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IN THIS ISSUE4 Opening Statement5 MoJ censured as Committee slates interpreter contract5 New Bill extends parental leave rights7 Top divorce lawyer offers cohabiting couples ‘no-nups’7 Directors warned as report highlights a rise in corporate manslaughter cases7 Dispute numbers fall as recession fades

PROPERTY & CONSTRUCTION8 New helpline aims to help catch property fraudsters8 How to find the right solution for the injured party9 RICS: lettings agents should be regulated9 Prizewinner demonstrates increasing importance of geomatics10 Special buildings need specialist advice11 With Chris’s advice, commercial service charges can be fairly determined13 Compulsory purchase – acquirer or acquired?

FINANCIAL14 QC told to expect jail over VAT fraud15 The offence of financial fraud

COMPUTER FORENSICS16 Serious organised crime – a computer forensics expert’s perspective

LIFESTYLE41 Four legs better! The joys of horse ownership41 Luxury car sales hit record highs

EXPERT CLASSIFIED42 Expert witness classified listings46 Medico-legal classified listings

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MEDICAL ISSUES

PERSONAL INJURY CLAIMS17 APIL predicts haemorrhage of personal injury staff

FAMILY ISSUES18 Adoption following care proceedings25 New rules restrict experts in child care cases

TOXICOLOGY & SUBSTANCE ABUSE19 What price ‘the cat’?21 Drug Driving

PSYCHIATRIC ISSUES23 Attention Deficit Disorder in adults

CARDIOLOGY25 SADS campaign saves lives, despite lack of expert agreement on definition25 Cardiac conference highlights health inequalities

OBSTETRICS & GYNAECOLOGY27 Failed female sterilisation: establishing liability

DENTISTRY29 CTMJ dysfunction: its diagnosis and treatment

SPEECH & LANGUAGE THERAPY31 New commissioning arrangements spell change for speech & language therapists

COSMETIC SURGERY33 Cosmetic surgery responses published

ORTHOPAEDICS34 The claimant’s perception of what has happened may be misleading

MEDICO LEGAL REPORTING37 Straying outside the boundaries39 Disability assessment for benefit claims and UK GPs’ conflict of interest

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WELCOME TO THE FIRST issue of Your Expert Witness of 2013.It looks as though this year is starting on the same foot as last yearended for some of our expert witnesses. Just as they got used totightening their belts following the reduction in fees and towelledthemselves down from a session in the hot tub, along comes LordMcNally and tells them they are no longer required at all. That is in thefamily court, where the government is trying to reduce the length oftime cases take.

There is, however, a potential opening for experts in anothersphere of activity. Solicitors Pinsent Mason have reported an almostexponential rise in the number of new prosecutions for corporatemanslaughter – 63 cases were initiated last year compared to 45 in2011. There have, however, been only three convictions since the Actcame into force in 2008.

However, the firm’s specialist health and safety partner SimonJoyston-Bechal has warned against complacency among high-riskfirms: “The three convictions so far are just the tip of an iceberg,” hesaid, adding: “We can now see from these figures that there are arapidly growing number of cases in the pipeline.”

He argues that the small number of convictions is due to thecomplexity of such cases, meaning there will be more as time goeson. Others argue that the fact the police are the primary investigators,rather than the HSE, is a major factor.

In August last year, Jonathan Grimes, criminal litigation partner atLondon law firm Kingsley Napley, wrote: “The police teams investigatingthese cases are invariably drawn from criminal investigationdepartments diverted, for the duration of the investigation, from theirnormal role investigating other forms of serious crime. Significantly thepolice officers involved rarely have any previous experience of fatalaccident investigations.”

It remains to be seen which of those opinions is borne out.

For those who still find themselves in straitened situations, however,the prospect of acquiring a luxury car to ferry them to and from thefamily court may seem a distant one. Sales, however, are booming forthose two stalwarts Bentley and Rolls Royce, with The US once moreproving to be the top market. Still, if we can’t afford a limo just yet, mostof us can enjoy the thrill of jointly owning a racehorse. Our new Lifestylesection explains how.

On the subject of sport, Fabrice Muamba has thrown himself into thecampaign to have defibrillators available at all sports venues. Had thedevice that saved his life been widely available, many more young livescould have been preserved. There is an online petition to sign.

OpeningStatement

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MoJ censured as Committee slates interpreter contractTHE JUSTICE COMMITTEE OFtheHouseofCommonsbecamethelatesthigh-profilebodyofMPstolambasttheMinistryofJusticeforitsappointmentofAppliedLanguageSolutionstoprovidealltranslationandinterpretingservicestothecourtsystem.

AccordingtoareportpublishedontheParliamentwebsiteon6February,thecommitteefoundthattheMoJ“…pushedaheadwithoutsourcingcourtinterpreterservicesdespitewarningsthatthequalityofcourtlanguageserviceswouldbereduced”.

ThechairoftheCommittee,SirAlanBeithMP,said:“TheMinistryofJustice’shandlingoftheoutsourcingofcourtinterpretingserviceshasbeennothingshortofshambolic.Itdidnothaveanadequateunderstandingoftheneedsofcourts,itfailedtoheedwarningsfromtheprofessionalsconcernedanditdidnotputsufficientsafeguardsinplacetopreventinterruptionsintheprovisionofqualityinterpretingservicestocourts.”

AccordingtotheMPs,significantconcernwasrevealedintheMoJ’sconsultationprocessthatqualitystandardscouldbediminishedbytheimpositionofatieredsystemtoenableawiderpoolofinterpreters,andbytheintroductionoflowerlevelsofpay.

TheCommitteealsocondemnedtheactionstakenbyMoJ:theCourtsandTribunalsService(HMCTS)instructedstaffnottoparticipateintheCommittee’sonlineconsultation.

“TheCommitteeconsidersthattheactionsoftheMinistryinthiscasemayhaveconstitutedacontemptoftheHouse,butasitreceivedsufficientevidencefromothersourcestomakeareliablejudgement,ithasnotaskedtheHousetotakefurtheractiononthismatter,”thereportstates.

DuringtheCommittee’sinquiry,thechairmanoftheMagistrates

AssociationsaidinevidencethathepersonallyhadexperienceofaRussianinterpreterfailingtotranslateevidencegivenbythedefendant.

“Thisperson’sjobwastointerpret,nottodecide‘that’snotimportant’,”hetoldtheCommittee.

Thereportwasthelatestinaseriesofhighly-criticalfindingsbyMPs,includingthePublicAccountsCommittee.TheMoJ’sownStatisticalBulletinalsoshowedsubstantialfailings.

Manyprofessionalinterpretersboycottedthenewsystemandanumbrellabody,ProfessionalInterpretersforJustice,wasformedby,amongothers,theCharteredInstituteofInterpretersandtheNationalRegisterofPublicServiceInterpreters.

RepresentativesmetwithJusticeMinisterHelenGranton4December,afterwhichthechairoftheCharteredInstituteofLinguists,KeithMoffittdeclared:“There’sarealriskofthelegalinterpretingprofessioncollapsingandweareencouragedthattheJusticeMinisterwantstolistenandproperlyengagetheprofessionintheinterestsofdeliveringjustice.Ourmembersareprincipledindividualswhofeeltheirprofessionalstatushasbeenwatereddownbytheabsenceofqualityinthisprivatecontract.”q

NewBillextendsparentalleaverightsON 5 FEBRUARY THEGovernmentpublisheditslong-awaitedChildrenandFamiliesBill,whichoutlinedanumberofchangesintheadoptionandfamilyjusticesystemandprovisionofchildcare.

Italsoproposedsignificantchangesinmaternity/paternityleaveandflexibleworking,inparticularallowing‘sharedparentalleave’.

AccordingtoastatementbytheDepartmentforBusiness,InnovationandSkills(BIS):“Thegovernmentwillmoveawayfromthecurrentold-fashionedandinflexiblearrangementsandcreateanew,moreequalsystemwhichallowsbothparentstokeepastronglinktotheirworkplace.”

