34 LAWYER MONTHLY EXPERT WITNESS AWARDS 2025 You co-authored the book Medical Negligence and Childbirth. How has this experience shaped your approach to expert witness work? As a neonatologist I participate in regular follow up of our neonatal graduates. It has become apparent to me that whilst asphyxiated and preterm babies may escape the development of cerebral palsy, they are at high risk of developing behavioural and cognitive problems. These tend to present later in life, are less well studied and not as readily acknowledged but can be equally as devastating to the child and their family; autism being a prime example. Witnessing this has sparked my interest in autism and its link to events in the perinatal period, hence me authoring one of the chapters in this book specifically about autism and its causation. In writing that chapter I spent a long time trawling the scientific and non-scientific literature, collating the theories and evidence surrounding the aetiology of autism. Put simply, the aetiology is split between genetic and environmental factors. The experience has emphasised to me just how broad the expert’s knowledge has to be, how medical thinking and understanding is ever evolving and how vital it is for the expert witness to keep up to date. Neonatal resuscitation is a critical aspect of newborn care, and you have been a leader in this field. How do you assess whether medical professionals have met the appropriate standard of care in emergency situations? There are 2 main neonatal resuscitation courses accessible to the neonatologist; the Newborn Life Support (NLS), a UK course, and the larger world wide Neonatal Resuscitation Program (NRP). Both make it absolutely clear that provider validation does not guarantee competency. Both the NLS and the NRP acknowledge that becoming competent in resuscitation is not simply undertaking their course, rather it is the safe application of the course principles under expert supervision ensuring competency is achieved. From personal experience the only way to ensure competency in trainee neonatologists, involved in acute resuscitation and intensive care, is to have them undertake the NRP or NLS and then be accompanied/supervised by senior neonatal team members to ensure that they apply the techniques in resuscitation appropriately. Hot debriefs are vital and to be encouraged, along with feedback to the junior doctors’ clinical and educational supervisors regarding progress. You have served as an expert witness in legal cases involving neonatal care and medical negligence. What are the key challenges in providing expert reports and testimony in such cases? Obviously maintaining impartiality and independence is vital, as is not straying out with my field of expertise. A lot of the cases I have been involved with are not specifically neonatal in nature, rather they are perinatal meaning that obstetrics and midwifery opinion are equally as vital. As a neonatologist I am often tasked to determine causation of an injury that may not have occurred in the neonatal period. It can be challenging to opine on causation in a birth injury case when as a neonatologist I do not participate in delivering any antenatal or intrapartum care. In addition, there is often neuroimaging involved and whilst neonatologists commonly have experience of point of care ultrasound imaging, it takes an expert neuroradiology opinion to interpret CT and MRI scans. Genetic testing evolves at rapid pace and often has relevance as does metabolic testing. The unique challenge for the expert neonatolgist is being able to acknowledge, understand and bring together coherently all of these strands in order to determine causation. Medical negligence cases involving newborns can be particularly complex. What are the most common issues that arise in litigation related to neonatal care? With regards medical negligence involving newborns, damage from avoidable hypoglycaemia (low blood sugar) is one of, if not, the commonest cause of neonatal litigation in the NHS. Despite highlighting this fact in a paper published in the British Medical Journal in 2017, litigation involving brain damage from neonatal hypoglycaemia remains common in my experience. Failure to follow protocols and a lack of knowledge appears to remain the underlying root cause. More recently, I have been involved in multiple cases regarding the causation of autism. With the incidence of autism estimated to have risen by over 700% between 1998 and 2018 in the UK, it is no surprise that claims with regard to autism and birth injury are increasingly commonplace.
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