For over 30 years, Professor Charles McCollum has been a leading figure in the world of medico-legal expertise. A distinguished vascular surgeon and academic, his introduction to legal medicine began with a pivotal case involving consent, innovation, and professional responsibility-setting the stage for a career dedicated to truth, independence, and high standards in clinical assessment. Since then, Professor McCollum has advised on thousands of cases, established two major expert witness organisations, and helped shape how the courts understand complex claims of clinical negligence. In this in-depth reflection, he shares key milestones, shifting litigation trends, and the urgent need to use legal insight as a tool to raise standards and protect patients across the NHS.
For over 30 years, Professor Charles McCollum has been a leading figure in the world of medico-legal expertise. A distinguished vascular surgeon and academic, his introduction to legal medicine began with a pivotal case involving consent, innovation, and professional responsibility-setting the stage for a career dedicated to truth, independence, and high standards in clinical assessment. Since then, Professor McCollum has advised on thousands of cases, established two major expert witness organisations, and helped shape how the courts understand complex claims of clinical negligence. In this in-depth reflection, he shares key milestones, shifting litigation trends, and the urgent need to use legal insight as a tool to raise standards and protect patients across the NHS.
My first step into medico-legal work came in 1989, when I was invited by now Lord Daniel Brennan KC to offer a second opinion on a clinical negligence case. The claim involved an internationally respected vascular surgeon accused of performing a 'research procedure' without informed consent.
Although the initial expert concluded that the claimant had been seriously harmed by a rare vein ligation, I noted that academic surgeons at the time often tested new techniques in their pursuit of medical advancement. After offering my opinion, I was surprised to hear another expert suggest my role was simply to help the case reach court. Concerned, I contacted the instructing solicitor, who reassured me-what was needed was an honest, independent assessment, regardless of the case's merit.
That moment clarified my purpose and encouraged me to pursue medico-legal work more fully, eventually building a fulfilling and intellectually stimulating practice.
Over the next ten years, my early caseload was dominated by personal injury claims, many involving complications such as deep vein thrombosis (DVT) and pulmonary embolism (PE). As I gained experience, the work increasingly shifted towards clinical negligence, where the stakes-and complexity-were far higher. I learned that while some clinicians in regional hospitals lacked exposure to rare vascular conditions, every doctor should recognise when a case demands specialist referral. Recognising this, I eventually stepped away from personal injury work to focus more meaningfully on academic and medico-legal roles.
To provide truly specialist insight across disciplines, I co-founded Cardiovascular Advisors Ltd with Richard Williams Lees, assembling a trusted team covering cardiology, stroke medicine, vascular surgery, haematology, rehabilitation, and more. Its success led to the launch of McCollum Consultants Ltd-a broader medico-legal advisory service that now spans over half a dozen medical specialties, from trauma and orthopaedics to oncology and neonatal care.
I'm proud of the calibre of experts we've attracted and the consistent praise we've received from solicitors, barristers, and the courts alike.
Ensuring Accuracy and Reliability in Expert Testimony
At McCollum Consultants, we translate our founding ethos of independence, precision, and clarity into structured practice. We offer complimentary guidance to help instructing parties identify the most appropriate expert for their case, ensuring that specialist insight is both accurate and relevant. Early screening allows us to assess case viability swiftly and cost-effectively, helping clients make informed decisions from the outset.
All our consultants undergo rigorous medico-legal training and appraisal, supported by continuous professional development through both internal and external programmes. We also provide training to legal and law enforcement professionals on interpreting clinical evidence and working effectively with medical experts. These mechanisms help ensure our testimony is reliable, impartial, and always aligned with the highest standards of clinical accuracy and legal integrity.
Trends in Clinical Negligence and Personal Injury Claims
From the thousands of cases I've reviewed, several trends in clinical negligence stand out. A significant 21% of my caseload involves failures to prevent, diagnose, or treat DVT and PE-conditions that, when missed, often lead to young adults dying unnecessarily or living with lifelong complications. Another 18% relate to arterial disease or thrombosis in limbs, where delayed diagnosis often results in preventable amputations. Tragically, signs of such diseases are too often overlooked in younger patients, misattributed to infections or gout instead of ischaemia.
The increasing bureaucratisation of the NHS has worsened these outcomes, particularly in hospitals where patients are passed from consultant to consultant. Even in specialist vascular units, I've seen delayed diagnoses of critical limb ischaemia and preventable strokes due to untreated carotid artery disease.
The rise in claims following the Mid Staffordshire scandal and the Francis Report has also changed public attitudes. Patients and families who once accepted poor outcomes as unfortunate mistakes are now far more likely to pursue justice-and rightly so.
Guidelines, particularly from NICE, have increasingly become legal benchmarks. Though intended as best practice, they are often treated by courts and nursing experts as minimum standards, leading to litigation in cases where, for example, pressure sores in high-risk patients or diabetic foot ulcers were not promptly referred.
Forefoot and limb amputation is now one of the fastest-growing areas of my caseload accounting for 14% of my most recent 100 cases, with projections suggesting this may rise to 20% within a decade. Notably, a disproportionate number of claims stem from a handful of NHS and independent hospitals, pointing to potential systemic or cultural issues that warrant closer scrutiny from the Department of Health and NHS Resolution.
There has also been a shift in DVT and PE litigation. Once mostly linked to trauma or road accidents, these claims now increasingly relate to long-haul travel and failures to follow clear prevention protocols. Orthopaedic surgery, in particular, remains a high-risk area, some surgeons still resist prophylactic anticoagulation, despite strong evidence that PE remains a leading cause of surgical death in young adults.
The Expanding Reach of McCollum Consultants
As clinical negligence cases continue to evolve, so too has McCollum Consultants. In response to growing demand across the medico-legal landscape, we have recently expanded to include both a Nursing Division and a Criminal & Coronial Division.
The Nursing Division draws on the expertise of nurses and allied health professionals from a wide range of specialties, offering informed opinions on patient safety, quality of care, and clinical practice standards. Meanwhile, the Criminal & Coronial Division supports criminal and inquest proceedings through independent, evidence-based analysis in complex cases including homicide, gross negligence manslaughter, serious assaults, and road traffic collisions. These developments reflect our continued commitment to providing trusted, multidisciplinary insight across the full spectrum of legal casework.
Shaping the Future of Medico-Legal Expertise
Ultimately, while we aim to protect the NHS from unjustified litigation, the cases we see reflect serious, recurring gaps in care. Used constructively, this data offers a powerful opportunity to improve patient safety and raise standards across the healthcare system.
