35 LAWYER MONTHLY EXPERT WITNESS AWARDS 2025 Simulation training increasingly has a role to play and the computer mannequins are now realistic enough to allow very effective simulation in all aspects of neonatology. Participation in regular simulation sessions is essential in the training and assessment of junior doctors in emergency situations. Your research on brain perfusion and injury provides valuable insights into neonatal care. How does scientific evidence influence the legal assessment of causation in cases involving newborn injury? Having large amounts of scientific data to back one’s opinion is obviously very helpful when determining causation; the challenge, however, is that we rarely have absolutely conclusive scientific data that lacks any ambiguity. In cases of brain injury resulting in long-term neurodevelopmental impairment, the current state-of-the-art neuroimaging techniques can, at times, offer very limited or inconclusive information with regards to causation. Take autism as an example, we currently have no brain imaging techniques (including conventional MRI scanning) that are able to reliably diagnose autism. In other words a normal conventional brain MRI does not rule out that the patient has autism and cannot give any information as to how they acquired autism. This is somewhat at odds with that fact that conventional brain MRI can sometimes evidence that perinatal asphyxia occurred and there are multiple scientific studies that have found that perinatal asphyxia significantly increases the risk of developing autism. Newer MRI techniques such as 3D volumetric MRI, Diffusion Tensor Imaging (DTI) MRI, functional MRI (fMRI), and Magnetic Resonance Spectroscopy (MRS) may eventually be able to diagnose autism, particularly when coupled with artificial machine learning. Until then, science has a long way to go, particularly with regards the ability of brain imaging to determine causation of long term neurodevelopmental problems. Until it progresses, we will have to rely on scientific epidemiological studies to inform the legal assessment of causation in some cases of neurodevelopmental delay. What role does an expert witness play in helping courts understand complex medical issues in neonatal cases, and how do you ensure your testimony is clear and accessible? Helping the courts navigate complex neonatal medical issues is obviously vital but not without its challenges. One must prepare a detailed report that presents findings in a clear, structured manner and that is accessible to the court with no medical background. Whilst referencing one’s opinion with medical papers and text is useful, a lot of scientific papers are challenging to understand and explaining medical terminology and the medical abbreviations commonly used is vital. I have found that coming up with analogised examples found in everyday life can assist the court greatly and consideration of examples that might help is a useful exercise pre testimony. Scientific papers are increasingly laden with statistical information particularly meta-analysis and it is imperative that the expert fully understands the statistics being presented before imparting to the court what the statistics actually mean. I personally have, on occasion, consulted with statistician colleagues to ensure that I have correctly understood the statistics contained in a paper before giving testimony. What advice would you give legal professionals working on neonatal medical negligence cases to ensure they effectively utilize expert witness testimony? One common issue it the provision of case records. As a neonatologist I often get asked whether I require the maternal obstetric records. Without them it makes preparing an opinion impossible. The resuscitation record, for instance, is vital and is often part of the maternal record. The antenatal history is essentially the newborn’s past medical history. I am regularly asked to comment on matters which are out of my field of expertise and are the remit of obstetric or midwifery staff expert opinion. In a case of alleged intrapartum asphyxia causing brain injury, whilst causation would typically be established by the neonatologist, an obstetric expert opinion will likely be required to determine liability. Both neonatal along with obstetric /midwifery expert opinion are vital in these cases. I have, on occasion, been invited to become initially involved in cases after the personal injury summons has been issued, with only obstetric evidence obtained up to that point. Whilst causation and liability may have been identified by the obstetrician, it is not unusual to find additional breaches of duty of care in the neonatal period that have not been identified and a neonatologist can lend weight to both causation and liability. Emphasising that both neonatal and obstetric /midwifery expert opinion are required ideally prior to any personal injury summons being issued.
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