in turn led to tooth loss and then the need to replace the teeth, usually with dental implants. Dental implants are a very costly treatment and usually not available in the health service and often should the negligence have led to loss of many teeth then treatment cost can be in the region of £50,000 in order to replace these missing teeth with implants.

The second most common cause of negligence is then due to tooth extraction where it has not been explained to the patient that there are other options which could lead to the tooth being saved. The patient is then not fully informed of other treatment options and if they had been fully informed they would have taken another route which would have led to the tooth being treated. Again, once the tooth has been removed the usual replacement is with the dental implant and a single tooth replacement is often in the region of £3,000 to £4,000.

The newer types of dental negligence which we are seeing more and more is to do with complex treatments for which the dental practitioner is either inadequately trained or he has not given the patient a reasonable estimate of the costs and the outcome together with the pros and cons of such treatment. Here the more expensive treatments include dental implants, cosmetic dentistry with veneers, etc., and also short-term orthodontics.

Patients are very often disappointed when having veneers or crowns placed that the end result does not match their expectations which can again then lead to a claim. Most dentists often do not complete enough diagnostic work in advance of treatment so that the end result can be easily previewed by patients and amended as required.

Dental implants have a failure rate and this is often overlooked when placing dental implants. The expected failure rate has always been in the region of 5% in the lower jaw and 10% in the upper jaw. More recently, however, there is peri-implantitis disease which has led to an increase in the failure rates in some patients.

Again this is often overlooked during the treatment planning stage. The patients are on the assumption that their implants will last them a lifetime.

Short-term Orthodontics can not only improve the patient’s appearance but can also provide problems with the patient’s bite in the long term and this can lead to claims due to poor function or to problems with the bite leading to problems with the temporomandibular joints and treatment being required in order to treat the temporomandibular joints.

2.

How have you seen dental education change over the years? Do you think that this has affected the occurrence of legal cases?

Dental education has changed massively over the years and I have been involved in it very closely with my company Tipton Training. We have trained dentists over the last 20 years both in the UK and abroad in some of the complex issues of the newer techniques in dentistry. Due to government cutbacks and lack of funding, often now some of the newer graduates are graduating from dental school without basic knowledge and without having performed some of the basic dental tasks in sufficient numbers to be proficient. This then leads to a lack of confidence on the dentist’s part which can be reflected in the quality of treatment that is provided.

3.

How would you deal with negligence, whiplash and general accident cases differently? Do any of those have different requirements when producing a medicolegal report?

Negligence cases take the most amount of time and are often very, very complex involving multiple dentists over a period of time during which the patient was treated. This is especially so in the area of periodontal disease where lack of care, lack of treatments and diagnoses may have been going on for a decade or more and the patient has seen multiple dentists or who have continued to non-diagnose the disease process and to not treat it which is kind of complex then to apportion the negligence percentage to each of the dentists involved in the case. The most important factor which is often overlookedby some experts is the issue of causation and understanding that it is then not enough just to deal with liability for the case to have merit. General whiplash and accident cases are far more easy and are reflected in the fact that the reports are cheaper to produce and are often of a more factual nature.

4.

What advise do you have for solicitors when choosing dental experts?

The choice of dental expert should be based on the understanding and knowledge of their field and certainly, expertise should be of a minimum an established private practitioner who has over 10 years of general dental practice. Alternatively, dentists who have gone on to have further education in a particular field, such as Master’s degrees or Specialists in Periodontics, Endodontics, Orthodontics, Prosthodontics, General Dentistry and Implantology, and finally to Professors or Consultants when required. It is also important to have continuity when choosing an expert and knowing that they have been through adequate training in the expert witness field and have enough experience in that field to write reports which are legible, easy to read and precise, and that they understand a basic knowledge of the legal system so as to help the court reach its opinion if required. I would also suggest that having a nationwide panel of experts who are all trained to the same standard and degree and whose reports have a similar if not identical makeup makes life easier for the solicitor and barrister when dealing with a large number of cases. We at LegalMEx employ experienced general dental practitioners, dentists with Master’s degree in their chosen field, Specialist Consultants and Professors in all areas of general and specialist dentistry and also on a nationwide basis so continuity is guaranteed.

5.

Tell me about your specialism of Prosthodontics.

I am a Specialist in Prosthodontics and also a Professor of Restorative and Cosmetic Dentistry in the City of London Dental School. Prosthodontics is that speciality which deals with the replacement of teeth and this can be via crowns, veneers, bridges and implants. Restorative dentistry entails not only prosthodontics but also periodontics, prosthetics and endodontics and cosmetic dentistry includes aesthetic dentistry and again veneers, crowns, implants, bridgework, all of a cosmetic nature. Prosthodontics would also include treatment of the temporomandibular joints and bite. This treatment is often wholly performed by dentists who have inadequate training in the field of occlusion(bite). Being a specialist in Prosthodontics and a Professor of Restorative and Cosmetic Dentistry gives me an overall view of all the fields involved in Restorative, Cosmetic and General Dentistry which is essential when writing reports and coming to opinions as to plans and treatments.

Eric Drabble MBBS, MS, MA, FRCS, FRCS(Ed)

Breast, Breast Reconstructive and Oncoplastic Surgeon General and Hernia Surgeon

Specialist in presenting clear explanations of: . How an event or mishap occurred . What has occurred and why . The implications and expected outcomes of mishap or injury I carry out approximately 20+ medico-legal reports per annum.

My reports are written in clear terms for the court and instructing lawyers, interpreting and explaining medical language and terms.

T:01752 761850 T: 07533 186772 E: pbgsurg@icloud.com Former Chairman of the Peninsula Breast Cancer Network, South west regional representative of ABS and BASO and chair of PHNT Breast MOT group

Dr Nick Plowman MA, MD, FRCP, FRCR

Is Senior Clinical Oncologist to St Bartholomew's Hospital and The Hospital for Sick Children Great Ormond Street, London. He also undertakes honorary duties at St Mark's Hospital in Harrow, the country's leading specialist hospital for colorectal and intestinal disease, and at Moorfield's Eye Hospital, London. His research ventures have led to changes in best stander care in the treatment of breast and prostate cancer. He wrote his thesis on aspects of lung cancer. Dr Plowman performs circa 70 medico legal reports a year and has 20 years experience in such reports for claimants and defence re: liability and causation in adult and childhood cancer.

Dr Plowman graduated from Guy's Hospital Medical School in 1974, having previously gained First Class Honours in both the Medical Sciences Tripos and the Natural Sciences Tripos at Cambridge University. He then completed his thesis at Cambridge University before joining St Bartholomew's Hospital, where he has been Head of Department since 1989.

Expert in prostate cancer treatment

Nick Plowman is a Harley Street based expert on the use of radiation therapy and chemotherapy for the treatment of cancer, with a special interest in improving cure rates in cancer, whilst reducing the side effects of therapy.

Modern computers and radiotherapy machines are used to mould the high dose of radiation to the tumour itself, minimising the risk of damage to the surrounding healthy organs and tissues and reducing any side effects to the bladder and bowel.

This treatment is suitable for patients in whom the cancer has not progressed beyond the capsule covering the prostate gland.

