UROLOGY EXPERT WITNESS ISSUE 2019 by Federation of Forensic and Expert Witnesses

UROLOGY EXPERT WITNESS ISSUE 2019 INSTRUCT ONE OF OUR EXPERTS DIRECTLY.....

Sponsored by and featuring a special interview

with Sudhanshu Chitale.........

Please contact Dr Chitale - chitalenorwich@aol.com

Also inside this issue: Scottish Expert Robyn Webber and informative articles from Simon Fulford and more.....

When When dealing dealing with with cases cases of of medical medical malpractice malpractice th t acting actingon onbehalf behalfof ofthe theplaintiff plaintiffor ordefendant, defendant,is isone oneof of MR. SUDHANSHU CHITALE Consultant Urological Surgeon & Expert Witness

Specialising in Urology, Sexual Medicine, Andrology, Paediatric Urology and Endourology, Consultant Urological Surgeon Mr. Sudhanshu Chitale is able to draw on his considerable academic training, which led to him achieving a Masters in Surgery (MS) and a Diploma in Urogology, together with his extensive practical experience covering a wide range of areas including Prostate Cancer and Benign Enlargement (BPH); TURP / TURBT; Cystoscopy; PSA Test and Advice; Cystitis/UTI; Kidney Stones / Ureteric stones: ureteroscopic extraction and Testicular Lumps, to provide an independent, professional service as an Expert Witness. Depending on the case in question, Mr. Chitale is also able to utilise his expertise in Andrology when acting as an Expert Witness, covering the following issues: • • • • • • • • •

Male sexual Dysfunction (MSD): Peyronie's Disease Premature Ejaculation / Erectile dysfunction Male Infertility Vasectomy and Vasectomy Reversal Hypogonadism and Testosterone therapy Genital cancers (Testis / Penis), scrotal lumps Prostate / BPH and all prostatic diseases Adult / Paediatric Circumcision

As well as offering specialist in the outpatient / day case / inpatient settings, Mr Chitale remains available for addressing any emergency or worrisome situations / episodes such as: • • • • • • • • • • •

Haematuria (Blood in the Urine) Haemospermia (Blood in the Semen) Acute Painful testis Testicular trauma Penile trauma / fracture sustained during intercourse Paraphimosis (Foreskin rolled back and stuck) Finding of worrisome lump in the testis: fear of cancer Finding of a raised / elevated PSA blood test reading on routine check Acute stoppage of urine (Urinary retention) Urinary Tract infections in men and women Blocked / painful kidney due to stone disease

Mr. Chitale is extremely knowledgeable in writing Medico-Legal Reports and is fully conversant with the formalities required of an Expert Witness, should he be required to give evidence in Court. As part of his continual commitment to research and development, Mr. Chitale has been involved in a number of research projects for which he has been the Principal Investigator (PI) including "Clinical Applications of Muscle & Myocutaneous Flaps in General Surgery". This research demonstrated versatility of these flaps in repair and reconstruction following trauma and extirpative surgery for cancer whilst informing General Surgical practice. Mr. Chitale’s study on the ‘Value of Prostaglandin E1 in the Management of Erectile Dysfunction’, highlighted the use of PGE1 in the diagnosis and treatment of erectile dysfunction secondary to various underlying disorders with a high success rate and minimal complications.

the he physician physician acting acting as as an an Expert Expert Witness, Witness, whether whether fthe themost mostimportant importantfigures figuresin inmalpractice malpracticelitigation. litigation.

