85 LAWYER MONTHLY EXPERT WITNESS AWARDS 2025 Awareness of the complexity of a patient’s journey through the hospital system has informed my understanding of the process and my belief in a thorough analysis of the medical records to arrive at the opinion given in my reports. Your special interests include urogynaecology and hysteroscopic surgery. How do these subspecialties enhance your expertise when providing opinions on complex clinical negligence cases? Urogynaecology concerns treatment of women with pelvic organ prolapse and urinary incontinence and I took a special interest in this, when I was appointed to Worthing Hospital. With a large elderly population, there was a considerable workload in this field and a huge backlog of patients waiting for over two years for surgery. Performing three operating lists per week for two years, the waiting time was reduced to three months. Surgery for stress incontinence has changed greatly over the last 40 years, with the open operation of colposuspension being the “gold standard procedure” from 1980 to 2000. After this, synthetic mid-urethral tapes, such as the TVT and TOT were introduced and appeared to be a minimally invasive procedure with superior results, so few patients chose major surgery. However, with the passage of time, increasing problems with these TVT and TOT procedures became apparent, with some patients developing tape exposure and chronic pain. The use of these devices was suspended in 2018 until a parliamentary inquiry had concluded. There are now a large number of claims involving the use of these mid-urethral tapes, as well as the use of mesh for vaginal repair, and this forms a significant part of my medicolegal practice. The issue of when consultants should have “known” about these complications and whether patients should have been warned about them is often the pertinent issue, which varies from case to case. Pyper Medical Services has been instrumental in providing expert witness services. Can you tell us more about the company, its mission, and how it has grown under your leadership? Pyper Medical Services (PMS) was founded in 2010 with a mission to offer accurate reports, which are fair to both claimants and instance, shortage of staff and low standards of care continue to be major factors in medicolegal cases. The more medicolegal reports I wrote, the clearer it became how important improved communication and teamwork were in avoiding negligent outcomes. Respecting all members of the team and listening to their concerns was vital for patient safety in the labour ward and theatre. I have been involved in the development of many maternity protocols to improve the care of pregnant women but am aware of the difficulties in getting doctors and midwives to read the guidelines and put them in to practice, due to lack of time and opportunity for training. Hospitals are complex organisations, and the care of a single patient is provided by many people during one admission. Each member of staff has the potential to cause a problem or prevent it and communication is vital, with failures causing harm to patients in many cases. The operating theatre is the place that requires the most effective teamwork, and the contribution of each person is essential for safe surgery. “With over 35 years in clinical practice and more than three decades in medicolegal work, Richard has delivered over 1,190 expert medical reports, specialising in urogynaecology and hysteroscopy.”
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