Private treatment

Dr Plowman is available for consultation at his rooms in Harley Street. He is able to offer the latest techniques in the management and treatment of cancer, with a special interest in:

• • • • • • • •

Prostate cancer Breast cancer Central nervous system cancers Paediatric cancers Urological cancers Cancers affecting the eye Thyroid and endocrine cancer Lung cancer

Dr Plowman is recognised as one of London's leading experts in the treatment of prostate cancer, using the most up-to-date techniques:

External beam radiotherapy

conformal

Seed implantation brachytherapy

A number of small, radioactive seeds are put into the prostate gland. Over a period of a few months, they deliver a localised high dose of radiation. The surrounding tissues only receive a very low dose, lessening the risk of damage. The seeds have faded away by the end of the treatment time and this therapy offers a low side effect option for the treatment of early prostate cancer.

Hormone therapy

Lowering the amount of testosterone in the body with medicines can reduce the chance of an early prostate cancer returning or can shrink or slow the growth of an advanced tumour that has spread beyond the capsule of the prostate. Treatment is dependent on the precise grade and stage of the cancer and Dr Plowman is able to offer experienced advice.

Key Published Papers • Overviews on breast and gastrointestinal cancer (modern management) • Optimal methods of treating prostate cancer • The complications of Cancer Management (Ed P.N.Plowman) • Stereotactically delivered Brain Radiation Therapy (Radiosurgery) and brain tumour therapies • Paediatric Oncology (Ed P.N.Plowman, CR Pinkerton)

Stereotactic radiotherapy

As well using the most modern standard radiotherapy machines, Dr Plowman is at the forefront of this new technology that uses a single targeted dose of radiation to treat tumours that were not otherwise killed by standard radiation therapy or were situated in dangerous positions.

The treatment is delivered using specially designed linear accelerator machines:

Gamma Knife

This is a safe, accurate and reliable state-of-theart machine that targets the affected cancer site only. There is no open surgery and the patient can be discharged within 24 hours. Because of its accuracy, the Gamma Knife is used for the treatment of tumours near the brain stem and optic nerve.

CyberKnife

This machine has a robotic arm that can deliver targeted high-dose radiation to tumours anywhere in the body, even parts that are moving such as the lung. Damage to the surrounding tissues is minimised and CyberKnife offers painless treatment for some tumours that were previously considered to be inoperable or untreatable.

Clinical interests

Dr Plowman's clinical interests include the diagnosis and treatment of breast cancer, brain tumours, endocrine cancer, urological cancer; cancers in children & young persons (chemotherapy & radiotherapy) and the use of stereotactic radiotherapy (CyberKnife And GammaKnife).

Dr Plowman's special interests are directed towards improving cure rates in cancer, whilst reducing the side effects of therapy. He is an expert on both radiation therapy and chemotherapy.

In medical oncology, his main contribution has been the demonstration of the importance of adrenal sex steroid production in both breast and prostate cancer and he pioneered therapies aimed at interrupting these pathways in both diseases that have now become standard treatment across the world.

Research interests

Reducing the toxicity of drug/chemotherapy and radiation therapy for cancer treatment.

P N Plowman MA MD FRCP FRCR Consultant Clinical Oncologist 14 Harmont House 20 Harley Street London W1G 9PH

T: 020 7631 1632 E:postmaster@pnplowman.demon.co.uk W:www.prostatecancertreatment.co.uk W:www.canceradvice.co.uk

B.Sc, MB.ChB, FRCOphth The Liverpool Eye Clinic, 1. Penny Lane, Liverpool.

L18. 0DG jondurnian@me.com 0151 733 7123 www.jondurnian.com

• I have been a consultant in ophthalmology since 2010.

• I completed my training in the UK but spent periods in New Zealand and the US. • My pre-clinical training was at St. Andrews and Manchester universities.

• I am a full-time NHS consultant based at the world renowned St. Paul’s Eye Unit, Liverpool.

• My clinical practice encompasses all aspects of ophthalmology.

• I am the lead clinician for neuro-ophthalmology and strabismus for the unit being responsible for the development and delivery of these service to the lovely people of Merseyside.

• I am an honorary lecturer at the University of Liverpool, School of Orthoptists.

• I also work as the Programme Director for Ophthalmology, Health Education North-West.

Medico-Legal Services

• I deal with clinical negligence and personal injury for all aspects of general ophthalmology, neuro-ophthalmology & strabismus giving clear, concise and evidence-based opinion.

• I also specialise in reports detailing the ophthalmic effects of catastrophic brain injury • I produce, on average, 50 reports a year.

• My Claimant:Defendant joint ratio is approximately 35:55:10.

• I have successfully completed the Cardiff University/ Bond Solon Civil Expert Witness Certificate in Civil Law. • Following receipt of all relevant papers, the report will be completed within 3 weeks.

• If the case needs to be expedited - please call and this can usually be arranged.

The Role of the Psychologist in Assessing Fitness to Plead and Stand Trial

The law on unfitness to plead is concerned with whether or not an accused is able to stand trial and, if not, the procedure that should be used to deal with that accused.

If at any time during the Court process the defendant’s competency to stand trial is questioned a full and detailed assessment should be sought. An example would be a defendant who as a result of very low intellectual ability is unable to follow the process of his or her trial. In England and Wales, the test known as the Pritchard test is applied by the courts when deciding whether a defendant is unfit to plead, however the test is outdated and inconsistently applied.

Following a consultation paper in 2010 and an issues paper in 2014, on 13 January 2016 the Law Commission published its report on unfitness to plead. The Law Commission proposed that the new test should centre upon the defendant’s decision making capacity and capacity for effective participation in their trial. This brings the new test in line with modern Court proceedings and the test for capacity in civil proceedings which focuses on decision making abilities (Mental Capacity Act 2005).

U

p until recently the determination of a defendant’s lack of capacity relied on the evidence of two or more registered medical practitioners in general such practitioners were psychiatrists. The new legislation has recognised that other professionals are suited for this role.

In particular psychologists are routinely involved in assessing, formulating and treating mood and cognitive disturbances and consideration of the assistance required for defendants to participate effectively in the trial process may be better suited to the expertise of a psychologist than a psychiatrist.

Consequently, the Law Commission has stipulated that one of the experts must be a registered medical practitioner duly approved under section 12 of the Mental Health Act and the second expert can be either a registered medical practitioner, registered psychologist or an individual having a qualification appearing on a list of appropriate disciplines approved by the Department of Health.

A separate but closely related issue is criminal responsibility, major mental illnesses and cognitive difficulties if severe enough, may impact upon criminal responsibility and the input of a Psychologist in these cases can also be invaluable. Cases can range from trying a juvenile as an adult, to capacity to form intent, to assessing diminished capacity in an individual with a learning disability or older person who is suffering from dementia.

Assessment by a psychologist can identify areas of concern to help inform whether any cognitive factors would mitigate criminal responsibility. For example, in the case of an adolescent with autism and moderate learning disabilities and who commits an offence it may be that age-related knowledge, poor cognitive skills, social understanding, theory of mind deficits (being able to evaluate others perspectives, emotional reactions and thoughts) are important factors to take into consideration.

A psychological assessment will usually include a detailed evaluation of the defendant’s mental health, cognitive functioning, verbal reasoning and comprehension skills, attention and concentration, short term memory, decision making abilities, suggestibility and any other relevant psychological factors. This information will be used in order to form an opinion about whether the defendant is deemed to be fit or unfit to plead and/or stand trial but more importantly the expert can make recommendations to the Court which will allow a vulnerable defendant to fully participate in the proceedings. At the heart of the Law Commissions’ recommendations is the belief that there should be a full trial wherever possible. This is because only such trials engage all the fair trial processes and guarantees for those involved. A departure from a full trial should be a last resort that is only taken when it is in the best interests of the defendant. In order to fulfil these criteria reasonable adjustments to the criminal process should be made.

