Mamdouh Shoukrey

With over 25 years of clinical experience and a consultant post in obstetrics and gynaecology since 2011, Mr. Mamdouh Shoukrey brings exceptional insight and precision to his role as a medico-legal expert witness. Through MNS Medical Ltd., he combines advanced surgical and obstetric expertise with formal legal training, including the Cardiff University Bond Solon Expert Witness Certificate, to provide clear, impartial, and evidence-based reports. In this interview, Mr. Shoukrey discusses the most common misconceptions in obstetric litigation, the evolving demands of expert witness work, and how continuous NHS practice ensures his opinions remain clinically relevant and legally robust.

Could you briefly describe your clinical background and how it led you into medico-legal work as an expert witness?

I have been working continuously in the NHS since 2001 and have served as a Consultant Obstetrician and Gynaecologist at Dorset County Hospital NHS Trust since 2011. My clinical experience spans over 25 years. This includes roles such as Gynaecology Minimal Access Lead Consultant and Obstetrics Risk Management Lead Consultant. My journey into medico-legal work stemmed directly from this extensive clinical practice and specific experience in roles like Obstetric Risk Management Lead, where I investigated clinical risks, medical malpractice, root cause analyses of serious untoward incidents, and child death reviews. This deep involvement in clinical governance, combined with a desire to apply my expertise to assist the legal process, led me to formalise my medico-legal knowledge. I obtained the Cardiff University Bond Solon (CUBS) Expert Witness Civil Certificate in 2022. This blend of extensive hands-on clinical experience and specialised legal training equips me to provide robust, evidence-based expert opinions, understanding both the clinical and legal dimensions of obstetrics and gynaecology.

What types of cases do you most frequently provide expert opinion on within obstetrics and gynaecology?

My medico-legal work covers a broad spectrum within obstetrics and gynaecology, reflecting my clinical specialisms. I frequently provide expert reports for clinical negligence claims and accidents involving O&G injuries. The specific areas include:

• Advanced Minimal Access Surgery: Cases related to laparoscopic (keyhole) hysterectomy, hysteroscopic surgery (like resection of fibroids), and management of conditions like endometriosis.
• Antenatal Care: Issues concerning the management of pregnancy, including medical disorders during pregnancy.
• Labour and Childbirth: Management of labour, caesarean sections, instrumental deliveries (ventouse and forceps), childbirth injuries (like perineal tears), and post-partum problems.
• Acute/Emergency Gynaecology & Early Pregnancy: Cases involving conditions like ectopic pregnancy, miscarriage, ovarian cysts, and pelvic abscesses.
• General & Benign Gynaecology: Matters related to vaginal and abdominal surgery (hysterectomy, pelvic floor repair), heavy menstrual bleeding, fibroids, and pelvic pain.

My case portfolio demonstrates experience across the spectrum, including instructions for claimants, defendants, and on a joint basis, preparing approximately 50 reports annually. I have experience providing oral evidence in Civil, Family, and Coroner's Courts

In your experience, what are some of the most common misconceptions legal professionals or clients have about obstetrics-related claims?

Common areas of misunderstanding in obstetrics medico-legal cases often include:

• Causation Complexity: Underestimating the complex interplay of factors in adverse outcomes. An undesirable result doesn't automatically equate to substandard care; distinguishing requires careful analysis of the specific clinical context and timeline available at the time.
• Hindsight Bias: Viewing decisions made during labour or pregnancy through the lens of the known outcome, rather than assessing care based on the information reasonably available to clinicians at the time.

"Normal" vs. "Optimal" Outcomes: Confusing an acceptable standard of care with a perfect outcome. Childbirth has inherent risks, and the legal test is whether care met the standard of a reasonably competent practitioner, not whether a different course might hypothetically have yielded a better result. CTG Interpretation: The nuances involved. While vital, CTG interpretation can be subjective, leading to disputes about whether abnormalities were recognised and acted upon appropriately and promptly.

How do you approach translating complex clinical details into language that's accessible to judges, juries, or solicitors without medical training?

My approach prioritises clarity, precision, and relevance to the legal questions. I excel in delivering clear, concise, CPR-35 compliant reports. Key strategies include:

• Avoiding Jargon: Translating complex medical terminology into plain English or clearly defining essential terms.
• Logical Structure: Organising reports logically, often chronologically, to clearly explain the sequence of events, findings, decisions, and reasoning.
• Focusing on Relevance: Directly addressing the specific questions posed, ensuring information is pertinent to the legal issues.
• Evidence-Based Reasoning: Explicitly linking opinions to factual evidence in the records and referencing national guidelines (e.g., RCOG, NICE) and relevant scientific literature.

My aim is always to educate the court effectively, presenting medical facts and opinions accessibly, impartially, and authoritatively to enable informed decisions.

What role does continuous clinical practice play in your credibility and effectiveness as an expert witness?

