Introduction
I’m Nicholas Vyner Todd. I’m a Marketing consultant Neurosurgeon and Spinal Surgeon. I retired from the NHS in 2011 and from personal apply in 2014. I proceed to work in educational neurosurgery in private damage and medical negligence litigation as an skilled witness.
My undergraduate coaching was at Guys Hospital. My postgraduate coaching in neurosurgery was at neurosurgical items in Derby, London, Edinburgh and Glasgow. I used to be awarded the FRCS (England) in 1982. In 1983 I turned a Medical Analysis Council Particular Coaching Fellow in Neurosurgery. I undertook analysis in experimental mind damage on the Institute of Neurology Queen Sq. between 1983 and 1984. This led to the award of an MD by the College of London and in addition led to my appointment as a Hunterian Professor RCS Eng in 1985. I subsequently studied for a diploma in legislation and was awarded the PgDL (College of Northumbria) in 2001. In In 2010 I used to be awarded an Honorary Fellowship of the Royal School of Physicians of Edinburgh. My {qualifications} are MB BS, FRCS, MD, PgDL, FRCPE.
Medicolegal beginnings
My introduction to important medicolegal work was abrupt and considerably spectacular. In 1995, I used to be requested to behave as an skilled witness on behalf of an Orthopaedic Surgeon who was suing the Each day Mirror for defamation. Mr Percy was a Marketing consultant Orthopaedic Surgeon on the Queen Mary’s Hospital, Sidcup. Mr Percy was answerable for the first triage of head damage sufferers. A forty five-year-old man had been intentionally run-down by a automotive. Mr Percy’s registrar had neurosurgical coaching and managed the affected person beautifully effectively; intubation, air flow and a CT scan had been carried out, a big acute subdural haematoma (ASDH) compressed the mind. Mannitol was given. The native neurosurgery unit couldn’t settle for the affected person as a result of that they had no intensive care (ITU) beds. Mr Percy was contacted at dwelling and he suggested the registrar, sequentially, to contact all the neurosurgery items in London after which most of England; all refused to simply accept the affected person due to a scarcity of ITU beds till lastly he was accepted by the neurosurgeons in Leeds. He was flown to Leeds, the haematoma was evacuated however sadly the affected person died. On 29.03.95 the Each day Mirror printed {a photograph} of Mr Percy beneath the heading “Dr Dolittle” an article that accused him of gross dereliction of obligation as a result of he had not gone into the hospital to handle the affected person. I emphasised that the affected person had been managed completely as much as the purpose the place he wanted a craniotomy to evacuate the haematoma, surgical procedure that Mr Percy was not skilled to carry out and couldn’t have carried out.
I ready a medicolegal report and the case was tried on the Excessive Courtroom in London. The Each day Mirror was represented by George Karman QC who was a well-known defamation lawyer of that point. I used to be cross-examined extensively over a interval of two days. The jury discovered that Mr Percy had been defamed and he was awarded £625,000 (which was halved on attraction). This was a dramatic introduction to high-level medicolegal work, which stimulated my curiosity within the topic.
I started to tackle more and more advanced circumstances in each private damage and scientific negligence. Later I studied for a postgraduate diploma in legislation, awarded in 2001 (College of Northumbria 2.1). I’ve subsequently printed quite a few papers on many medicolegal matters. I’ve supplied stories for a lot of Courts together with the County Courtroom, the Excessive Courtroom, Coroners’ Courts and on one occasional the Legal Courtroom of Enchantment. I’ve been instructed in lots of jurisdictions together with England, Wales, Scotland, Eire, Gibraltar, Malta, Singapore, Hong Kong, Australia and the USA. I’m instructed by solicitors performing for each Claimants and Defendants. I’m typically really useful by Counsel to organize stories in my areas of specific experience. I don’t act for litigants in individual.
A typical day
I spend a part of my time in educational apply. I undertake authentic analysis primarily within the space of spinal surgical procedure and I publish 3 or 4 educational papers per 12 months; sometimes these are papers on the usual of care and end result in spinal surgical apply. I’ve analysis collaborations with a number of educational departments of spinal surgical procedure within the UK. I act as a referee for quite a few worldwide journals reviewing papers which are submitted for publication. My medicolegal apply relies in a cottage that overlooks the North Sea. The apply is wholly digital. I and my secretaries are linked by a community and all of us do business from home.