Dovehouse Psychology Services Dr Sharna Lewis BSc Hons, MSc, DClinPsy, CPsychol Chartered Clinical Psychologist and Expert Witness (Midlands Area) I have considerable experience of conducting Court reports in matters of personal injury, clinical negligence, mental capacity, assessment of cognitive functioning, mental health and personality, fitness to plead/stand trial. I am registered with the BPS and HCPC.

T: 07716846488 E:info@dovehousepsychology.com w:www.broadoakshealthclinic.com

Fitness to plead – case example one – a woman with learning disabilities Reason for assessment

Ms Karim an Asian lady in her 40’s was referred for an assessment. She was facing serious allegations of fraud (including dishonestly obtaining a British passport and beach of immigration) which she denied and was due to appear at Crown Court. Her solicitors reported that she did not appear to understand what was happening at her last Court hearing and appeared to agree with everything that was being suggested to her which made it difficult to take her instructions.

Assessment

The assessment included a detailed background history (including early developmental history, educational and occupational functioning) an assessment of mental health, cognitive functioning/IQ, adaptive functioning, verbal memory/recall and suggestibility.

Ms Karim spoke Punjabi and her English was very poor. The assessment was conducted with the use of an interpreter.

Ms Karim reported that her father was from Pakistan and her mother was English she was born in the UK. She was sent to Pakistan to live when she was four years old and never received any formal schooling. Ms Karim married in Pakistan and then came back to live in the UK when she was 18 years old.

Although a full IQ assessment could not be completed due to language barriers Ms Karim was found to have a nonverbal IQ of 63 and extremely poor adaptive functioning. She was unable to read or write and relied upon family and neighbours to assist her with most aspects of independent living (including cooking, washing, finances). Ms Karim had a very poor understanding of the charges and the proceedings and did not understand her role in instructing a solicitor. She was also found to be highly suggestible and presented with acquiescence i.e. tendency to agree with questions/statements put to her.

Summary and conclusions

It was concluded that Ms Karim even with the use of an intermediary did not have capacity to take part in proceedings and therefore was deemed unfit to stand trial. Although a separate issue the assessment also highlighted the fact that it was highly unlikely that Ms Karim possessed the cognitive and literacy skills needed to have physically committed the offences she was charged with and it was unlikely that she was criminally responsible.

Fitness to plead – case example two – a man with a head injury Mr Davies was referred for an assessment in connection with charges of historical sexual abuse. He had pleaded not guilty and was due to attend a trial at Crown Court. Mr Davies was in his sixties and had suffered a series of strokes three years previous to the allegations been made.

The assessment included a detailed background history, assessment of mental health, cognitive functioning/IQ, adaptive functioning, assessment of executive functioning and memory.

Although Mr Davies non-verbal IQ was found to be in the normal range he presented with cognitive deficits in working memory and verbal comprehension which impacted on his ability to respond verbally to questions put to him. Mr Davies was relatively independent in the home but required support to access the community. Before his stroke Mr Davies was of average intelligence had worked as a bus driver. Mr Davies was found to have a good understanding of the charges against him, the role of the professionals involved and of the prosecution evidence.

It was concluded that with the appropriate support Mr Davies did have capacity to stand trial as long as the recommendations suggested were put in place. This included the use of an intermediary to support Mr Davies throughout the whole of the trial process and reasonable adjustments being made e.g. extra breaks in order to recap and summarise proceedings, practical support getting to and from the Court, avoiding leading questions during cross examination and questions to be written down with extra time allowed for Mr Davies to formulate a considered response.

References: Assessment of Capacity in Adults: Interim Guidance for Psychologists (2006), The British Psychological Society.

Code of Practice for Mental Capacity Act (2005), Department of Health.

Unfitness to Plead, Volume one and two, (2016) Law Commission.

Dr Naresh Buttan MBBS, DPH, DPM, DNB (Psy), CESR,Sec 12 (2) AC

Consultant Psychiatrist Tenacity Consulting Service Ltd PO Box 295, Glenfield Road, PLYMOUTH Devon PL5 9DB www.nuffieldhealth.com/consultants

Areas of Expertise:

I specialise in general adult psychiatry and have been working a consultant in NHS since February 2008. I previously worked in Australia and India as a Consultant Psychiatrist and Clinical Director since 2001.

My special interest areas are in transcultural psychiatry, asylum seekers and refugees’ mental health, impact of war, trauma and physical, emotional and sexual abuse on mental health, bullying and harassment at work and impact on mental health.

Also specialise in diagnosing and treating common and severe mental disorders such as: • ADHD. • Schizophrenia and psychoses including drug induced psychosis.

• Depression, bipolar mood disorders.

• Anxiety spectrum disorders including GAD, phobias, OCD and PTSD. • Dissociative conversion disorders.

• Eating disorders including anorexia nervosa, bulimia nervosa and binge eating disorder.

• Psychosexual disorders such as erectile dysfunction and impotency.

• Self-harming or suicidal behaviours.

• Personality disorders.

• Alcohol and drugs dependence.

Areas of Expertise: I’ve been working as a full time substantive Consultant Psychiatrist in NHS since Feb’08.

Previously, I worked as a Consultant, Clinical Director and Deputy Medical Superintendent in various hospitals in India & Australia since 2001.

I also specialise in using psycho-pharmacological (antidepressants, anti-psychotics, mood stabilizers) and psychotherapeutic treatments including CBT for mental illnesses.

I have provided Medicolegal Expert Witness Psychiatric Reports for over 50 cases to various legal firms and other organizations with high success rates. I’m able to see clients at mutually convenient places and times and provide time efficient high quality expert reports”.

I currently work in NHS contracted organization and also see patients privately at Harley Therapy Ltd, London and Nuffield Health Plymouth Hospital by appointments in my private time. For medico-legal cases, please contact me by phone or email to arrange appointments.

Dr. Deepak Jain SENIOR MEDICAL LEADERSHIP

MBBS, MD, FRCP, Msc, PGCert

I joined NHS in 1991, and i am a Consultant in General and Elderly Medicine at the QE II Hospital, East and North Herts since 1997, besides working as: • Senior Lecturer, Royal Free/UCL Medical School, • Clinical tutor, • Foundation Programme Director, • Associate regional advisor, medicine. • Clinical Lead Clinician for revalidation of trainee doctors, Eastern Region, • Panellist, Clinical Case Managers Eastern Deanery and Clinical Governance Committees. • Formerly, Clinical Director, elderly medicine, NHS. I attended Medico- Legal Training (2010), and, i am a • Registered in expert witness (www.expertwitness. co.uk). • Bond and Solon Course including Courtroom Skills 2018 also Excellence in report writing 2018 and Cross examination 2018 and Civil Law and Procedures 2019 and i have the Certificate of expert Witness 2019.

University of Cardiff Proficient in General internal medicine, Falls, Syncope, Stroke, cardiovascular diseases affecting elderly, and mental capacity assessments, I’m interested in undertaking related medico-legal works.

MEMBERSHIP OF LEARNED SOCIETIES: • Royal College of Physicians • Fellow of British Society of Medical leaders • British Heart Failure Society • British Medical Association and The Federation of Forensic and Expert witnesses QUALIFICATIONS: 2014 PG Cert Medical Education 2011 MSc Senior Medical Leadership, RCP 2001 FRCP UK 1992 MRCP UK 1983 MD, K.G. Medical College, Lucknow, India 1977 MBBS, K.G. Medical College, Lucknow, India AWARDS AND HONOURS: School honours for academics Distinction in Mathematics (0 Level) Distinctions in Physics and Chemistry A level National Scholarship for Medical studies 1st prize in University Sitar recital competition. I will be completing the certificate of Cardiff university in 2019.