TimChambers,oftheCharteredManagementInstitute,explained:“TheChildrenandFamiliesBillissettoallowmothers

tofinishmaternityleavefollowingatwo-weekperiodofrecovery,afterwhichparentswillbeabletoshareout50remainingweeksofleaveiftheywish.

“Dadsarealsosettobegivenanewright,meaningtheywillbeabletogetunpaidtimeawayfromworktogotouptotwoantenatalappointmentsregardinganewborn.

“Meanwhile,peoplewhohaveanewchildthattheyhaveadoptedaregoingtobegivenentitlementtoleaveandpayatanequivalentleveltoparentswhohaveanewchildbybirth.”

IntroducingtheBill,BusinessMinisterJoSwinsonsaid:“Currentworkplacearrangementsareold-fashionedandrigid.TheChildrenandFamiliesBillwillbringthewaymumsanddadsbalancetheirlivesatworkandathomeintothe21stcentury.”q

Sir Alan Beith MP, chair of the Justice Committee

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experiencetellsusthatanyfatalitiesatworkare,inthemain,theresultofmanagementfailure.Thismeansthatdirectors,intheirrole,mayfindthemselvesincourtandbeingprosecutedpersonally.Theycannothidebehindthecompany”.

Patfinishedbysaying:“Directorsneedtobeawarethatcuttinginvestmentinhealthandsafety,firesafety,foodsafetyandtraining,isnotanoptionforbusinesses–therealcostscanbetoogreatifthingsgowrong”.q

Dispute numbers fall as recession fadesTHE TOTAL NUMBER OFcommercialandcivildisputesresolvedthrougharbitration,mediationandadjudicationfellinthetwoyearsto2011–from27,110in2009to21,260.Thefallwasattributabletotheabatingofasurgeindisputesintheimmediatewakeofrecession,accordingtoaresearchreportpublishedbythefinancialserviceslobbygroupTheCityUK.Accordingtothereport,LondonandtheUKremainwellpositionedinternationallyintheconductofdisputeresolution.

Announcingthepublicationofthereport,TheCityUKsaid:“LondonisthemostpreferredseatofarbitrationandcompaniesaretwiceaslikelytochooseEnglishlawoveranyotherlaw.ThenewRollsBuildinginLondon,openedin2011,ishelpingtosustaintheUK'sreputationasthefirstchoiceforbusinesslaw.”

Thereport,Dispute Resolution in London and the UK,wassponsoredbytheLawSociety,theBarCouncil,theCentreforEffectiveDisputeResolution(CEDR)andlegalconsultancyJomati.InadditiontoprovidingacomprehensivegazetteeroforganisationsactingintheUKtoprovidedisputeresolution,itoffersanoverviewofthealternativedisputeresolutionforumsofferedbytheUKtointernationalorganisations.

“CasesinvolvinginternationalpartiestoadisputetendtobeheardinanumberofthespecialisedcourtsintheUK,notablytheAdmiraltyCourt,CommercialCourt,theTechnologyandConstructionCourtandChanceryDivision,”thereportsays.“TheuseofthesecourtsindicatesapreferencebyforeignpartiestolitigateintheUK.Factorsmotivatingpartiestochooseoneofthesespecialistcourtsasthevenuefordisputeresolutioninclude:specialistjudgesdrawnfromthebestspecialistpractitionersinthefield,efficiencyandspeed,consistentdecisions,enforceablejudgmentsandpreferenceforLondonasalocation.

“Thesecourtsalsohaveanimportantrolewithrespecttoarbitrationclaims,includingdeterminingwhetheranarbitrationagreementisvalid,determiningwhetheranarbitrationtribunalhasbeenproperlyconstituted,seekingthecourts’powersundertheArbitrationAct2006tosupportarbitralprocedureandchallenginganarbitralaward.”

ThosefactorshaveresultedincompaniesbeingtwiceaslikelytochooseEnglishlawoverothergoverninglawsforarbitrations.Englishlawwaschosenby40%ofcompaniesandNewYorkstatelawby17%.ThecommoncostsofarbitrationsintherestofEuropearealso18%higherthanintheUK,accordinga2011surveyof20arbitralorganisationsbytheCharteredInstituteofArbitrators.q

•Dispute Resolution in London and the UK is the latest in a series of reports on the subject published by TheCityUK. The reports have been published biennially since 2006 and every three years prior to that.

Topdivorcelawyerofferscohabitingcouples‘no-nups’

Directorswarnedasreporthighlightsariseincorporatemanslaughtercases

THE NUMBER OF COUPLESsigning‘no-nup’agreementsbeforetheymoveintogetherisrisingsharply,accordingtoDeborahJeff,HeadofFamilyLawatcentralLondonlawfirmSeddons(above).

Someofthecontractsareintendedtoensurethatfamilywealthorassetsbroughtintoarelationshipbyonepartnerremainundertheircontrol.

Deborahexplained:“Whilstthosewhotakeadvicebeforelivingtogetherarestillintheminority,thosewhodocantakevariousstepstoprotectthemselvesfinancially.Mostpeopledon’tthinktotakeadviceorjustaren’tawarethattherearestraightforwardstepstheycantakeatthebeginningofarelationshiptoprotectthemselvesshouldthingsnotworkout.Thiscansparethemconsiderablecostfinanciallyandemotionallyiftherelationshipends.

“Thecohabitationagreementsoftenfollowpressurefromparentsdeterminedtopreventmoneygiventotheirchildrenfrombeingwastedbyfree-spendingpartners.

“Theycanalsocoverareasofpotentialconflictsuchaswhopayshouseholdbillsandwhetherthecouplewillhavejointcreditcardsandbankaccounts.

“Othercommonelementsofthecontractsincludestipulatingwhoshouldtakeresponsibilityforloans,whatshouldhappenifonepartnerdies,andwhetheronepartnershouldbeabletobuytheotheroutoftheirshareofpropertyiftheysplit”.q

•Figures from the 2011 Census showed 6.5 million people are now in cohabiting relationships.

ACCORDING TO LAW FIRMPinsentMasons,therewere63newcorporatemanslaughtercasesopenedin2012,upfrom45in2011andcurrentlythereare56prosecutionson-going.

There’snodoubtthatregulatorsaregettingmoreandmoreexperiencedinbringingthesetypeofprosecutionsandit’swidelyacknowledgedthatsoon,whenthereisafatalityatwork,itwillbethenormforaprosecutiontobebrought.

PatPerry,ExecutiveChairmanofleadinghealthandsafetyconsultants,PerryScottNashAssociates(pictured),haswarnedallbusinessesinthehospitalityandlicensingsectorstopaydueregardtohealthandsafetyandtohaveproceduresinplacetoprotectbothemployeesandcustomers.Shesaid:“Directorsofbusinessesneedtorememberthatthechargeofcorporatemanslaughtercanbebroughtwheretherehasbeen‘managementfailure’and

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How to find the right solution for the injured partyASSESSING COMPENSATION IN THE fieldof personal injury often requires an accurateassessment of the adaptations needed to thevictim’s home to accommodate their disabilityand allow them to live a normal life. Suchassessments require the view of an expert inthe field, in order for an accurate view to bearrived at.

One such expert is James Groux, founderof Building Design Workshop, whichspecialises primarily in the field of personalinjury. Since founding the practice in 1990James has acted for over 200 clients in the

design of both new build and adaptation workfor many types of disability. Many of theseprojects have been undertaken by way ofJames acting as expert witness, giving adviceand writing reports for the courts.

Building Design Workshop operatesthroughout the UK and abroad, undertaking avariety of projects – all professionally carriedout utilising expert knowledge spanning 23years in the field.

• To find out more about James and Building Design Workshop, visit www.expertsbdw.com.