My days are very diversified. I will be working upon a medicolegal report, reviewing the medical information, witness statements, radiological imaging and stories from different consultants then placing collectively my report. For private damage and a number of the scientific negligence circumstances sufferers must be seen and examined to organize a situation and prognosis report or to find out causation.
Sufferers will be seen at my native personal hospital or at their dwelling or one other establishment nationally, or sufferers will be seen remotely by way of a video session. Video consultations are handy and low cost however the affected person can’t be examined which in neurosurgery could be a important drawback. There are common consultations with solicitors and counsel typically by way of video-link. One benefit of my present apply is that stories will be ready very urgently and sufferers will be seen all through the UK and any conferences or questions will be addressed as quickly as is required.
Medicolegal work
I’ve handled many kinds of private damage and scientific negligent circumstances and/or longstanding produced many hundreds of stories. I used to offer stories for any space of neurosurgery that I encountered in scientific apply. I now solely settle for directions upon circumstances the place I’ve an ongoing educational or longstanding scientific curiosity. This contains all circumstances of head and spinal trauma and nearly all spinal circumstances together with spinal epidural haematoma, spinal an infection, spinal epidural abscess, spinal most cancers and the cauda equina syndrome (a critical medical situation that happens when the bundle of nerves on the decrease finish of the spinal wire (referred to as the cauda equina) is compressed) . There have been areas the place I had intensive scientific and educational expertise comparable to for instance paediatric neurosurgery however since leaving the NHS I’m not energetic and I not settle for such circumstances.
In all mind and spinal circumstances the start line is to establish the character and website of the pathological course of. From that I decide whether or not a affected person was appropriately referred, a ample historical past taken and scientific examination carried out.
This determines the timing and nature of investigations, together with imaging. The causation of damage is set in PI circumstances. In CN circumstances I establish whether or not there was any breach(es) of obligation of care and whether or not any breach brought on or contributed to the ultimate end result. It’s typically the case that the ultimate end result is a consequence of a non-negligent complication with obligatory surgical procedure; issues of neurosurgery and spinal surgical procedure are actually comparatively unusual however once they happen the consequences will be devastating.
Duties to the Courtroom
The Civil Process Guidelines (CPR) and the apply instructions set out the duties of an skilled which all medicolegal consultants ought to learn and perceive. Essentially the most elementary obligation is that the skilled acts for the Courtroom not for the social gathering that instructs or pays the skilled. Consultants are required as a result of the Courts usually do not need the experience to grasp, for instance, how a neurosurgical process is determined upon and carried out. The skilled gives that data for the Courtroom and should achieve this independently. A not unusual tactic for Defendant Counsel when beginning cross-examination is to ask the Claimant’s consultants in the event that they perceive their duties of care to the Courtroom. If requested the skilled can be anticipated to undergo their duties of care to the Courtroom; all consultants should be ready for such a query.
All consultants should be aware of the well-established checks for obligation of care and causation. A health care provider’s selections should be affordable and accountable (Bolam) and logical (Bolitho). In a memorable case (Thimmaya) a spinal accidents skilled criticised a surgical process however he was wholly unable to elucidate the idea of his criticism of the surgical process primarily based upon the Bolam and Bolitho rules. The Claimant’s case dismissed and the physician needed to pay wasted prices.
For causation, we apply 2 rules: the stability of chance check (the breach was extra seemingly than to not have brought on the hurt [Wilsher]) or that it materially contributed to the hurt (Bailey). The independence of consultants can’t be over-emphasised. A GP (Liverpool v Zafar) supplied a PI report. Then, on the instruction of his instructing solicitor performing for the Claimant, he rewrote the report exaggerating the disabilities. Mistakenly each stories had been disclosed to the Defendant, each had been in entrance of the Courtroom. Dr Zafar was given a suspended jail sentence. By no means present stories which are beneficial to the one social gathering; this results in catastrophe.
When getting ready a medicolegal report for the Courtroom notably in negligence factors made must be supported by the medical literature; Judges need to see your authorities. For negligence stories I often carry out a literature search to remind myself of key papers and to make sure I’ve not missed an vital paper. That is time-consuming however important. A Excessive Courtroom Choose as soon as instructed me that the extent at which a report must be pitched is that of an clever 14-year-old. Judges is not going to be aware of the technical jargon and it’s important that technical phrases are defined throughout the textual content and/or with the usage of a glossary.