CLINICAL EXCELLENCE AWARD: Bronze (9)

Dr. Deepak Jain Senior medical leadership MBBS, MD, FRCP, Msc, PGCert Department of Medicine for the Elderly Lister Hospital Corry Mills Road Stevenage Tel No: 07715420812 E mail: deepak@jains.eu deepak.jain@nhs.net No:07715420812 (for medico legal enquiries)

Federation of

Forensic & Expert witnesses

Dr Sunkanmi Osunsanmi Child/Adolescent Psychiatrist

MBBS, MSc, MRCPsych, Certificate in Family Law, Section 12 approved.

Dr Osunsanmi is a Consultant Psychiatrist based in Gloucestershire, his specialised area is Child and Adolescent Psychiatry.

His duties involve providing psychiatric leadership and input to a specialist Child and Adolescent Mental health team. He also provides psychiatric input to a countywide Neurodevelopmental Clinic and a Schoolbased Learning Disability Clinic. In his role as a clinician, he has extensive experience of a broad range of psychiatric and Neurodevelopmental difficulties in both in and out-patient settings.

His experience includes; • Expertise in psychopharmacology • neurodevelopmental disorders such as ADHD and ASD. • Cognitive Behavioural therapy • Behavioural modification and therapy • Medico-legal writing for MHA tribunals and the court systems • Assessment of capacity and consent • Use of standardised Continuous Performance tool for assessing ADHD in children, adolescents and adults •Ffitness to plead/stand trial assessment.

Dr Osunsanmi has published a number of book reviews relevant to child and adolescent psychiatry and articles in relevant scientific journals on ADHD and learning disability in the child and adolescent population. He has also presented (both Oral and Poster presentations) at a number of national and international conferences.

Training

Completed the Cardiff University Bond Solon Certificate course on Family law and procedures, British Association for Psychopharmacology scholarship award to attend the European College of Neuropsychopharmacology- was one of 3 selected candidates across the UK for the 1st school of Child/ Adolescent psychopharmacology- 2012. Fully up to date with CPD activities with the Royal College of Psychiatrists.

Membership

Member of the Royal College of Psychiatrist, membership awarded following success in the membership examinations (stages 1 and 2) in 2006. Registered with the General Medical Council, UK with full registration and on the specialist register of Child and Adolescent Psychiatrists. Section 12 (2) approved since 2006 and an Approved Clinician since 2010

The Devereux Centre Barton Road. Tewkesbury Gloucestershire GL20 5GJ 07785 785 647 osunsanmi@doctors.org.uk enquiries@edcapelimited.co.uk www.edcapelimited.co.uk

Dr Nick Cooling Consultant Psychiatrist MBBS, MRCPsych, Dip Clin Psych

My career as a full-time Psychiatric expert began with three disasters: Hillsborough, The Bradford Fire Disaster and The Sowerby Bridge Disaster.

The Hillsborough Disaster was extremely traumatic for family members, as the whole unfolding disaster could be seen on television. I remember watching the match in my living-room and coming to the realization that there were going to be multiple fatalities. Subsequently, as psychiatric expert for one of the families, I saw a large quantity of forensic evidence, post mortem evidence and police statements on blank sheets of paper!

Over subsequent years, it became increasingly apparent that there was a credibility issue which was on-going. The family members were further traumatized by their sense of injustice and failure of closure. There was mounting anger regarding the lies and dishonesty displayed by police officers.

In later years I have provided evidence for multiple terrorist events. The Omagh Bomb case was a legal landmark because it was the first time that victims, families and survivors sued the alleged perpetrators for damages and won their civil case. The case went to a full hearing, but I was the only psychiatric expert. No defendant expert was appointed.

The Childers Fire Disaster in Australia provided me with useful experience of an horrific fire-setting event which caused multiple fatalities amongst international backpackers staying in a hostel. I assessed the Dutch victims in Amsterdam, after their return from Australia. I was the single named expert.

Of course, not all my work involves major disasters and terrorist events. I also carry a large case-load of road traffic accident victims, workplace accidents and victims of emotional, physical and sexual abuse. Assessing multiple victims for the Irish Redress Board was particularly challenging.

My Experience of the Interface Between Serious Personal Injury Cases and Psychiatry:

Lessons Learnt in Twenty-Five Years For legal practitioners and my fellow psychiatric experts my key learning experiences have been in the following areas: 1.

The types of psychiatric injury that are common in serious personal injury cases:

Depression, anxiety, specific isolated phobia, post-traumatic stress disorder, somatic symptom disorder, obsessional presentations, adjustment disorder and substance-abuse are frequently identified. Previous psychiatric vulnerability is an important factor which shapes the psychiatric manifestations and consequences of trauma. Psychologically robust individuals may have very little in terms of mental health consequences, even in the face of prolonged torture or almost unimaginable horror. The medico-legal assessment provides a unique opportunity to gain insights into how the long-term mental health of the individual may have been impacted. Often, the assessment uncovers psychological disorder which has never been recognized at the primary or secondary healthcare level. Medico-legal psychiatry can provide an entirely new perspective in terms of diagnosis, causation, prognosis and treatment.

2.

Issues relating to timely psychiatric diagnosis, early treatment and the effect that early psychological treatment may have on long-term prognosis:

In primary healthcare a significant proportion of cases of depression are never diagnosed. Victims of road traffic accidents often present with traumatic stress and phobic anxiety, but diagnoses are often missed, meaning that symptomatic chronicity becomes an issue, with significant impact on social and family life, occupational functioning and overall quality of life.

It is well-recognized in clinical practice that up to 20% of cases of depression may approach chronicity and people may be left with residual symptoms, even if remission has taken place. Modern antidepressant treatment and cognitive-behavioural therapy can be very effective in terms of reducing the length of depressive episodes. Maintenance prophylactic treatment may reduce future recurrent episodes.

Routine NHS healthcare may miss important psychiatric presentations which follow trauma and personal injury cases may provide a different route to obtaining accurate diagnosis and then appropriate treatment.

The modern civil litigation process now provides an additional opportunity for victims to access effective treatment. This can be life-changing.

In my experience, even in cases of historical trauma, the medico-legal process, challenging and traumatic as it can be, may well provide a pathway to receiving effective treatment, achieving a sense of closure and finality.

Victims of road traffic accidents and industrial injuries may well be able to access effective psychotherapy in a timely fashion, without languishing on an NHS waiting-list!

Experts are required to provide joint statements of areas of agreement and disagreement. The opportunity of having the diagnostic understandings of two experts assists the Court, but it can also assist and inform clinical understanding, providing a potential pathway for best-practice treatment and ultimate recovery.

Experts have an important opportunity for improving and enhancing psychiatric prognosis, even in severe and difficult cases.

Dr Tinnevely Ananthanarayanan MBBS FRCPsych DPM(Lond) DPM(RCSI)

Consultant Psychiatrist Dr Ananthanarayanan is a Consultant Psychiatrist with extensive experience in the NHS, treating various types of mental illnesses for 22 years, from 1981 to 2003. He was a Specialist Medical Visitor for the Lord Chancellor's Department from 2003 until June 2014. This work mainly involved Mental Capacity, Cognitive Assessment, Memory problems etc. due to organic brain conditions, such as Alzheimer's and other dementias, head injury and alcohol related brain damage. He was also a Medical Member of the Mental Health Tribunal from 1998 until June 2015, where he performed Mental Capacity Assessments and Mental Health Act Assessments during this period.