James Groux, founder of Building Design Workshop

New helpline aims to help catchproperty fraudsters

A PROPERTY FRAUD LINE has beenlaunched by the Land Registry for homeownerswho are concerned that their property might be

subject to a fraudulent sale or mortgage. Callerscan speak to specially trained staff for practical

guidance about what to do next.Properties most vulnerable to registration or mortgage

fraud are usually empty, tenanted or mortgage-free.Individuals at a higher risk of fraud include owners who donot live in the property because they live abroad, are buy-to-let landlords, are in long-term hospital or residential careor are in a position where a relationship has broken down.

Examples of property fraud include situations where abuy-to-let landlord gets a call from a local estate agentsaying that one of his rental properties seems to bebeing marketed for sale or where a relative learns that aproperty has been ‘stolen’ by a fraudster impersonatingthe deceased proprietor.

Director of legal services at the Land Registry,Alasdair Lewis, said: “Fraud affects all parts of today'ssociety and everyone in it, costing this country anestimated £38bn each year. Government has a zerotolerance to fraud against the public purse, but inorder to fight fraud everyone needs to work together.The need for everyone to play their part is just asrelevant in the fight against property fraud as in othercontexts.”In addition to the new helpline, the Land Registry’s

trial of a free restriction for absent owners is being continued.Around 5,000 properties have been protected in this way since the trial began in February 2012.

Designed to help prevent forgery, the restriction requires a solicitor or conveyancer to certifythey are satisfied that the person selling or mortgaging the property is the true owner. There is noLand Registry fee for homeowners who wish to register this restriction as long as they do not livein the property. Owner occupiers pay a small fee.

Land Registry’s Counter-Fraud Unit picked up the top prize in the Fraud Prevention Categoryat the inaugural Fighting Fraud awards in December.

• The new helpline number is 0300 006 7030 and it is open from 8.30am to 5pm, Monday to Friday.

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RICS: lettings agents should be regulatedTHE RICS HAS CALLEDforthecompulsoryregulationoflettingsagents.Theprofessionalbodyrepresentingexpertsinallareasofthedomesticandcommercialpropertysectoriscallingforthelawtobechangedtoensurethatlettingsagentsfallunderthesamescrutinyasagentswhosellproperty.

Currently,theinstitutionsays,anyonecansetupalettingsagencywithoutappropriatequalificationsorindustryknowledge.Notonlydoesthatmeanthattenantsandlandlordsarepotentiallysubjecttounscrupulouspracticewithnocomeback,butitisalsocostingthewidereconomymillionseveryyear.

Researchshowsthat,followinganinitialset-upcostof£45m,theregulationofUKlettingsagentsandtheintroductionofprofessionalstandardswouldprovidenetbenefitsofover£20mperyear.Newstatutory

requirementswouldpayforthemselveswithinlessthantwo-and-a-halfyears,whileofferingtheconsumerincreasedlevelsofprotection.

PeterBoltonKing,RICSglobalresidentialdirector,said:“RICShaslongcalledforasingleregulatoryandredresssystemforlettingsagents,whichthissurveydemonstratesisclearlysupportedbytheoverwhelmingmajorityofconsumers.Untilthishappens,werecommendthattenantsusealettingsagentthatisamemberofaprofessionalorganisation,suchasRICS.

“Thesefindingsdemonstrateexactlywhythegovernmentneedstoact,notjusttosafeguardthethousandsoftenantsandlandlordswhofallvictimtounscrupulouspractice,butalsotorelievepressureonthewidereconomy.”q

PrizewinnerdemonstratesincreasingimportanceofgeomaticsON 11 FEBRUARY THERICSannouncedthataformerstudent,basedinDublin,hadwonaninternationalacademicprizeinthefieldofgeomatics.ArisingoutoftheburgeoningGPSindustry,geomaticsis,accordingtoRICS,oneofthefastestexpandingglobalmarketsandatrulyworldwideprofession.

Accordingtotheinstitution:“Drivenbytechnologyandmaintainingtheirroleinlandlawandothersocio-economicareas,leadingcharteredsurveyingfirmsrealisetheimportanceofgeomatics,notonlytotheprofessionbuttothefuturesuccessoftheirbusinesses.”Itgoesontoquotea2012survey,whichfoundthattheUKgeospacialmarketalonewasworth£1.2bn.

Asaresultoftheincreasingimportanceofthefield,ageomaticsprofessionalgroupwasformedwithinRICS.Thegroupcomprisesmemberswhocanprovidespecialistexpertisein,amongotherfields,disputeresolutionandexpertwitnesswork,landlawadministrationandreform,

projectmanagement,researchandconsultancy.Oneissuethatarisesconsistentlyinpropertydisputesisthatoftheprecise

geographyofthepropertyinquestion–atitsmostbasic,whereexactlydoestheborderofthepropertylie?Geomaticsisenablingthatquestiontobeansweredwithincreasingaccuracy.q

•Further information on the work of the group can be found on the RICS website at www.rics.org.

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SpecialbuildingsneedspecialistadviceTHE ANNOUNCEMENT IN THEBudgetlastyearthatanexemptionwastoberemovedregardingVATonextensionstolistedbuildingsbroughtanoutcryfromthoseorganisationsresponsibleforthemaintenanceandupkeepofhistoricandotherinterestingbuildings.ThemeasuresparkedacampaignbytheListedPropertyOwnersClub(LPOC)tohavethemeasureoverturned–acampaignwhichLPOClaterconcededhadultimatelyfailed.

Thefurorealsohighlightedhowmanylistedbuildingsinthiscountryareordinaryhomesinhabitedbyordinarypeople.AlthoughLPOCrepresentsmanyownersandmanagersofstatelyhomes,itsmembershiplargelycomprisespeoplewhoinhabitoldhouses,cottages,farmsandformercommercialoragriculturalbuildingsthat,foronereasonoranother,areconsideredworthpreserving.

Itisthosepeoplewhoaretaskedwiththeupkeepofourheritage,oftenhedgedinbyincreasinglycomplexregulations.

Experthelpisoftenneededbybeleagueredowners,thebreadthandextentofwhichisdemonstratedannuallyatthesociety’sListedPropertyShowatOlympia–thisyearheldon16-17February.Exhibitorsofferadviceonallaspectsofowningandmaintainingalistedbuilding.Thereareexpertsintraditional

buildingtechniques,dealingwithdampandevenenergyefficiencywithinthestatutoryconstraints.

Inadditiontotheplethoraofpracticaladvice,moreover,thehouseholdercanfindoutwheretogoforadviceonlistedbuildingconsent,grantsandlegaladvice.TherearearchitectswhospecialiseinextensionsforthosewhoarepreparedtostumpuptheVATandevenspecialistwillwriterstoensurethetitleispassedonproperly.

AsLPOCpointsout:“Failuretoobtain

consentbeforealteringalistedbuildingmayresultinafineorevenatermofimprisonment.Alocalauthoritycanalsoserveanenforcementnoticeinrespectofunauthorisedworksrequiringownerstorestorethebuildingtoitsformerstate.Thesenoticescanalsobeenforcedforworkscarriedoutbypreviousowners.”

Insuchcases,forewarnedisforearmed.Andiftheworsecomestotheworseandacourtcaseensues,manyofthespecialistsofferexpertwitnessservices.q

Listed cottage in Rivington, Lancs

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With Chris’s advice, commercial service charges can be fairly determinedONE OF THE MOSTcommonareasofdisputebetweencommercialtenantsandtheirlandlordsistheservicechargeontheproperty.Thosedisputescanall-too-oftenendupinthecourts–anexpensiveandunsatisfactoryoutcomeforallconcerned.

Expertopinioninthesubjectcan,therefore,beinvaluabletotheparties.ThatiswhereCommercialPropertyAdvisorsLtd(CPA)comesin.CPAcandevisepracticalandworkablestrategiesforservicechargesandadviseonhowtheycanbestbeimplementedincollectiveandindividualcases.Theycanalsoadviseonservicechargesfornewproperties,moderniseolderarrangementsandimplementinterimprocedurespriortoestablishingnewagreements.