Continuous clinical practice is fundamental. I have been continuously employed in the NHS since 2001, and took up the consultant role in obstetrics and gynaecology at Dorset County Hospital since 2011, which is a role I still hold. This ensures:

• Up-to-Date Knowledge: Staying current with the latest advancements, standards of care, guidelines, and protocols.
• Real-World Experience: Regularly managing the clinical situations common in litigation provides practical insight beyond academic knowledge.
• Understanding Clinical Context: Appreciating the real world pressures and environment within the NHS.
• Demonstrated Competence: Roles like Minimal Access Surgery Lead, teaching for the RCOG, and being a Royal College Examiner further validate ongoing high-level engagement.

This active grounding ensures my opinions are relevant, reflect contemporary practice, and carry the authority of current clinical experience.

Have recent developments in women's health or maternity care had an impact on the nature of the cases you're involved in?

Yes, significantly. Recent developments shape the medico-legal landscape:

• Focus on Safety & Learning: High-profile inquiries, notably the Ockenden report, have increased scrutiny on safety culture, governance, multidisciplinary teamwork, listening to families, and learning from incidents. Cases now often examine adherence to national safety initiatives and potential systemic failings. There is an increasing UK focus on risk management and patient safety.
• Informed Consent (Montgomery): The Montgomery v Lanarkshire Health Board ruling mandates a patient-centred approach. Doctors must ensure patients know material risks and reasonable alternatives. Consent-related cases now scrutinize the quality and documentation of these discussions specific to the individual.
• Advancements in Technology & Treatments: Progress in areas like minimally invasive surgery or complex fetal medicine raises new questions about appropriate application, skill, and managing associated risks.
• Risk Management Focus: An increasing emphasis on risk management and patient safety in the UK aligns with my background and influences case analysis.

What do you believe sets a highly effective expert witness apart in high-stakes litigation?

A highly effective expert witness combines several critical attributes, all of which are central to my practice and MNS Medical's ethos:

• Deep Clinical Expertise & Current Practice: Possessing demonstrable, current, and relevant clinical experience in the specific area under review, maintained through ongoing consultant practice.
• Robust Medico-Legal Understanding: Having a thorough knowledge of legal principles, the duties of an expert, and procedural requirements (CPR Part 35), reinforced by formal qualifications like the Cardiff University Bond Solon (CUBS) Expert Witness Certificate.
• Unwavering Objectivity & Impartiality: A steadfast commitment to providing an unbiased, independent opinion based solely on the evidence, irrespective of the instructing party, delivering unbiased reports.
• Exceptional Clarity & Communication: The ability to articulate complex medical issues clearly and concisely, both in comprehensive written reports and during oral evidence, effectively bridging the gap for a non-medical audience.
• Thoroughness & Attention to Detail: Conducting a meticulous review of all relevant documentation and carefully considering all pertinent facts to ensure precision and reliability.
• Strong, Evidence-Based Reasoning: Providing clear, logical justifications for opinions, firmly grounded in the factual evidence, national guidelines, and scientific literature.
• Professionalism, Reliability & Efficiency: Adhering strictly to agreed deadlines, maintaining prompt communication, operating with integrity, and offering a reliable turnaround time (typically 4-6 weeks for reports).

Looking ahead, how do you see the role of expert witnesses evolving in the field of obstetrics and gynaecology over the next few years?

The role will continue to evolve, demanding adaptability and forward-thinking:

• Increased Specialisation: As obstetrics and gynaecology become more sub-specialised, there will likely be a greater need for experts with highly specific, niche expertise to address complex clinical questions accurately.
• Integration of Technology: Technology will become increasingly integral. This includes leveraging digital platforms for secure and efficient case management and report delivery, potentially using validated AI tools to assist in analysing large datasets or specific clinical information (like CTG traces or imaging results), while always maintaining ultimate clinical oversight and judgment. Adapting to remote consultations and virtual court appearances will also be standard.
• Greater Focus on Human Factors & Systemic Issues: There's a growing understanding that adverse events often result from system failures, not just individual errors. Experts will increasingly need to analyse and comment on factors like teamwork dynamics, communication breakdowns, workload pressures, and organisational safety culture.
• Emphasis on Formal Training & Standards: The requirement for specific, high-quality medico-legal training (such as the CUBS certificate) and demonstrable adherence to professional and ethical standards set by bodies like the GMC and Royal Colleges will become even more critical for credibility.
• Data Analytics & AI Interpretation: The emergence of AI in clinical practice may mean experts need to not only understand its applications but also potentially critique AI generated insights, evaluate their reliability, and integrate them appropriately within their own clinical reasoning.

I am committed to navigating these changes proactively by expanding my medico-legal services, enhancing digital report delivery systems, actively participating in ongoing professional development and conferences, and incorporating relevant new technologies. My focus remains steadfast on delivering unbiased, high-quality, evidence-based expert opinions with professionalism and integrity, continuously pursuing excellence in both the medical and legal domains.