Over the years Dr Ananthanarayanan has given Independent Psychiatric Reports on Mental Capacity for the Court of Protection and other bodies, including giving opinion on patients’ fitness to plead in court. His experience has involved, mainly Mental Health Act Assessment for detained patients, also assessment of patients' Mental Capacity, to appear before the Tribunal, and understand the proceedings. Mostly he deals with civil cases involving capacity.

Dr Ananthanarayanan also appears in criminal cases, both for defence and prosecution in which mental capacity is an issue. In addition to this he attends court to provide expert evidence in criminal cases both defence and prosecution.

He has extensive experience in clinical and medico-legal aspects of Mental Health and given frequent independent psychiatric reports on patients appearing before for the Mental Health Tribunal. Special expertise in Mental Capacity, Cognitive Assessment, and memory problems, primarly due to organic and functional mental disorders.

Training Dr Ananthanarayanan has attended various courses over the years, as part of his continuing professional development and continues to do so. These courses were organised by the NHS, Royal College of Psychiatrists, British Medical Association (BMA), Court of Protection, Mental Health Tribunal and various other bodies. Throughout the year Dr Ananthanarayanan also attends medico legal courses which keep him up to date with relevant issues.

Membership He is a member of the British Medical Association, Royal College of Psychiatrists, Royal Society of Medicine and was a Medical Member of the Mental Health Tribunal for sixteen years, until June 2015.

He is a member of the expert witness panel for the Medical Protection Society.

15 De Burgh Gardens, Tadworth. Surrey. KT20 5LU. 07921 299110

Dr Sohom Das MBChB, MRCPsych, BSc, MSc Consultant Forensic Psychiatrist

Looking for a medico-legal expert?

Dr Sohom Das has extensive experience in undertaking medicolegal assessments. He regularly prepares high-quality reports on a number of psychiatric issues for a variety of courts, including the Criminal Court, Civil Court, Immigration Tribunals and Mental Health Review Tribunals, and has authored in excess of 500 reports in his career.

His specialist areas of expertise include: Civil court work • • • • • •

High value and complex personal injury cases High value and complex clinical negligence cases - including Breach of Duty, Causation, and Prognosis and Condition Historical sexual abuse Psychiatric consequences of a wide range of incidents and accidents - including post-traumatic stress disorder, issues at work and physical disability Recommendations for psychiatric treatment AvMA approved expert

Criminal court work • • • • • • •

Fitness to plead Defendants’ mental state at the time of offences Mental health disposals - including hospital orders, restriction orders and community orders Mental health defences - including not guilty by reason of insanity, diminished responsibility and automatism Capacity to form intent / mens rae Risk assessments - including violence, sexual offending and risk of reoffending Assessments carried out on male, female and adolescent defendants in secure hospitals, prisons and court

Other areas of expertise • • • • • • •

Mental health review tribunal reports Parole Board reports - including giving oral evidence Immigration tribunal reports Family court reports Employment tribunal reports - including grievance investigation assessments Formal capacity assessments Psychiatric assessments for housing issues

Dr Das can take instructions on behalf of either claimant or defendant or as a Single Joint Expert. He offers unlimited free telephone consultations to solicitors about any medicolegal case. His consultation rooms are based in North London, though he is able to travel to assessments.

sohom.das@nhs.net | www.sigmadeltapsych.co.uk

MR SAMEER SINGH MBBS BSc FRCS FRCS Trauma and Orthopaedics, November 2006 FRCS Royal College of Surgeons England, April 2000 MBBS University of London, June 1995 BSc Psychology University of London, June 1992

About

61 Churc

Mr Sameer Singh qualified from Guys and St Thomas Medical School in 1995. He completed his basic Biddenha surgical training in London and was appointed to the St George’s Hospital orthopaedic rotation in 2001. In ford MK 2006 Mr Singh was appointed as Fellow to the Liverpool Upper Limb Unit, gaining expertise in shoulder, elbow and hand disorders. He was appointed Visiting Fellow to the Adidas Sports Medicine Centre, New Zealand and the Adelaide Sports Medicine Centre in 2007, concentrating on sports injuries and the treatment of elite athletes.

Mr Singh’s elective practice concentrates exclusively on shoulder, elbow and hand disorders. He is trained to perform ultrasound scans of the shoulder and provides a one stop shoulder service for common shoulder disorders as well as general trauma and complex upper limb trauma. He is faculty member for the Advanced Arthroscopic Shoulder Course in Liverpool, where he trains other surgeons on new techniques and stays updated with new and developing procedures. Mr Singh is also a faculty member for the Royal College of Surgeons, training surgeons in basic surgical skills.

Mr Singh tailors treatments to suit individual patients and uses advanced arthroscopic techniques and minimally invasive methods. He works in conjunction with physiotherapists to maximise non‐operative treatment of upper limb disorders and to make sure patients receive the appropriate rehabilitation after surgery. He utilises accelerated rehabilitation techniques to promote faster recovery and reduced time off work.

61 Church End, Biddenham, Bedford MK40 4AS

Consultant Orthopaedic Surgeon & Expert Witness *

Consultant Orthopaedic & Trauma Surgeon at Bedford Hospital NHS Trust

*

Specialist in upper limb disorders

*

Expert Witness since 2008 - over 200 instructions per year

*

Personal Injury - all aspects of trauma (bone and soft tissue) and whiplash injuries

*

Medical Negligence - general trauma and upper limb disorders

*

Instructions on behalf of either claimant or defendant

*

Appointments usually available within 7-10 days

*

Home visits are possible - will travel up to 50 miles

*

Medco Certified

Expertise. These include:

ch End, am,*Bed-All K40 4AS

* * *

aspects of trauma – soft tissue and bone injuries Sports and work injuries Upper and lower limb disorders and injuries Whiplash injuries

Mr Singh has been acting as an expert witness since 2008 and currently completes around 200 medico legal reports per year. His high quality reports - turnaround usually within 10 days from receipt of all relevant information - provide an accurate prognosis based on analysing the available evidence without prejudice.

He is a member of the Expert Witness Institute and has received training in courtroom skills.

Mr Singh can take instructions for cases on behalf of either claimant or defendant.

Clients can be seen in clinic locations in Bedford and Milton Keynes with appointments usually being available within 7 to 10 days. Home visits can be arranged within a distance of 50 miles.

T:01908 305127 | M:07968 013803 W:orthopaedicexpertwitness.net

MR NIKHIL SHAH FRCS(Tr & Orth) FRCS, MCh(orth), MS(orth), DNB(orth) MBBS

Consultant Orthopaedic & Trauma Surgeon Wrightington Hospital Mr Nikhil Shah can act as an expert witness in personal injury and clinical negligence cases, taking instructions from either claimant or defendant or as a Single Joint Expert.

He can provide medico legal reports for personal injury claims involving: •Trips and slips • Whiplash • Ankle, knee and hip fractures, lower limb injuries • Pelvic and acetabular fractures •Long bone and articular fractures •Soft tissue injuries • Low velocity impact cases

Mr Shah can provide clinical negligence related reports in his specialist areas of expertise concerning: • Primary and revision hip and knee replacements • Pelvic and acetabular fractures • Long bone and periarticular trauma

T: 0161 393 3059 E: Nikhil.shah@consultantcare.com

Mr Nikhil Shah, c/o Consultantcare Ltd, Riverside Centre, Alexandra Hospital, Mill Lane, Cheadle, SK8 2PX

Bernard J. B. Kat

BA, MSc, DipClinPsychol, CPsychol, FBPsS PROVIDING PSYCHOLOGY, PSYCHOTHERAPY & EXPERT WITNESS SERVICES Registered as both a Health and Clinical Psychologist, Bernard Kat worked as a clinician and manager in the NHS for 28 years. In 2005 he formed his own company Psynapse (Psychological Services) Limited based in Newcastle upon Tyne.