Theirservicesfallintofourbroadcategories:•DevelopmentAdvice•ManagementStrategy•AuditandComplianceReview•Dispute(andpre-dispute)ResolutionManagingdirectorChrisEdwardshasover40yearsexperience

asaspecialistincommercialpropertymanagementmatters.BeforeestablishingCommercialPropertyAdvisorsheheadedaUK-top40realestateconsultancy.

HeischairoftheRICScommercialmarketprofessionalgroupandhasadvisedboththeOfficeoftheDeputyPrimeMinisterandDepartmentofCommunitiesandLocalGovernmentonarangeofcommercialpropertyissues.

ChrisisanaccreditedmediatorandamemberoftherespectiveRICSPresident'spanelofindependentexpertsandarbitrators.Inevitably,however,therearetimeswheredisputescannotbesettledbynegotiationandChrisisfrequentlycalledupontoactasanexpertwitness.HeisamemberoftheStandingConferenceforMediationAdvocatesandcanpresentoneparty’sviewinamediationasrequired.q

CPA WAS APPROACHED BYretailstoreRiverIslandinrespectofaleaserenewalofashopunitwhichpartlyfrontedtheexternalHighStreetandalsotheinternalmallofashoppingcentre.Theleasewasupforrenewal,withacourthearingdueinlessthantwoweeks.

RiverIslandfelttheapportionmentoftheservicechargedidnotreflectthepartialexternalnatureoftheunitandapproachedCPAforadvice.PaulaTucker,estatessurveyoratRiverIsland,saidthattheexpertiseofCPAmeantthematterwasresolvedwithouthavingtoreverttothecourts.

“NotonlydidCPAresolvethecurrentissue,”shesaid,“buttheiradvicegaveusclearindicatorsastowhatstepstotakeinfuturerenewals.Itisreassuringtofeelmorecluedupandincontrolofthesituation.Theirspecialistexpertadvicewasanimportantadditiontoourcase.”

ChrisEdwardsexplained:“Leaserenewalsgiveownersandoccupierstheopportunitytomodernisetheleasesoitreflectsbothmodernbestpracticeandthepracticalissuesontheground.Issuesthatmayhavebeenwronglydocumentedfor25yearscanberesolvedatrenewalandneitherownernoroccupiershouldmissthisopportunity.”q

Revising at renewal pays dividends

CPA WAS APPROACHED BYthemanagementcompanyofablockofflatsinEtonwhichhadrecentlyacquiredthefreeholdfromtheirdeveloper.Asfreeholderthemanagementcompanywasrequiredtoruntheservicechargefortheflatsthemselves,andwasalsoentitledtorecovercostsfromadjoiningownerswhoeitheraccessedtheirownpropertythroughthedevelopmentorparkedvehiclesontheexternalpartsofthedevelopment.

Thesecretaryofthemanagementcompanyhadproducedaplan,schedules,servicechargeallocationandapportionmentstrategywhichCPAwasaskedtoreview.TheanalysisbyCPAmeantthat,intheeventofanagreementnotbeingreachedwiththeadjoiningownersbynegotiation,arbitrationcouldbeinvokedwiththemanagementcommitteeassuredthattheirapproachmetbestpractice.

MikeBlightman,secretaryoftheresidentsassociation,said:“CPAworkedwithustoamendsomeofourexistingdocumentationandtoapproachthewholesituationfromawiderviewpoint.Knowingthatalltheangleshadbeencoveredandreviewedbyanexpertwasarealrelieftothewholemanagementcommitteeandmadetheprocessmuchsimplerandhasslefree.”

ChrisEdwardscommented:“ItwasarealpleasuretoreviewMikeBlightman’splan.AfterbriefdiscussionsandemailexchangestherevisedplanmeetsBestPracticewhichthemanagementcompanycanenforce.”q

Pre-empting a mess in Eton

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Compulsory purchase–acquireroracquired?By TOM ASLIN of Kingston Smith LLP

COMPULSORY PURCHASE – THE namesaysitall!Itiswhenland,withorwithoutbuildings,ispurchasedwithouttheconsentoftheowner/occupier.OnlyentitiesauthorisedbyanActofParliamenthavethepowertodothis.Therefore,insuchcases,theacquirerwouldbealocalauthority,aregionaldevelopmentagencyoranotherparty,usuallygovernmental,andcreatedbyanActofParliament.Thelegislationlaysdownthatsuchpowershavetobeinthepublicinterest.Itisforthisreasonthatinmanycases,althoughnotall,thereisapublicinquirybeforethepowerscanbeconfirmed.

However,legislationsetoutintheLandCompensationAct1973providesthatfaircompensationbepaidtoaformerowneroroccupier.Thesestatutoryelementstocompensation,knownasbasiclosspaymentandoccupier’slosspayment,arestatutoryamountsoverandabovetheactualvalueslost.Theamountsthereofaredependentonthetypeandvalueofthelandandbuildingsinquestion.

Inadditiontothese,theLandCompensationAct1961provides,within

Section5thereof,forpaymentstoanownerequivalenttothemarketvalueofthelandandbuildingsatthedateofpossessionbytheacquiringauthority.Thisisprovidedforunderwhatisfrequentlyreferredtoas‘Rule2’,whichisthesubsectionwithinSection5.

Subsection6ofSection5,knownas‘Rule6’,providesforcompensationtooccupiersforthedisturbancelossthattheymayhavesufferedbyreasonoftheacquisitionoftheland.Thistypeoflosswillincludethelossessufferedbyabusinessowneroccupyingtheacquiredpremises,aslongastheoccupierhadarighttooccupy,irrespectiveofanyleaseortenancy.

Itisfrequentlythecasethattheowner,andtheoccupierifdifferent,cannotagreewiththeacquiringauthorityastothelevelofcompensationtobepaid.Itisherethatexpertwitnessescomeintotheirown.

Therearetwomainclassesofexpertrelevanttosuchcompensationclaims.Thefirstisnaturallyasurveyor,whocanusehisskillandjudgmentinassessingthemarketvalueoftheland,buildings,plant,equipment,fixturesetc.Inmanyinstances,anexpertsurveyorwillalsobeappointedbytheacquiringauthoritysothattherespectiveexpertscanmeet,discussandhopefullyresolvedifferencestoreachanagreedsettlement.Intheeventthatagreementcannotbereached,thedisputecanbereferredtotheUpperTribunal(LandsChamber)whereguidelinessimilartotheCivilProcedureRulesprevail.

Wheretheoccupierisabusinessortradeoperator,theremayalsobeasignificantelementofdisturbancesufferedbysuchanoccupier.Inthesecases,thesurveyorsengagedbytheformeroccupiermaywellcallinanexpertforensicaccountanttoassistinmeasuringthedisturbanceloss.Thismaywellleadtoforensicaccountantsbeingengagedonbothsidestofollowthesameprocedureastheexpertsurveyors.

Inallcasesthereisanonusontheoccupiertomitigateitslossesandthusthecompensation.Thereisanaturalassumptionthatunlesstheoccupiercandemonstratethatitwasnotpossibleto

relocatethebusinessortrade,thenthelosseswillbeassessedonthebasisthattheoccupiercould(andshould)haverelocated,whetherithasornot.

Thereisalsoanunwrittenunderstandingthattheconceptofrelocationshouldonlytakeplaceifthecostofsuchrelocationdoesnotresultincompensationbeingmorethanthatpayableifthebusinessortradewastotallyextinguished.However,acquiringauthoritiesareoftenpreparedtopaymorethanthetotalextinguishmentcompensationinordertopreservejobsorothermatters,butthisusuallydoesnotgiverisetoadditionalcompensationoverandabovetheextinguishmentvalueofbetween10%and20%.

Insummary,thisisaspecialistareawhichoftenrequiresexpertevidencefrombothsurveyorsandaccountantsinordertoensurethattheproperlevelofcompensation,fromboththeacquirer’sandacquired’sperspectives,isarrivedat.Theimportanceofinstructingappropriatelyqualifiedandexperiencedexpertsisthereforeessential.