Having led the first ever Prospective Randomised Controlled double blind Trial of ESWT vs sham therapy for Peyronie's disease (published in BJU Int. in Dec 2009, Mr. Chitale had the honour to be chosen as an co-investigator for two Randomized Controlled Trials (RCT) in Urology and contributed significantly to patient selection and recruitment, as well as helping bring the studies to completion. The following two trials have been published in peer-reviewed journals. • A prospective randomised single blind comparison of ureteric stents composed of firm and soft polymer: (Multi-centre trial: Norwich, Wakefield, Bristol UK) • A multi-centre randomised controlled study to compare the impact of different ureteral stent lengths on patients' quality of life using a validated questionnaire: (Multi-centre trial: Norwich, Wakefield, Bristol UK). Mr. Chitale has also conducted and published outcomes of several Clinical Audits, one of which has had significant impact on current clinical practice. published in the Journal of sexual Medicine (JSM), this Audit highlighted the link / relationship between Lower Urinary tract Symptoms (LUTS) and Erectile Dysfunction (ED). The high esteem in which Mr. Chitale’s expertise is held within the profession is highlighted by the fact that he holds a post of Honorary Senior Lecturer at the UCL Medical School, London. As you would expect from such a consummate professional Mr. Chitale is a Member of a number of leading organisations including: British Association of Urological Surgeons; British Medical Association; American Urological Association and European Association of Urology. All of the above signify that Mr. Chitale has all the necessary credentials to offer a highly professional service as an Expert Witness; including the preparation of Medico-Legal Reports and appearing in Court, in negligence cases relating to cases involving his specialist areas of expertise.

FOR MORE INFORMATION PLEASE CONTACT: Mr. Sudhanshu Chitale Private Urology London C/O Highgate Hospital 17-19 View Road London N6 4DJ

Free Phone: 0800 025 7519 Email: chitalenorwich@aol.com Website:www.privateurologylondon.co.uk

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.

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.

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.

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

Simon Fulford FRCS (Urol)

“I was initially surprised to hear ofinitially the award but am “I was surprised very happy to accept it. to hear of the award but am I regard as recognition veryithappy to acceptof it. the quality of the reports I regard it as recognition of I produce an the quality of the and reports acknowledgment of the I produce and an hard work I putofinthe to acknowledgment them. hard work I put in to” them.” CES is the combination of low back pain, sciatica,CES saddle sensation is theanaesthesia combination(loss of lowofback pain, around anus anaesthesia and over the(loss buttocks), motor sciatica,the saddle of sensation weakness in the leg(s) combined with bladder and around the anus and over the buttocks), motor bowel disturbance (retention and / or incontinence) weakness in the leg(s) combined with bladder and and loss of sexual function. bowel disturbance (retention and / or incontinence) Forming partfunction. of the Cauda Equina, the and loss of sexual Sacral nerves bladder, bowel, urethral Formingsupply part the of the Cauda Equina, the sphincter, anal sphincter and the sexual organs. Sacral nerves supply the bladder, bowel, urethral All of whichanal can sphincter be effected by the CES. sphincter, and sexual organs. Patients with established CES All of which can be effected by CES. should be referredPatients to a Urologist with an interest in Neuro with established CES should be Urology assessed and their referred to to be a Urologist with anhelped interestwith in Neuro pelvic Unfortunately Urologyorgan to bedysfunction. assessed and helped withmany their cases CESdysfunction. result in litigation for alleged pelvic of organ Unfortunately many negligence in relation treatment. cases of CES resultto indiagnosis litigationorfor alleged Itnegligence is important in these cases expert opinion in that relation to diagnosis or treatment. from a Urologistthat withinan interest in Neuro It is important these cases expertUrology opinion in regard to pelvic organ dysfunction is sought in from a Urologist with an interest in Neuro Urology order to nsure appropriate assessmentisofsought ongoing in regard to pelvic organ dysfunction in disability, treatment and prognosis. order to nsure appropriate assessment of ongoing disability, treatment and prognosis.

On his medico legal work, Simon had this to say: On his medico legal work, Simon had this to say:

"I have been preparing expert witness reports since shortly after appointment andwitness have attended "I have been preparing expert reports training courses medico legal writing. since shortly afterinappointment andreport have attended Having as an expert witness for trainingappeared courses in in court medico legal report writing. both claimant and in defendant, asexpert well aswitness receiving Having appeared court as an for joint instructions, I currently receive instructions both claimant and defendant, as well as receiving for approximately to ten cases per month. joint instructions, six I currently receive instructions for approximately six to ten cases per month.