He provides services as a Psychologist, a cognitive behavioural psychotherapist and as an Expert Witness throughout what he calls “the true North of England” i.e. from Northumberland down to Teesside in the East, across to Cumbria in the West.

A Cardiff University / Bond Solon certificated Expert Witness, Bernard is able to draw on the extensive 7 year training undergone by all clinical psychologists which includes the study of normal human development and functioning as well as specialist knowledge concerning mental health, disabilities and the problems of children and young people.

Bernard told us: “The philosphy component of my undergraduate degree has been particularly useful and taught me how to approach and write about complex problems. The psychology component emphasised the scientific and statistical skills on which my work is still based.”

As an NHS clinician Bernard specialised in work with general practitioners and community teams. This wide experience enables him to offer a rounded service as an Expert Witness.

He explained: “Throughout my career, in both my clinical and managerial responsibilities I was responsible for psychological services for clients of all ages and disorders.

My own cases were mainly working age adults. Many of my patients suffered from psychological disorders resulting from traumatic events and experiences. I was also involved with psychological aspects of primary health care, general medical services, acquired brain damage services, systemic approaches to relationship and organisational problems, as well as public health psychology.”

Bernard has seen many changes in Expert Witness work since 2005 owing to Government policies concerning funding: “I used to be instructed in criminal, family, personal injury and clinical negligence cases and I had Court experience in all of them. At present my Expert Witness work is primarily reports for the Court in criminal cases, initiated by the Defence. However Expert Witnesses do not act for either side. Psychologists’ reports are addressed to the Court and will very likely say the same whomever commissioned the report in the first place, so my reports are often accepted by the Prosecution and there is no need for me to attend Court. But I am fully aware of the formalities required when attending Court, which I do perhaps a couple of times a year on average.”

FOR MORE INFORMATION PLEASE CONTACT: Bernard Kat Psynapse (Psychological Services) Ltd Churchill House, 12 Mosley Street Newcastle upon Tyne NE1 1DE Tel: 0191 230 6461 Email: b.kat@psynapse.co.uk Website: www.psynapse.co.uk

Our goal is to assist clients advisors and the Courts to bet the unique aspects of medica individual cases, so that they informed decisio

PROFESSIONAL QUALIFICATIONS & ACADEMIC DISTINCTIONS •FRCS Edinburgh 1977 •FRCS Ireland for services to victims of trauma and developing the ATLS System in the Irish Republic 1993 •FRCS England (by election) for services to Surgical Education in the UK 1995 •FRCP London for services to Medical Education (in Northern Ireland region) 1997 •PGDL, College of Law, London, 1999 •Appointed Miller Professor of Surgery, University of Johannesburg 2001 •Werner Korte Gold Medal for services to German Surgical Education 2002 •International Development Advisor, Royal College of Surgeons, England (Tutor since 1994, Principal Tutor for Faculty Development 2003-2008) •Medal of the Swedish Surgical Society for services to medical education 2005 •FRCS Glasgow for international services to medicine 2008 •Rudolf Pichlmayr Medaille of the German Surgical Society

s, their legal tter understand al evidence in can make more ons.

The Importance of Preliminary/Screening Advice in Medical Negligence Cases A 72 year old with Alzheimer’s Disease was admitted to a respite unit for several weeks so that his wife could go on holiday. At home he would sleep in his own bed although occasionally in the night he would get up and wander around. He did not require a stick and had no problems with his sense of balance.

He was able to feed and clothe himself with minimal assistance.

The Respite Unit was part of a more general ward in a Community Hospital. He was in a four bed unit as part of a 24 bed ward which at night was staffed by two nurses and three nursing assistants.

There were no bed rails on his bed and the floors were carpeted.

Ten days after admission he got out of bed at 3am as he wanted to go to the bathroom. He fell down beside the bed onto his left side. The noise of the fall attracted one of the nursing assistants in another bay. He was put back into bed and seen by a doctor. The following morning an x-ray of his hip confirmed a fracture.

The family instigated a claim on his behalf for medical negligence because of the fall. The lawyers involved obtained reports from an Orthopaedic Expert in relation to the fracture, a Geriatric Specialist in relation to some potential increase in his levels of confusion after the incident and especially in rehabilitation. The statement of claim indicated that the gentleman should have been more closely supervised and there should have been bed rails in place.

Unfortunately there was no initial report in relation to liability and causation. There was in fact no indication why this gentleman should have been subjected to any “special� nursing care over and above that which was available on the ward, nor was there any indication for the use of bed rails which in some circumstances could have served to increase his levels of confusion. It is of note that he did not have any bed rails in place at home.

The case was easily defended at a preliminary stage although unfortunately the legal firm had already incurred considerable expense in obtaining other reports for which they were not able to recover their costs from the family, who were of limited means.

This is an important lesson in case management. Any case which has a potential for a suit in medical negligence should have a preliminary screening report in order to ensure that the elements of duty, breach and consequential damage are likely to be in place, prior to commissioning any other costly specialist reports.

MDU figures for 2016 show that less than one in six actions in medical negligence actually succeed with the vast majority failing on the grounds of causation. It must be remembered that subsequence is not the same as consequence.

Initial screening is therefore essential to manage client expectations at an early stage.

This avoids unnecessary effort and costs for all concerned. Too many cases are taken to Court with no chance of success. This is stressful for both the client and their legal advisor and indeed for the medical personnel involved.

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. KHALID MAHMOOD

Consultant Cardiologist & Expert Witness

Having undertaken the post of Consultant Cardiologist at Solihull Hospital, Heart of England NHS Trust for the past 8 years, since 2013 Dr. Khalid Mahmood has also offered his services as a MedicoLegal Expert Witness.

You only have to look at the extensive academic training Professor Mahmood has undertaken, leading to him achieving qualifications including Mb ChB, MRCP (UK), together with the wealth of practical experience on which he can draw, to appreciate that he has all the necessary credentials to provide a highly efficient, unbiased service as an Expert Witness.

In a recent interview Dr. Mahmood told us: â&#x20AC;&#x153;I have over eight years experience as a consultant cardiologist with a wide variety of clinical interests.

This has allowed me to gain knowledge and experience of many different clinical cases which allows me to provide critical review of cases where I am asked to act as an Expert Witness.I also have experience in general internal medicine which broadens my knowledge base and helps to review cases in more detail and with wider expertise.â&#x20AC;?

Dr. Mahmood has been requested to give evidence in as an Expert Witness in court cases on a number of occasions, including those listed below: •

A case which took place at a Coroners Court: Independent Expert Witness - Review of a case of in hospital mortality

•

A case for which Dr. Mahmood acted as an independent Expert Witness on behalf of the Crown Prosecution service regarding case of mortality linked to alleged medical negligence.

•

Dr. Mahmood acted as an independent Expert Witness: Medico-legal compensation injury claims - multiple.

•

Dr. Mahmood acted as an independent Expert Witness in a case which took place in Crown court- Case involving motorist involved in fatal car accident.

Dr Mahmood is involved in advanced cardiology training and teaching as evident in the fact that he has been the Educational lead for medical student teaching; undertaken a Regional role in SpR teaching/assessment, together with undertaking MRCP training and providing a contribution to core medical training for FY1 and FY2 trainees.