InthenexteditionofYour Expert Witness,Iwillsetoutsomecasestudiestobringoutspecificpointsfrompastcasesinthisinterestingarea.q

•For further details please contact: Tom Aslin

Senior Manager, Kingston Smith LLP

Forensic Accounting Services

E:taslin@ks.co.uk

T:+44(0)2075663725

David Epstein

Consultant, Kingston Smith LLP

Forensic Accounting Services

E:depstein@ks.co.uk

T:+44(0)2075663726

Kingston Smith LLP

DevonshireHouse,60GoswellRoad,

LondonEC1M7AD

www.kingstonsmith.co.uk

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QC told to expect jail over VAT fraudA LONDON QC HAS beentoldtoexpectacustodialsentenceafterbeingconvictedofa£600,000VATfraud.RohanPershadwasconvictedon11FebruaryatBlackfriarsCrownCourtononecountofcheatingthepublicrevenuebetween1June1999and24September2011.

KeriAshworth-Beaumont,specialistprosecutorfromtheCPSCentralFraudDivision,said:“RohanPershadQCfailedtopayVATforaperiodof12years,despitecharginghisclientsthatVAT.Asaresult,heretainedanadditionalprivateincomeof£624,579,whichshouldhavebeenpaidtoHMRCandthepublicpurse.Byconvictinghimtoday,thejuryhasconcludedthatPershadwas

actingdishonestlyandhisfailuretopaywasnotsimplyanerrorormistake.

“HeclaimedthathischambershadgiventheimpressionthatpaymentofhisVAThadbeentakencareof,butthejuryclearlyrejectedthatassertion.Pershadalwaysadmittedthatheunderstoodthelawandtheresponsibilityformeetinghisobligationsrestedonhimalone.

“Themessageisclear–payingtaxisnotanoptionalextra,inanyareaofworkinglife,andwithholdingtaxdishonestlymayleadtoprosecution.”

TheconvictioncomesinthewakeofaspeechbyDPPKeirStarmerabouttheimportanceofprosecutingtaxevasion,whichhesaidcoststheBritisheconomy£14bnayearinlostrevenue.q

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Theoffenceoffinancial fraudby DEREK WILLIAMSON, Forensic Accountant

FRAUD COVERS A WIDErangeofoffences,frommanipulationofbasicaccountingrecords,throughmakingfalseinsuranceclaims,tomakingbenefitclaimstowhichoneisnotentitled.Italsoincludesbriberyandcorruption.

Historicallytheaccountingmanipulationwashandwrittenandcomprisedofmakingfalseprimeentriesoramendingthosealreadyentered.Acommoncauseofaccountingfraudwasthemisappropriationofcash.Thiscouldtaketheformoffailingtoringupcashtakingsinaretailshoporraisingfalsesupplier’sinvoices.Theseactionsoccurredforanumberofreasons:

a)Auditfindingsaredeemedtobeerrorsandirregularitiesb)Internalcontrolsarenotenforcedoroftencomprisedbyhigherb)authoritiesc)Individual’sbehavioursignificantlychangesd)Theaboveisbecauseofalargepersonaldebtorfinancialb)lossesandadriveforpersonalgaine)Missingdocumentsoronlyphotocopiesavailablef)Discrepanciesinaccountingrecordsg)Missinginventoryormissingassetsh)Excessivecreditnotesi)Alterationsofdocumentsj)Transactionsoccurringoutofsynck)Anemployeehavingcontrolofaprocessfromstarttofinishk)withnosegregationofdutiesandnoauthoritiescheckingk)theiractions.Growingareasoffraudarethesharescamsorboilerroom

frauds.Thesearewherepartnersaresellingsharestoinvestorsincompanieswhichareusuallyfakeorarenottrading.Theseactivitiesareoftencarriedonoffshorebyphoneusinga‘postrestaurant’addressintheUK.Alltoooftenpotentialinvestorsfailtocarrybasicchecksontheallegedcompanyorthe‘brokers’viatheinternet.

Anotherareaofinternetfraudisthe‘Ponzi’or‘Pyramidscheme.’Heretheinvestorisofferedahigherrateofreturnthenthenormal(sayat30%when10%mightbereasonable).

Thefraudstersthenusetheinvestor’smoneytopaypreviousinvestorstoconvincethemthattheschemeissuccessful.Inrealityitisashorttermfixtocreateafacadewhilstmostofthemoneyisstolen.

Assetstoppingisanotherwayofdefraudingcreditorsandshareholders.Herethedirectortransferstheassetsofacompanytoanotherataknockdownprice,soleavingtheoriginalcompanywithlargeliabilitiesthatcannotbemetresultinginthecompanybeingliquidated.

Sharerampinghasprovenpopularoverthelastfewyears.Thisiswherethecriminalsinfluencethesharepriceofacompanyandthentakeadvantageofit.Thisisusuallydonebybringingacompanytothemarketwithfalseexpectationsofitsprofitability.Thealternativeistobuysharesinthecompanyandthenstartarumourthatthecompanyisbeingtakenover.Whenthesharesriseinprice,theyaresoldataprofitwhichisafraudontheshareholders.q

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SeriousorganisedcrimeA computer forensics expert’s perspective

MOBILE PHONE FORENSIC ANALYSISisquiteanewtechnologybutisveryhighprofileatthemoment.Itwasn’tmanyyearsagothatIthoughtitmustbepossibletoundeleteatextmessageonaSIMcardandIsetaboutworkingouthowtodoit.Arathercrudeelectroniccircuitandhoursofsecondguessingthecodingresultedintherecoveryofmyfirstdeletedtext.Soonasteadystreamofenquiriesledtoaneedtoimprovetheequipmentandearlycommerciallyavailablesystemswereevaluated.Now,lessthan10yearslater,wehaveaplethoraofdifferentsystemsmadenecessarybecauseoftheeverchangingfaceofmobiletechnology.

Whenitcomestoinstructionsfromdefencelawyers,incasesbeinginvestigatedbySOCAforexample,therearefrequentlycallsformobilephoneattributionassessmentandcell-siteanalysis.Incasesofkidnappingandhigh-jacking,particularlyofhighvaluecommoditiesfromroadhaulagefirms,cellsiteanalysisandphoneattributionhavetobecomparedwithothergeo-locationaldatasuchasSATNAVs,trackersandotherGPSrelatedequipment.

Highvaluedrugsmugglinganddistributioncasesfrequentlyrelyonthistypeofhi-techevidenceanditisessentialthatconclusionsdrawnandopinionsderivedbyprosecutionexpertsaretestedandcheckedforbalanceandobjectivity.

ManyexpertservicesorganisationshavethelatestequipmentandthenecessaryknowledgeoftheprocessesandproceduresforsecuringdatafromthirdpartieswithintherequirementsoftheRegulationofInvestigatoryPowersAct,theDataProtectionActandtheCommunicationsAct.However,inseriousdrugdistributionandmoneylaunderingcasesforexampleitisnolongersufficienttocompletetheanalysisofcellsitedataandotherassociatedelectronicinformationpresentingitintablesandmaps.Thisisfortwomainreasons.Firstly,insuchcasestherecantypicallybedozensofmobilephoneswithtensofthousandsofpagesofdataandconductingadetailedanalysisofallthatdatabytraditionalmethodsissimplynotpossiblewithinthenormalmeasuresofbudgetandproportionality.Secondly,evenifsuchananalysisweretobecarriedouttheresultsareoftensimplytoocomplexforeventhemosttechnicallyablejurymemberorcounseltodealwithinthecontextofatrial.