The cases I have reported on include post spinal injury compensation claims, on postinclude accidental injury The cases I have reported post spinal compensation claims post headpost injury compensation injury compensation claims, accidental injury claims, along with urological medical negligence compensation claims post head injury compensation cases criminal cases."medical negligence claims,and along withinjury urological wouldinjury expect from such a dedicated cases As andyou criminal cases." professional, Simon is committed research As you would expect from such atodedicated and development as aismeans of introducing new professional, Simon committed to research techniques: "I have run audits on several new and development as a means of introducing new techniques procedures which on include artificial techniques:and "I have run audits several new sphincter insertion, BoTox injection and implantation techniques and procedures which include artificial of Invance and Advance male slings. These sphincter insertion, BoTox injection and implantation results have been presented male at local, nationalThese and of Invance and Advance slings. international meetings and in some cases published. results have been presented at local, national and We have been and collaborating with published. Professor international meetings in some cases Jenny Southgate of York University and currently We have been collaborating with Professor our thirdSouthgate research fellow writing up her on Jenny of Yorkis University and thesis currently the Ketamine Induced Cystitis currently. This is an our third research fellow is writing up her thesis on exciting research opportunity as understanding may the Ketamine Induced Cystitis currently. Thisitis an well improve our opportunity understanding and management exciting research as understanding it may of other painfulour bladder syndromes. therefore well improve understanding andI am management working with other epidemiologists, of other painful bladderurologists, syndromes. I am therefore public health doctors, drug abuse experts and basic working with other urologists, epidemiologists, scientists to develop a comprehensive studyand of these public health doctors, drug abuse experts basic patients. scientists to develop a comprehensive study of these patients.

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

Mr Hugh Newbold Whitfield MA MChir FRCS FEBU

Consultant Urological Surgeon, Urology Expert Witness & Mediator

Mr Whitfield was a consultant urological surgeon in the NHS for over thirty years. He was at St Bartholomew’s Hospital for fifteen years before moving to the Institute of Urology. He spent his last five years at the Royal Berks Hospital. He held honorary appointments at St Marks Hospital and Great Ormond Street Hospital and was clinically involved in both. He was civilian consultant to the Army in Urology for 20 years. He has extensive experience as an author and editor and has been author or co-author of more than 150 publications He edited the British Journal of Urology for 9 years. He continues to have a private consulting practice in urology. He has been a frequent visiting professor to the Sindh Institute of Urology & Transplantation in Karachi. He undertakes medico-legal practice, principally in the field of medical negligence, receiving instructions from solicitors for both claimants and defendants. He is a trained Mediator and is the founder and Director of Independent Medical Negligence Resolution.

Areas of interest: • Iatrogenic urological injury • Bladder outflow obstruction. • Urinary tract infection • Upper urinary tract obstruction. • Urinary tract stone disease • Ureteroscopy. • Percutaneous renal surgery.

Awards received include: • Hunterian Professor Royal College of Surgeons of England 1979 • St Peter’s Medal British Association of Urological Surgeons 2003.

Consulting Rooms

King Edward VII's Hospital | 37 Devonshire Street | London | W1G 6QA

Please Contact 020 7935 3095 020 7467 4375 urology@whitfield.uk.net

Professor Frank Chinegwundoh MBE Consultant Urological Surgeon

Produced medico-legal reports since 2000 for solicitors – by direct instruction or via third parties such as Premex, Injury QED and the GMC (fitness to practice investigation). This includes medical negligence work. 2015 produced over 90 reports which included personal injury and criminal cases where erectile function is pertinent.