Also regularly attending international and national Seminars & Workshops, as part of his commitment to continually develop his knowledge-base.

As you would expect of such a consummate professional, Dr. Mahmood is a Member of the Royal College of Physicians, a Member of the Medical Defence Union and a Member of the British Medical Association.

If required, Professor Mahmood is happy to provide details of three referees.

TO DISCUSS YOUR REQUIREMENTS FOR AN EXPERT WITNESS CONTACT:

DR. KHALID MAHMOOD Tel: 07795460224 Email: khalidmahmood99@hotmail.com

Dr Digoarachi Sudantha Bulugahapitiya

Consultant Cardiologist

I am a Consultant Cardiologist at Bradford Teaching Hospitals, Bradford since January 2006. I am dual accredited in General Cardiology and General Internal Medicine with Special Interests in all aspects of Cardiac Imaging, Heart Failure and Cardiac Risk stratification.

In my role as the cardiac imaging lead for Bradford Teaching Hospitals, I have been responsible for developing all aspects of advanced echo services in Bradford. I have been responsible for bringing Cardiac CT as a routine investigative modality for possible cardiac chest pain and making it available for the whole West Yorkshire Cardiac Network. I have developed an integrated cardiac imaging strategy for patients with cardiac chest pain with the use of multi-modality imaging, including Cardiac CT, stress echo and myocardial perfusion imaging in patient evaluation.

As the Clinical Lead for the Heart Failure Services, I have developed in-hospital and community management services for heart failure patients.

I have a keen interest in teaching, education and research particularly using audit as a research tool. I am a Personal tutor for medical students at Leeds University and act as an educational and clinical supervisor for junior doctors. I organize cardiology teaching programs for the cardiac physiologists, heart failure nurses and medical undergraduates. I organize and run a Level 1 nuclear cardiology training course with attendance from across the UK. I have also delivered courses in General Cardiology and ECG interpretation.

Dr Digoarachi Bulugahapitiya Consultant Cardiologist

Mob: 07801 950 385 E:sudibulu@btinternet.com

I have undertaken medico-legal work since my appointment and am happy to provide reports in a timely manner within my areas of expertise. I ensure my learning is maintained and up-to-date to ensure my medico-legal work is accurate and relevant.

Cardiology Expert Witness

Federation of

Forensic & Expert witnesses

Dr Toomas Sarev FRCP, FESC Consultant Cardiologist

Areas of Expertise: I am a Consultant Interventional Cardiologist and Cardiology Service Director at NNUH, Norwich. I cover all aspects of heartrelated problems in adults. I am mostly interested in ischaemic heart disease and coronary interventions. I work as an independent medico-legal expert and am particularly interested in cardiological issues related to clinical negligence and personal injuries..

I am a Consultant Interventional Cardiologist and Cardiology Service Director at NNUH, Norwich. I cover all aspects of heart-related problems in adults. I am mostly interested in ischaemic heart disease and coronary interventions. I work as an independent medico-legal expert and am particularly interested in cardiological issues related to clinical negligence and personal injuries.

The waiting time for my next medico-legal appointment is 1-2 weeks and report completion time is 3-6 weeks, depending on the complexity of the questions and issues. I keep myself up to date with CPR. To ensure the best practice as an expert, I have attended workshops arranged by Lynden Alexander and Giles Eyre via Professional Solutions Learning and Development at 12 Bloomsbury Square, London, a course of successful communication at expertsâ&#x20AC;&#x2122; meetings and preparing to give oral evidence in court and an advanced workshop in writing expert reports in Jan 2017. I have completed medico-legal expert training courses via specialistInfo.com at 218 Strand, London, led by the wellknown Jonathan Dingle and Judith Kelbie; the courtroom skills course and clinical negligence medico-legal course in November 2014. I also completed a refresher in medico-legal expert advanced training in September 2014.

I am a member of the Norfolk and Norwich Medico-Legal Society and The Medico-Legal Society of London. I subscribe to their journal and the Medical Law Review.

Kardiostar Ltd

6 The Ridings CRINGLEFORD Norfolk NR4 6UJ 07432 552056 medicolegal@kardiostar.com kardiostar.com

FORENSICS INDUSTRY

E-MAGAZINE

AWARD NEWS

Simon Fulford FRCS (Urol)

Consultant Urological Surgeon & Award-winning Expert Witness in cases of Compensation for Post Spinal Injury, Post Accidental Injury, Post Head Injury & Urological medical negligence The Senior Management team of the Forensics & Expert Witness E Magazine are delighted to announce, Simon Fulford as the deserving recipient of the Expert Witness Award for Urology 2014. The Award reflects the professionalism and experience that Mr. Fulford brings to the forefront of medico-legal cases that he is instructed on, as well as the highly respected expert witness testimony that he provides in the court of law.

W

hen it comes to medical negligence and personal injury claims its vital for those in the legal sector to seek the independent, unbiased advise from a professional Surgeon. When it comes to court cases for compensation for spinal cord injury, cauda equina syndrome, pelvic fractures and urological medical negligence cases, Simon Fulford FRCS (Urol) has become recognised as a leading provider of Expert Witness Reports for Barristers and Lawyers on both sides of the case, as well as for law enforcement agencies.

Boasting an MBBS Bachelor of Medicine & Surgery from London University, Fellow of the English Royal College of Surgeons,Together with subspecialist qualification in Urology (FRCSurol) is able to combine these qualifications with the wealth of practical expertise he has gained throughout his illustrious career. From his first post in August 1987 as House Surgeon dealing with general and vascular surgery at Dulwich Hospital, through to his current position as Consultant Urological Surgeon at James Cook University Hospital, which he has held for the past 17 years, as he explained in a recent interview: "I am one of twelve consultants in a very busy department of Urology serving a population in the Tees Valley of over a million. I am also Consultant Urologist to the regional spinal injuries unit based at James Cook University Hospital which provides acute and long term care to patients with spinal cord injury from the whole of the North of England. In addition I see NHS , private and medico legal patients at BMI Woodlands Hospital Darlington.

Simon Fulford FRCS (Urol)

My primary interest within Urology is the care of the neuropathic bladder in patients with spinal injuries or neurological disease. I see and manage large numbers of patients with spinal cord injury, Multiple Sclerosis, Parkinsons disease and many other neurological conditions. I regularly perform urodynamic investigations on such patients and offer a full range of management options ranging from ongoing surveillance to major urinary tract reconstructive procedures."

Holding Membership to a number of major quality organisations including BMA; GMC; RCS; MPS and BAUS, Simon is also a member of the Teesside Urological Cancer MDT, and also pelvic exenteration for advanced gynaecologica or colorectal cancer. A great deal of Simon's medico legal work involves patients with Cauda Equina Syndrome (CES). The Cauda Equina is a bundle of nerves that lie within the spinal canal below the termination of the spinal cord from the level of the first or second Lumbar Vertebra to the coccyx. It is vulnerable to injury by compression. Most commonly this will be caused by a prolapsed inter vertebral disc but can also be the result of spinal fracture, tumours of the spine, congenital or degenerative spinal conditions or complications of procedures such as lumbar puncture or spinal anaesthetic.

Simon Fulford FRCS (Urol)

On receiving the Forensics & Expert Witness E Magazine’s Award, Mr. Fulford commented:

“I was initially surprised to hear of the award but am very happy to accept it.

I regard it as recognition of the quality of the reports I produce and an acknowledgment of the hard work I put in to them.”

CES is the combination of low back pain, sciatica, saddle anaesthesia (loss of sensation around the anus and over the buttocks), motor weakness in the leg(s) combined with bladder and bowel disturbance (retention and / or incontinence) and loss of sexual function.