Theanswerliesinpost-processingtechniquesandsoftwaredevelopmentsthatenabletrendsandpatternstobeextractedfromtheresultsofcellsiteanalysisandcombinedwithsimilaranalysesofotherrelevantdata.Suchtechniquesexistalreadyintheareaofemailanalysiswherespecialistdevelopmentshaveenabledalimitednumberofkeyforensicexpertstopresentemaildisclosure,notmerelysothatitcanbesearchedbutsothat,forexample,thedistributionofattachmentscanbeseeninavisualformatenablingpatternstobespottedandconsidered.Applyingsuchpost-processingtechniquestothelargedatatypicallyproducedbycellsiteanalysisinseriousorganisedcrimecaseswillenable

muchmorefocussedopinionstobedrawnonthewhereaboutsofkeyindividualsandsuspects,therebytestingprosecutionevidencemuchmorerobustly.q

•Tony Sykes, Senior Partner in IT Group, is a Chartered IT Professional and a Chartered Electrical Engineer. He has twenty years experience as an IT and Electrical Engineering Consultant and is an experienced Expert Witness. IT Group provides a broad range of consultancy services including due diligence, business process review, QA audit, insurance assessment, forensic IT / telecoms / electrical systems examination and expert services. www.itgroup-uk.com.

Tony Sykes has been instructed in many ground-breaking IT disputes. A burgeoning spin-off from

his hands-on approach to IT is a successful Computer Forensics division of IT Group UK

Limited. Here he sets out some observations and opinions on the types of defence instructions that are taken on in cases of serious organised crime.

1717www.yourexpertwitness.co.uk 17

PERSONAL INJURY CLAIMS, ONCE accepted by asolicitor, can all too often herald the beginning of whatcould be a potentially lengthy medico-legal process. Theinstruction of an appropriately qualified medical expert,to examine the client and provide a written report of theirfindings, is a significant part of this process. Often withinthese reports experts recommend additional diagnosticprocedures, imaging or therapeutic interventions whichsolicitors are required to arrange. Diagnostic & RehabServices Ltd can organise all of these imaging needs on anationwide basis. They are able to source and issue a noobligation quote – within one business day in most cases.It is worth remembering that mismanaged claims causeunnecessary delays in reaching a settlement.

Diagnostic and Rehab Services Ltd will work with yourclients to provide appointments and venues that suitpersonal circumstances wherever possible and their belief inoffering a bespoke service to all instructing solicitors is thefoundation of the business and the key to its efficiency.

Diagnostic and Rehab Services Ltd, will arrange all of yourmedical imaging, medical investigations and therapeuticinterventions on a nationwide basis. Furthermore, they willalways endeavour to ensure that you receive the results orwritten reports in a timely manner as part of a commitment toservice.

Diagnostic and Rehab. Services Ltd…...Bespoke Medical Solutions for Legal Practitioners.

Company Profile

THE GREAT MAJORITY OF personal injuryfirms are planning to cut staff numbers in thenear future unless the government pulls backfrom plans to reform civil litigation, according toa report in the Law Society Gazette.

It quoted a survey carried out by theAssociation of Personal Injury Lawyers (APIL)which found that 118 of the 155 firms taking partwere planning to cut their workforce this year.

According to The Gazette: “The surveyformed part of APIL’s full response togovernment plans to cut fixed fees for low-valuepersonal injury work. The new recoverablecosts for RTA claims valued under £10,000would reduce from £1,200 to £500, whilst thereare also fixed fees for claims up £25,000 andemployer and public liability claims, which wouldbe dealt with by an electronic portal for the firsttime.”

APIL argued that the government was lettingindependent advice be eroded to the detrimentof the injured person. It also claimed thatthe government had forgotten or ignored theirreducible minimum amount of work required inall cases.

Law firms would be unable to runsuccessful practices advising claimants onpursuing claims for minor injuries and insteadclaims management companies would moveto running the cases themselves.

APIL also claimed the government had noevidence to suggest that a £700 cut in costswould be balanced by firms no longer payingreferral fees. Furthermore, more than half ofpersonal injury firms do not pay referral feesand would not see any savings from the ban.

“The government continues to drawconclusions about the link between referralfees and lawyers’ costs which are illogical

and flawed,” the response said.Nigel Muers Raby, chairman of claimant

lobby group the Consumer Justice Alliance,said: “Lord Dyson, Master of the Rolls andhead of civil justice, has said that he doesnot want the changes to the civil justicesystem to deny access to justice. However,the government must recognise that anyattempt to reduce fixed recoverable costsassociated with RTA cases would likelyresult in such cases becoming commerciallyunviable, leaving consumers findingthemselves unable to find legal supportfollowing an accident.”

APIL predicts haemorrhage of personal injury staff

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Adoptionfollowing care proceedingsHELPING CHILDREN TO RECOVERfromtraumaticexperiencesisadifficulttaskandweunderstandtheparticularchallengesfacedbycarersandparents.Wealsounderstandhowcomplicateditistobuildrelationshipsforthelong-term,workingthroughupsanddownswithchildrenwhobringtheirhistorieswiththem.

Itisimportanttobringtogetherbothachild’sandparent’shistoryinordertobeginanewsharedexperience.Webelievethatgoodqualitysupportforadoptiveparentsandfortheprofessionalsworkingwiththemisessentialandthereareseveralwayswecanhelp:

Placement planning support

Wherechildrenhavebeenthroughcourtproceedingsanassessmentoftheirneedsmaybeinplace,butifnotweareabletoprovidetargetedassessmentstoguideplacementplanningorsupportservices.Anassessmentofachild’sattachmentprofilecanhelpwithplacementforadoption,whilstacognitiveassessmentmaybeusefulinplanningforafosteroreducationalplacementwhichwillbestmeetachild’sneeds.

Support to placement stability

Weofferconsultationservicestosocialworkers,otherprofessionalsanddirecttocarersandparentstosupporttheminunderstandingandworkingwithdifficultiesinaplacement.

Direct therapeutic work

Keytorecoveryfromtraumaaretherelationshipschildrendevelopwithintheirnewplacements,butsometimessomeextrahelpisneededtodevelophappierandhealthierwaystointeractwithothers.

Wecanprovidedirecttherapeuticworktohelpaddresssomeoftheunderlyingdifficultieswhichmightdestabilisecaringrelationships.ThetherapiesweofferatPsychologyAssociatesforchildren,youngpeopleandtheirfamiliesinclude:

• DyadicDevelopmentPsychotherapy(DDP)• Theraplay• EyeMovementDesensitisation&Reprocessing(EMDR)• NarrativeAttachmentTherapy• SensoryAttachmentTherapy• CognitiveBehaviouralTherapy(CBT)• SystemicFamilyTherapy• AttachmentParentingTherapyYoucanfindoutmoreabouttheworkofPsychologyAssociatesby

visitingwww.psychologyassociates.org.uk.q

By Sam Hastings ofPsychology Associates

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What price ‘thecat’?

By DR M GRAHAM,MBChB, PhD, FRSM, MICR, MFSSoc

MEPHEDRONE, OR METHCATH CATHINONE(formerly‘LegalHighs’),isrelatedtoephedrine.ItsstreetnameisMiaowMiaow,KittyKatorCatFoodandonthecorneritsellsfor£10agram,whichis£30cheaperthan‘coke’(cocaine).

Ithastakenoverthemarket,notonlyonprice,butonpurityasstreetcoke,‘speed’or‘phet’(amphetamine)rangesfrom2%(typicalstandard)to30%purity(premiershipfootballstandard)whereasMiaowis100%pureforitsstreetprice!Thesavvydealerswilltryandcutitwithcreatineorsoapsuds,butwithlittlesuccessanditmaintainsitspuritybyitsprice!

TheSaturdaylotteryticketcostsonly£1withchancesofwinningof17milliontoone.TheEuromillionslotteryticketcosts£2andthechancesofwinningare47milliontoone.Miaow,however,canbeboughtforjust£10pergramandthechancesofwinningare100%!

The‘high’lastsallnightandcanaffectthepersonalityoftheuserforuptoaweekbeforethenextdose,wreakinghavoconyoungcouples’newfragilerelationships!