• • • • • • •

50:50 claimant:defence. Also joint expert witness instruction. Received international instruction from Hong Kong (2010), Australia (2011), Ireland (2012-15) On the UK register of Expert Witnesses amongst other medico-legal databases. Court appearances averaging three per year 2010 awarded Master of Medical Law degree from the University of Glasgow, after three years of a distance learning programme under the direction of Professor Sheila McClean. Medical negligence was one of the modules. 2018 Member of Medico-legal society 2013 undertaken Part 1 of Cert MR certification. This is a certificate in medical reporting. It is a highly regarded online module created by the leading expert witness training firm Bond Solon. Cert MR - Certificate in Medical Reporting demonstrates to the market that the expert on the Premx Group and Premier Medical Group is cognizant with the Civil Procedure rules Part 35 (Part 1)

2019

Federation of Federation of

Expert witnesses ensic Forensic & Expert&witnesses

www.urologyconsultant.co.uk

Mr David Baxter-Smith MA, MSc, MB, BCh, BAO, FRCS Consultant Urological Surgeon

2019

Federation of Federation of

Expert witnesses Forensic Forensic & Expert&witnesses Medico-Legal Experience:- After forty years of clinical work in General Surgery and Urology I retired from clinical work in 2013 to devote more time to my interest in Medico-Legal work. I now write reports for claims arising from urological or genital problems. I do not claim medico-legal expertise for any other specialties. In recent years my MedicoLegal work has increased such that I now write about thirty-five reports per year. This consists of 80% for alleged Personal Injury and 20% for alleged Medical Negligence. About 75% of my work if for the claimant and 20% for the defendant and 5% are Single Joint Expert reports.

I have experience of Court Procedure and have attended Crown Court on three occasions as a witness in Murder Trials and once for a high-cost case of alleged Personal Injury. I have attended two Medico-Legal Expert Witness Courses organised by Specialist Info, the most recent of which was on 4th November 2015 and I am a Fellow of The Faculty of Expert Witnesses. I attended the Premex Annual Conference in November 2017 and received The Bond Solon Training Certificate for the Civil Procedure Rules Part 35 and I am a member of The Birmingham Medico-Legal Society.

Please contact David on: 01562 882314 | davidbaxtersmith@gmail.com

Award for medico-legal services to UROLOGY 2018-2019 Federation of

t Gives us great pleasure to announce that the Federation of Forensic and Expert Witnesses has announced this years Independent Awards and has profiled one of its members for their outstanding work with in their chosen specialty in this case Dr Robyn Webber who works out of Glasgow, Edinburgh and Dunfermline

Forensic & Expert witnesses

Award

Federation of

2019

& Expert This is for the lifetime of commitment she has given to theForensic field of Urology both towitnesses her patients and to the Expert witness industry. The Awards are independent to the Federation are designed to raise the profile and highlight in their opinion the best in their given fields of expertise. The Federation hope to bring this to the attention of the lawyers and barristers that follow them on linked in and who visit their site and read thier E-mag that can be viewed at www.forensicandexpertwitness.co.uk. Dr Robyn Webber is a Scottish based expert and has a special interest in Urology, medical negligence and personal injury cases including all subjects like •

• • • • • • • •

Obstructed kidneys Benign prostate enlargement Prostate Cancer Bladder Cancer Urinary tract infection Vasectomy Reversal of vasectomy Haematuria (blood in the urine) Phimosis

And of course is available to advise in any of these subjects that may need a Medico legal report needed for the courts. The Federation fully recommend Dr Robyn Webber and are pleased to announce her as this year’s recipient.

You can book a consultation with Dr Robyn Webber Enquiries by e mail are welcome at

robynwebber@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/

Chris Dawson MS FRCS LLDip

Consultant Urologist

Medicolegal Work I have been engaged in writing medicolegal reports since 2004. To date 85% of my reports have been on behalf of claimants. I have built up an extensive network of referring solicitors. I have currently written over 500 reports with 130 of these being in the last year. I am regularly asked to provide Fitness to Practice Reports by the General Medical Council, and also "short form"/screening reports for the NHS Litigation Authority and other agencies. I offer a prompt service and usually undertake to return a report within 4 weeks of accepting instructions. I am happy to accept instructions for personal injury, clinical negligence, and condition and prognosis reports. Please note that my employing NHS Trust requires 8 weeks notice from me for professional or other leave. I will therefore require a minimum of 8 weeks notice for any attendance at Court. By issuing instructions it will be deemed that you are in agreement with this requirement.

T: 01733 261717 F: 01733 332561 For any medicolegal enquiries please contact me at chris@chrisdawson.org.uk