Cross-examination
Cross-examination is a worrying expertise. Consultants can be cross-examined on the science, however generally, there may be an advert hominem assault upon the skilled. The cross-examining Counsel has the street map. The skilled can not write down the questions and responses, they’ve to recollect the response beforehand given. Counsel can ask you a similar or a really comparable query at totally different deadlines to see should you give a unique response. In cross-examination closed questions, to be answered sure or no, are typical.
Should you really feel a sure or no reply doesn’t adequately take care of the difficulty say so. If Counsel doesn’t ask you to elaborate the Choose may and if not your Counsel actually will in re-examination. So, increase the purpose and depart the Courtroom to select it up as and when it needs. Except it’s completely elementary to the case keep away from have a “brilliant thought” in the course of cross-examination.
Judges want consultants to supply and clarify their opinions in writing as a part of a main or subsequent report and/or in a joint skilled report. Introducing a brand new idea in the course of cross-examination will hardly ever be welcome. The important thing to all of that is preparation. You could learn and re-read all the things that has been disclosed to the Courtroom in your behalf and, hopefully, all the stories and joint stories of the opposite consultants. You must reply to questions in a cautious and thorough manner wanting within the basic path of the Choose however not staring on the Choose which many Judges discover distracting.
Particular pursuits
I’ve a specific curiosity within the cauda equina syndrome. I’ve extra scientific publications as regards to CES than another creator on the earth and I’m recognised as a global authority on this topic. I’ve printed on the usual of care, scientific evaluation, imaging, and so many investigations, administration and end result in CES and I’ve audited medicolegal CES circumstances. I even have a specific curiosity in spinal damage. I used to be the lead neurosurgeon to NICE trauma pointers, together with pointers for the administration of acute spinal damage, which was printed in 2016. I’ve a number of educational publications in respect of spinal damage, together with a assessment of secondary neurological deterioration in medicolegal spinal damage circumstances (the most common trigger is failure to immobilise the backbone). I’ve a specialist curiosity in spinal an infection and spinal epidural abscess and once more I’ve quite a few publications in that space.
Fascinating circumstances
A lot of my circumstances have been memorable. What pursuits me most are areas of medicolegal apply which are evolving. Within the cauda equina syndrome present controversies embody failure of broadly used subclassifications of CES to find out administration and end result. They embody the analysis of extreme CES at a time when sufferers have bladder ultrasound and catheterisation previous to urinary incontinence (a marker of extreme CES) and whether or not CES causes a larger severity and frequency of again ache (in my view it does); I’ve the unique analysis to help that however that is extremely controversial. In spinal damage the important thing questions are the reason for secondary neurological deterioration after the first damage and whether or not any secondary damage is reversible (as a result of matter of truth). The important thing subject within the case of spinal an infection is making an early analysis the place outcomes are sometimes good if not glorious; A delayed analysis is usually related to extreme neurological impairment as much as paraplegia.
The important components of a very good report
At an early stage set out why you’re an applicable skilled for this case, in a mini-CV. A Choose has neither the time nor the curiosity to trawl by way of a full CV to attempt to pull out your experience. The details of the case must be set out intimately, emphasising any conflicts within the proof (that are frequent). Begin with a abstract in order that the Choose can see what the problems within the case are.
You’ll have to assume some details as appropriate however state that you just recognise that proof is a matter for the Courtroom, to whom you defer.
The Courtroom might don’t have any data of specialist phrases, both use footnotes to elucidate them or present a chronology, or each; make life simple for the Choose. Set out the checks you apply; “the affordable and accountable neurosurgeon will…” or “on stability the end result with surgical procedure would…”. CPR insists that if there’s a vary of opinion it should be said, say the place your opinion lies throughout the vary and why. Above all exhibit impartiality, be measured and clarify your reasoning with regards to the medical literature.
Different pursuits
I used to be beforehand an offshore yachtsman and a pilot (energy). I’m at the moment coaching as a glider pilot.
Professor Nicholas Vyner Todd
Marketing consultant Neurosurgeon & Spinal Surgeon
[email protected]
www.nicktoddweb.co.uk
Printed by: www.lawyer-monthly.com – June 4th, 2024