Wheretheodd‘spliff’(cannabis)orafewpintsof‘wifebeater’(cider)weretheculpritsonlyadecadeortwoago,Miaow,sinceitwasmadeillegalin2009,hasseenitsstatusrise100fold–itissnortedlikecoke.

UnbeknowntothepartyanimalItcanbedetectedinhair,afteronesampleofuse,upto10monthslater.Itleavesthepotentialaddict‘chilled’,mildlydisinhibitedandpotentiallysubjecttoabuseandviolencebyavociferous,aggressivepartner–maleorfemale!Ifbothpartnersabuse‘thecat’itcanresultinbabiesbeingleftaloneintheircotswithwet,soilednappiesforfartoolong.

Itcanturnsubmissivefemalesintopowerfultyrantsandbigstrongmenintoweepingbabies,whenchildrenarethebargainingtool.Especiallywhenthe‘Justice’systemandtheTreasuryhaveputalltheirfaithandmightbehindthemother(whointheireyescandonowrong).

Itsdetectioninthehairofeitherpartnerhasaffordedcustodytotheother–ortosocialservicesifrecreationaldrugsaredetectedinbothparents.

Attemptstodyeorcutthehairbyfemaleshasnoeffectonitsdetection,providingdilemmasforfamilycourts.Wherefemaleswerepreviouslygainingcustodyofthechildren,thecourtshaveswungtotheoppositespectrumandawardedcustodyagainstthemother.

Theultimatevictimsarethechildren.Disruptionincontinuityofcare,rowingparents,socialservicesinterventionanduntoldpressuresonsupportivegrandparentscanonlyservetodestabilisethefabricofsociety.BothDavidCameron’sandTonyBlair’sgovernmentsshouted“backtobasics”toattainpower!

Isthisnowcontrolleddrugreallyanyworsethanalcoholindismantlingouryouth’scommitmenttotheupbringingofourchildren?Onlytimewilltell.

Advocatesofdomesticviolencepreventionarebangingtheirheadsagainstabrickwall.Theydon’tappeartounderstandthatmakingadrugillegalpromotesitsstatusonthedrugscene.Today’skids,justlikeyesterday’s,likebeingnaughty.

Intheinterim,alcohol(withorwithout‘thecat’)willcontinuetowrecklivesandfamiliesandstillremainsuncontrolled,whilegovernmentswhosworetosupportyoungfamiliesreapenormousrewardsfromitssaletothem!q

REFERENCES

•O’ByrnePMetal.Screening of Stimulants Including Designer Drugs in Urine

Using a Liquid Chromatography Tandem Mass Spectrometry System.JAnal

Toxicol.2013.

•ElieMPetal.Keeping pace with NPS releases: fast GC-MS screening of

legal high products.DrugTestAnal.2013.

•denHollanderBetal.Long-term cognitive and neurochemical effects of ‘bath

salt’ designer drugs methylone and mephedrone.PharmacolBiochemBehav.

2013.

•MabbottSetal.2p or not 2p: tuppence-based SERS for the detection of illicit

materials.Analyst.2013.

•PetrócziAetal.New non-randomised model to assess the prevalence of

discriminating behaviour: a pilot study on mephedrone.2011;6:20.

SubstAbuseTreatPrevPolicy.

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DrugDrivingofinactivemetabolites(e.g.Carboxy-THCorTHC-acidforcannabisandbenzoylecgonineforcocaine)donotprovethedrivertohavebeen‘undertheinfluence’andmayreflectusagedaysorweekspreviously.Thereareno‘legallimits’butverylowlevelsmaybeincapableofcausingintoxicationorcanresultfrompassiveexposure.

Impairment TestingThestandardimpairmenttestconsistsof5sections:•Eye Examination–excessivedilationorconstrictionofpupils,

reddenedconjunctivaeand/ornystagmuscanbesymptomsofintoxication–notatestofimpairment.

•Romberg Test–subjectstandswithlegsapart,eyesclosedandheadbackandaskedtoestimate30seconds–atestofbalanceandtimeperceptionwithapassifwithin5seconds.

•Walk and Turn–subjectrequiredtotake9stepsalongastraightlineheeltotoe,turninadesignatedmannerandreturntostartingposition–atestofcomprehension,balanceandco-ordination.Failforsteppingoffline,wrongnumberofstepsorincorrectturn.

•One-legged Stand–subjectrequiredtoraiseeachleginturnandcountoutloud–atestofbalance.

•Finger to Nose–subjectrequiredtostandwithheadbackandeyesclosedandtouchtipofnose6timeswithendoffingerascalledbytester–atestofbalance,co-ordinationandabilitytofollowinstructions.

Defendantscommonlyfailthesetestsduetonotfollowinginstructionstotheletter–thereiscurrentlynocautiontothateffectgivenbeforethetestisadministered.Also,manyFMEsarenotnativeEnglishspeakersandcanbedifficulttounderstand.Testsareoftenjudgedsubjectively–aslightwobblemaybeignoredbyonetesterbutruledasexcessiveswaybyanother,particularlyastestsarenotconducted‘blind’astothecircumstances.Itisstronglyrecommendedthatimpairmenttestsarealwaysvideoandaudio-recordedasanobjectiverecord,sothecourtcanformanindependentviewofproceedings.

Due to Drug?Ifthedefendanthasanyunderlyingmedicalconditionordisabilitythis

shouldbedisclosedatthetime.Howlonghadhe/shebeenawake?Ishe/sheunabletounderstandinstructionsduetolanguagedifficulties?

Effects of DrugsNotalldrugsimpairdriving,somemayevenimproveit.Somedrugs

improvesomeaspectsofdrivingwhilstimpairingothers.Theeffectsofdifferentclassesofdrugcanbesummarised:

Cannabis–noeffectonreactiontime,butcanleadtoimpairedtracking(e.g.lanediscipline)andjudgement,drivingbehaviourtypicallyimproves(slowerspeeds,greaterdistancesbetweenvehicles,fewerriskymanoeuvres)andthiscanoutweighanydeficitsinperformance.Littleornoeffectonaccidentriskinexperiencedusersanddrivers(unlessuseexcessive).Youngerdriversandinexperiencedusers,particularlyfemales,poseasignificantlygreateraccidentrisk.

Stimulants(amphetamines,cocaine,cathinones)–Lowdosestendtoimproveperformance–alertness,reactiontimesetc–highdosescanimpairjudgement–morerisky/aggressivedrivingbehaviour,excessiveself-confidenceandfeelingsofinvulnerability.

Opiates(heroin,codeine,morphine,methadone)–Littleeffectinexperiencedordependentusersunlessinoverdose,butimpairmentcanbefoundduringwithdrawal.Depressanteffectinnaïveusersmayimpairperformance.

Depressant drugs(alcohol,tranquillisers,barbiturates,ketamineetc)–clearandlong-establisheddose-relatedperformancedeficits–slowerreactions,drowsiness,impairedjudgementanddrivingbehaviour.q

•Due to space constraints, this is but a brief introduction to the issues in these cases. For a more detailed review please visit the following page on the IDMU website: http://www.idmu.co.uk/drugdrivingsolsadvice.htm.

Arrests for driving whilst unfit through drugs are on the increase. As an expert witness with wide experience of drug driving cases Matthew Atha, director of the Independent Drug Monitoring Unit, offers some practical advice.ELEMENTS OF DRUG DRIVINGoffencesincludeprovingintoxication,provingimpairmentandprovingthattheimpairmentwasduetodruguseandnototherfactors.

•Intoxication:Normallyprovedbyshowingpresenceofadrugwhichcouldcauseimpairmentwithinbodilyfluidsamples.

