Medical Negligence
By Conal McGarrity
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Exchanging Expert Reports in Medical Negligence Litigation Cases

The recent medical negligence case of Arksey, is a useful reminder of the pitfalls of finalising expert reports for disclosure. The Judge criticised the Plaintiff’s expert neurosurgeon, in a number of respects. Most of which stemmed from his disclosed report predating the pleadings. Therefore not taking account of the pleaded Defence or the statements from the treating doctors. The Arksey case concerns the negligent discharge from the Emergency Department of a patient suffering a sentinel subarachnoid bleed who then subsequently suffered a major re-bleed at home.

Lawyers and experts alike can learn from this medical negligence case as a learning exercise on expert evidence. The case can make us think of other potential medical negligence pitfalls. Indeed other expert areas involving litigation cases on expert reports which you learn over the years. To help both lawyers and their expert witnesses here is a ten point checklist for getting it right when it comes to finalising expert reports for exchange:

1. Has the expert put the current date on the report? This sounds obvious, but amazing how often experts fail to re-date their finalised report from the draft they did the year before. Embarrassing and tells the other side how long ago their draft report was prepared!

2. Has the expert set out the nature of their instructions? This can be as brief as “I have been instructed to provide a report on liability”- but it has to be there. If not, the Court can order disclosure of the letter of instruction – not a good start to cross examination of your expert in the witness box!

3. Has the expert set out their qualification to provide an opinion specifically on the issues arising in this particular case? Cases have been lost because an expert explained (normally to the lawyers surprise in the witness box for the first time) that although for example, a spinal surgeon, they did not operate at the level which was the subject of the claim. It is important for experts to confirm in their report why they are qualified to give an opinion on the specific issue in the present case.

4. Has the expert set out the legal tests which they have been asked to address? In cross examination an expert could be asked what test they applied to breach of duty. Most lawyers might struggle to run off the full Bolam test without hesitation but experts certainly can’t do it, and nor should we expect them to. It can be an easy point against an expert but one which cannot be scored if they have set it out at the start of their report. Remember – There are an increasing number of scenarios where Bolam is not the right test to use so make sure you tell your expert the appropriate test for that specific case. Also – don’t forget causation – has your expert set out what is meant by the ‘but for’ test and material contribution?

5. Have they set out all the documents with which they have been provided? Best to refer to other experts’ reports simply as draft reports, rather than the date of every draft. Is the list complete?

6. Specifically – have they included the pleadings and witness statements in the list of documents? The main difference between a draft report and a final one. This was what handicapped the neurosurgeon in Arksey medical negligence case. The pleadings and, more importantly, the witness statements are likely to be crucial to the expert’s final opinion. They need to be in the list and commented upon in the body of the report.

7. Have they identified issues of fact? A common error is for experts to make assumptions in their report about the facts upon which they base their opinion, when those facts are actually one of the issues in the claim. Experts need to be alert to such factual issues, lawyers should alert and identify them in their report.

8. Have they deferred to the Judge on issues of fact? Experts give their view on issues of expert opinion, not on issues of fact. However this does not mean that they cannot comment on issues of fact. They can and indeed should comment on issues of fact where their expertise enables them to assist the Court with that determination – for example by interpreting medical records and explaining medical issues – as long as they qualify their view by stating that they appreciate that issues of fact are ultimately a matter for the Court.

9. Have they given reasons, reasons, reasons? Experts and lawyers sometimes forget that the report and joint statement will stand as evidence in chief at trial. If a point is not contained within the reports, the likelihood is you will not be able to adduce in evidence in trial. A point can be as powerful as you like, but if it’s not in the report it’s useless.

10. Finally – is the report balanced? An expert’s duty is to provide an independent unbiased objective to assist the Judge trying the case. The report should be drafted in a manner which demonstrates that. For more information please contact Conal McGarrity. You can also make an enquiry by clicking on the below link.

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