Forming part of the Cauda Equina, the Sacral nerves supply the bladder, bowel, urethral sphincter, anal sphincter and the sexual organs.

All of which can be effected by CES. Patients with established CES should be referred to a Urologist with an interest in Neuro Urology to be assessed and helped with their pelvic organ dysfunction. Unfortunately many cases of CES result in litigation for alleged negligence in relation to diagnosis or treatment.

It is important that in these cases expert opinion from a Urologist with an interest in Neuro Urology in regard to pelvic organ dysfunction is sought in order to nsure appropriate assessment of ongoing disability, treatment and prognosis.

On his medico legal work, Simon had this to say: "I have been preparing expert witness reports since shortly after appointment and have attended training courses in medico legal report writing.

Having appeared in court as an expert witness for both claimant and defendant, as well as receiving joint instructions, I currently receive instructions for approximately six to ten cases per month.

The cases I have reported on include post spinal injury compensation claims, post accidental injury compensation claims post head injury compensation claims, along with urological medical negligence cases and criminal injury cases."

As you would expect from such a dedicated professional, Simon is committed to research and development as a means of introducing new techniques: "I have run audits on several new techniques and procedures which include artificial sphincter insertion, BoTox injection and implantation of Invance and Advance male slings.

These results have been presented at local, national and international meetings and in some cases published.

We have been collaborating with Professor Jenny Southgate of York University and currently our third research fellow is writing up her thesis on the Ketamine Induced Cystitis currently. This is an exciting research opportunity as understanding it may well improve our understanding and management of other painful bladder syndromes. I am therefore working with other urologists, epidemiologists, public health doctors, drug abuse experts and basic scientists to develop a comprehensive study of these patients.

FOR FURTHER INFORMATION PLEASE CONTACT: SIMON FULFORD FRCS (Urol) Tel: 07855312901 Email: simonfulford@nhs.net

ROBYN J.S. WEBBER MD FRCSEd (Urol)

Consultant Urological Surgeon & Expert Witness in Urological Cases Having qualified from the University of Otago, Dunedin, New Zealand in 1987, Robyn J.S. Webber emigrated to the UK in 1989, where she undertook further training obtaining the FRCS(Urology) in 1998. She was appointed as a consultant urological surgeon at Hairmyres Hospital in East Kilbride in 2000, and in 2005 Robyn moved to Fife and is now based at the Victoria Hospital in Kirkcaldy. She also works in the NHS hospitals in Dunfermline and St Andrews. She is currently Clinical Lead for Urology for NHS Fife.

Robyn added: "I have had a particular interest in medical education and training, and during my time at Hairmyres Hospital was Associate Director of Medical Education. Currently I am an examiner the FRCS(Urol) examination, leader of the oral question writing group for the FRCS(Urol) and an assessor for the MRCS examination. I am also a Regional Surgical Advisor for the Royal College of Surgeons of Edinburgh.

Having worked for a variety of medical publications in the past 20years, Robyn is able to draw on her expertise in medical journalism and editing in her present position as Deputy Editor of Surgeons News. She is a former editor of Urology News, former editor of SN Global, and a former member of the web editorial team for BJU International.

Throughout her career Robyn has taken an active part in the activities of the Royal Society of Medicine; currently being a Council Member for the RSM Section of Urology.

In acting as a Expert Witness for investigations Robyn is required to give her professional opinion on: All aspects of urological surgery, urological malignancy, delayed diagnosis of urological conditions, urinary incontinence, complications of TVT/TOT mesh surgery, clinical negligence, informed consent and personal injury including genito urinary tract injury, renal and pelvic trauma and erectile dysfunction.

Writing approximately 50 reports as an Expert Witness per year, Robyn is equally well versed in giving evidence in court.

In addition to having undertaken medico-legal work for the past 11 years, Robyn has also been a Clinical Advisor to both the Parliamentary and Health Services Ombudsman, and an independent Clinical Advisor to the NHS.

"Please note that I can only undertake to write a report on the instruction of a solicitor or other competent body," Robyn explained, " If you require a urologist expert report, and think I may be able to help you, please ask your solicitor to contact me."

T: 07915 423924 F: 448701249975 E: robynwebber@nhs.net

CASE STUDY No.1: CAUDA EQUINA SYNDROME: A 30 year old woman with a long history of back pain and “sciatica” attends her GP complaining of worsening of pain in her lower back and tingling in her buttocks. Her GP increases her analgesia prescription. Two days later she attends her local Accident and Emergency Department. Her pain has worsening, and she describes feeling numb over her buttocks and inner thighs, and has difficulty in passing urine. She also complains of constipation.

Her constipation is attributed as a side effect of her analgesia, her medication is changed again, and she is discharged. She returns to hospital the following day, in retention of urine. She is catheterized, and has over a litre of urine in her bladder.

Neurological examination reveals loss of sensation over the buttocks and inner thighs, and an emergency MRI scan of her spine is requested.

This demonstrates a large central disc prolapse at L4/L5 and she undergoes an urgent decompression. Post operatively her residual symptoms include numb ‘patches’ over her buttocks, and continuing difficulty with both urination and defecation.

Her symptoms vary, at times she has difficulty in passing urine and may be constipated, on other days she experiences episodes of urinary and fecal incontinence. These symptoms do not improve. She becomes housebound, leading to a loss of her income, and her embarrassment and distress over her bladder and bowel symptoms contribute the breakdown of her long term relationship.

CASE STUDY NO.2: CONSEQUENCES OF A MALE PELVIC FRACTURE A 25 year old man sustained a fractured pelvis following a fall from a motorcycle. He also sustained a partial rupture of his urethra, and has suffered from erectile dysfunction since the time of the accident. Erectile dysfunction occurs due to damage to the nerve and blood supply in the penis following the accident. Although he may have some spontaneous improvement, he is unlikely to regain full erectile function and will require treatment as long as he wishes to remain sexually active.

His urethral trauma places him at risk of subsequently developing a urethral stricture. He developed such a stricture 18 months later, with symptoms of an increasingly poor urinary flow. He undergoes an optical urethrotomy (a procedure performed using a special ‘telescope’ to divide the stricture).

Within months the stricture recurs, and he elects to undergo a urethroplasty, a larger open operation, which is curative, but places him at risk of complications including urinary incontinence, which may be permanent in some patients.

W: www.privatehealth.co.uk/patientadvice/legal-services/

Mr Stuart A Metcalfe BSc (Hons) MPhil FCPodS Consultant Podiatric Surgeon

Mr Metcalfe EXPERT WITNESS

"TWENTY FIVE YEARS OF EXPERIENCE AS AN EXPERT WITNESS" Mr Metcalfe has over twenty five years clinical experience in the field of Podiatry including general Podiatry, biomechanics / sports medicine, specialist wound care and foot surgery. For over a decade Mr Metcalfe has been on the list of approved UK register of expert witnesses gaining an enviable reputation for high quality medical reports.

Services include: • Short form reports (by prior agreement) • Liability reports • Condition & Prognosis reports • Personal injury claims • Tier 1 Expert Association of Personal Injury Lawyers

Areas of specialist interests include • • • • • • • • • • •

Biomechanics / Sports Injury Bunion surgery Cryosurgery Diabetes Foot surgery Gait analysis General Podiatry Nail surgery Orthotics Verruca treatments Wound care

SECRETARY Anne Fellows TELEPHONE 0845 222 0007 or 07960 472824 EMAIL pa2footconsultant@icloud.com