Friday, March 10, 2006

Expert Witnesses

I have spent most of the day working on a report for a medico-legal case. I feel sorry for the poor woman who has had her life spoiled by a mishap during her first pregnancy. She suffered a rare complication of pregnancy that was nobody's fault. It was treated as well as it could be in the 1970s, but she was left with a disability that has persisted. A couple of years ago she suffered an exacerbation of her original problem so that the resulting disability got worse. My role in this as an expert witness was simply to dismiss a red herring that someone had raised as a possible cause.

Reading through the whole thing it seems to me that there is no reason to blame anyone for what happened. Everyone acted throughout according to the guidelines available at the time. At least some of the deterioration can be put down to the patient's lifestyle choices, but I doubt whether she made those choices with any inkling of the likely outcome. I guess she is looking round for someone to blame for her predicament and her doctor was a likely candidate.

Patients sometimes have unreasonable expectations of modern medicine. Such are its successes that it is expected always to come up with the goods. But life doesn't work like that. Even if doctors did the right thing every time patients would still die. And no-one could expect doctors to do the right thing every time. To err is human. The standard by which British doctors are judged is would an ordinary doctor (not an expert or specialist) be expected to act in a different way. We are judged against our peers not against the best.

Being an expert witness is a hazardous business these days. Professor Meadows was struck from the Medical Register for misleading the court because of his misunderstanding of statistics in the Sally Clark case. He has now been re-instated and the judge had harsh words for the Disciplinary Committee of the General Medical Council. Doctors had been deterred from acting as expert witnesses for fear of making a mistake. It seemed to me that it was the court that had made the mistake, not the witness. In an adversarial system an expert witness gives what he thinks is the correct interpretation of the evidence. If the opposition thinks he is wrong then they put up another expert to refute what he says. If Meadows' statistical error was so childish, why did nobody dispute it at the time?

1 comment:

Anonymous said...

Well, although to err is human, it doesn't mean that negligence is acceptable. It's one thing to forget to put the mower away after cutting the grass. It's another to forget and leave surgical sponges inside after surgery.

A higher level of care is expected when medical procedures are involved. My father died in part because everyone forgot to check for a common side effect of a drug. That is a medical error. There are thousands of medical errors each year in the United States. Sometimes, the mistakes are covered up.