The Lawyer Monthly Expert Witness Awards 2021

LAWYER MONTHLY EXPERT WITNESS AWARDS 2021 UNITED KINGDOM - 16 - www.lawyer-monthly.com in medicine and surgery to advise on the whole range of medical specialties. The first specialist divisions were in Gastroenterology and General Surgery and in Trauma and Orthopaedics. We have now added specialist divisions in Women’s Health, Obstetrics and Neonatologist, Plastic Reconstructive and Cosmetic Surgery, Cancer and Oncology and Pulmonary Medicine and Thoracic Surgery. I am extremely proud of the superb team that Richard Williams-Lees has recruited and of all the experts that give specialist advice in a format has achieved widespread acclaim from instructing solicitors, barristers, QCs and the Courts. From your experience, what are the most frequent types of clinical negligence claims? Overall, 21% of my clinical negligence practice relates to the failure to prevent, diagnose or promptly treat DVT or PE. Many young adults die unnecessarily of PE, or suffer debilitating life-long symptoms due to irreparable damage to leg veins. Clinical assessment alone is unreliable and the consequences of delayed diagnosis are serious for patients and their families. The next most frequent negligence claims in my practice (18 %) are failures to diagnose arterial disease or thrombosis in limb arteries resulting in amputation and significant disability. Unfortunately, and often tragically, symptoms that would be diagnosed as peripheral artery disease or thrombosis in the elderly are often missed in younger adults. GPs, who receive brilliant training in the UK, simply forget to attribute calf or foot pain in young adults to artery disease. Common errors are that GPs or trainee doctors feel pulses that are not there or mistake the cause of a red foot as infection or gout. In the ‘sunset foot’ (indicating appearance and prognosis) the microcirculation has dilated and filled with blood to try to compensate for blocked arteries in the legs, giving the forefoot a red appearance. Our medical schools should teach students to measure ankle arterial pressure using inexpensive Doppler ultrasound rather than feeling foot pulses and to elevate the red foot (it will turn white if ischaemic). Regrettably, as our NHS has become increasingly bureaucratic with a huge expansion in the number of consultants, I am seeing more claims relating to breach of duty over delays in the diagnosis of critical limb ischaemia (CLI) in hospital. Some of these delays are even in Specialist Vascular Units, particularly those where a different consultant is on each day. We also see claimants suffering stroke as a result of a missed opportunity to treat carotid artery disease. An increasing number of patients with abdominal aortic aneurysm (AAA) rupture and die having been lost in the system even after the diagnosis of a small aneurysm has been made. I have sympathy for General Practitioners (GPs) who end up having to settle claims when they relied on poor advice from either an Accident and Emergency (A&E) Department or even a specialist service. There is also an increase in the number of claims that simply cannot be justified and should obviously be resisted by the NHS. What are the major changes that you have seen in clinical negligence claims and what changes do you expect to see in the future? The developing bureaucracy of treatment protocols, guidelines and serious untoward incident reports has aggravated the explosion in clinical negligence claims over the last decade. I also think that the scandal surrounding the Mid Staffordshire NHS Foundation Trust (The Francis Report, 2013) was fundamental to changing patients and their families’ attitudes to clinical errors they previously accepted as mistakes. Any breach in a guideline may now be the subject of claim, with many claims based on the serious untoward incident reports prepared by nurses at the defending hospital. Nursing experts in particular treat the Nursing and Midwifery Guidelines as minimum standards of care when the reality is that these are standards of excellence. As an example, a nursing expert is unlikely to accept that a patient at high risk of developing a pressure sore developed such as sore as a consequence of this increased risk rather than negligent care. “ Overall, 21% of my clinical negligence practice relates to the failure to prevent, diagnose or promptly treat DVT or PE. “ Forefoot or major limb amputation is the most rapidly growing sector in my clinical negligence practice: It represented 14% of my last 100 clinical negligence cases and may well rise to 20% in the next decade.