•Impairment:Usuallydemonstratedbyfailureofimpairmenttestsand/ormedicalexamination,maybeinferredfrompoordrivingbehaviouroranat-faultaccident

•Impairment due to a drug:Ratherthananotherreasonsuchasinjury,illness,disability,fatigue,shockoraccidentscausedbydistraction

Blood TestsAbloodsamplecanonlybetakenwhereadoctorbelievesthatthere

isaconditionpresentwhichmaybeduetoadrug.Delaysintakingthesamplecanbecriticalaslevelsofsomedrugs(e.g.THCandcocaine)droprapidlywhereasothers(tranquillisers,opiates,amphetamines)fallmoreslowly.Theforensicevidenceneedstoshowquantifiablelevelsofactivedrugsoractivemetabolites.Testswhichshowthepresenceonly

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Attention Deficit Disorder in adultsBy DR JEREMY STIRLING, Consultant Addictions and General Psychiatrist

ATTENTION DEFICIT DISORDER (ADD)isaclinicalconditionthathasbeenrecognisedinchildrenformanyyears.Itisaneurodevelopmentaldisorderwithastronggeneticpredispositionalthoughantenatalfactors,suchasmaternalsubstanceabuse,andlaterchildhoodenvironmentalfactorsmayalsobeimportant.

Themainsymptomsofthedisorderareinattention,poorconcentration,distractibilityandimpulsivity.WhenmarkedhyperactivityispresentthetermADHDisused.Thediagnosisisoftenmadeinchildhood.Itrequiressymptomstobepresentinmorethanoneenvironmentandtohaveitsonsetbeforetheageofseven.Akeypartofdiagnosisisdistinguishingthepresentationfromnormallevelsofboisterousbehaviouranddistractibilityaswellasotherbehaviouraldisordersofchildhoodsuchasconductdisorder.

Inthepastcliniciansconsideredthatthedisorderwouldcompleteitscourseduringadolescence.Morerecentresearchsuggeststhatthedisordermayoftencontinuepartiallyorincompleteformintoadulthood.Adultsmaypresentasbeingcareless,notpayingattentiontodetail,beingeasilybored,notabletolistentoothers,frequentlyinterruptinginconversations,havingdifficultyfollowinginstructions,beingrestless,irritable,impulsiveandpoorlyorganised.

ItislikelythatmanyadultswithADDgetmisdiagnosedandacquireotherpsychiatricdiagnosessuchaspersonalitydisordersorproblematicsubstancemisusers.Thisisparticularlythecaseifachildhooddiagnosiswasmissed.ThesymptomsoftheirADD/ADHDmaywronglyattracttheseotherdiagnosesalthoughitisalsopossibleforindividualswithADD/ADHDtohavearangeofadditionalpsychiatricdiagnoses(includingpersonalitydisorder,drugoralcoholdependenceordepression)

Whyisthisofrelevancetothelegalprofession?1.WhilemostadultswithADD/ADHDdonotcommitoffencesthey

aremorelikelytohaveproblemswithpoorimpulsecontrolwhichcanberecklessorviolentinnature.Thisincludesroadtrafficoffenceswhicharemoreprevalentinthisgroup.Theyalsohaveanincreasedriskofsubstanceabuseandassociatedcriminalbehaviours.Indeed,researchsuggestsahighprevalenceofADD/ADHDintheprisonpopulation.

2.ImpulsiveandrecklessbehaviourfromADD/ADHDmayunderlieoffendingbehaviourandhelpgivesomeunderstandingoftheoffence.Psychiatricevaluationmaybeofassistanceindeterminingdiagnosisandpotentialtreatability.Suchtreatmentmayimprovetheoutcomesofanycommunityordersgivenbythecourt.

3.ADD/ADHDmaybemaskedbysubstancemisuse.ThereisanincreasedprevalenceofsubstancemisuseinthosewithADD/ADHDandthesymptomsofthedisordermaywronglybewhollyattributedtotheirintoxicatedstates.DrugintoxicationmayeasilymimicADD/ADHDsymptomsandonlycarefulassessmentcanuntanglethediagnoses.Adherencetoanysubstancemisusetreatmentprogrammedirectedbyacourtmaybeenhancedbytreatmentofthedisorder.

4.AdultswithADD/ADHDareoftenforgetfulanddisorganised.Theymay,asaresult,missimportantappointmentsrelatedtotheircasesuchassocialworkassessmentsandcourtappearances.Theymightinadditioncomeacrossasindifferentordisinterestedintheproceedings.ThiscouldeasilybeseenasbeingpoorlymotivatedorcallouswheninfacttheunderlyingproblemisrelatedtotheirADD/ADHD.

AssessmentofADD/ADHDinadultsinvolvescarefulpsychiatrichistorytaking(inparticularthechildhooddevelopmentalhistory),useofratingscales(suchastheCAARS)andgatheringofinformationfromkeyinformantssuchasparents.Thereisnodiagnosticbloodtest.Treatmentcaninvolveacombinationofpharmacological(with

suchdrugsasatomoxetine,methylphenidateanddexamphetamine),psychological(suchascognitivebehaviouraltherapy)andoccupationalinterventions.Paradoxicallysomeofthedrugtreatmentsarestimulantinnature(andarecontrolleddrugs)althoughtheireffectinthosewithADD/ADHDreduceshyperactivityandimprovesconcentrationandfocus.ThelongtermbenefitsofthesetreatmentsofadultADHDarenotasyetclearandtheprovisionofservicesforthosewithADD/ADHDintheUKisquitevariable.Thediagnosisstillcourtssomecontroversyamongpsychiatrists.

ThisbriefoutlineofadultADD/ADHDaimstoencouragelawyerstobeawareofthepotentialdiagnosisintheirclients,toconsiderthewaysinwhichthisdisordercanunderlieoffendingbehaviourandtohighlighthowtreatmentcanreducetheriskofre-offending.q

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New rules restrict experts in child care casesRESTRICTIONS ON THE USEofexpertsinfamilycourtscameintoforceon31January.Itisclaimedthenewmeasureswillenablechildcarecasestobedealtwithmorequicklyandeffectively,sochildrenandfamiliesaresparedunnecessarydelaysand–significantly–thecosttotaxpayersisreduced.

Familycourtsarenowrequiredtorestrictexpertevidencetothatwhichis‘onlynecessarytoresolvethecase’andtoapprovethequestionsthataretobeputtotheexpert‘toensuretheyarefocusedonthedeterminativeissuesforthecourt’.

Courtswillalsohavetotakeaccountofspecifiedfactorsbeforeagreeingtoexpertwitnessreports.Incarecases,thosefactorsincludetheimpactonthewelfareofthechild,theimpactonthetimetableforproceedingsandwhethertheevidencewhichisneededisavailablefromanothersourcesuchasthelocalauthority.

AccordingtotheMinistryofJustice,untilnowmultiplereportshavebeencommissionedinmanycaseswhichcanleadtodelaysofseveralweeks.Thereports,theMoJsays,aretypicallycommissionedfromexpertwitnesses,forexampledoctorsorspecialistpsychologists.

FamilyJusticeMinisterLordMcNallysaid:“Wearetakingactiontotackletheunacceptabledelaysinourfamilycourts.Thenumberofexpertreportsbeingcommissionedatthemomentisfarbeyondwhatisactuallyneededtomakeaconsidereddecision–andiscausingdelayswhichcanultimatelyharmchildren.

“Thenewrulesmeanexpertevidencewillonlybeusedwherenecessaryandreportswillbecommissionedmoresensiblyandsparingly.”

ThechangesarethelateststepsintheGovernment’scommitmenttoensuringfamilycasesaredealtwithwithin26weeks,followingarecommendationbytheFamilyJusticeReviewconductedbyDavidNorgrove.q

Cardiac conference highlights health inequalitiesTHE HUGE INEQUALITIES INaccesstohealthcareacrosstheEuropeanUnionwerehighlightedon23JanuarywhentheEuropeanCriticalCareFoundation(ECCF)hostedadebateattheEuropeanParliamentonimprovingaccesstolife-savingtherapyforacuteheartattackpatients.Differencesintheorganisationofhealthcaresystems,suchasemergencytransportsystems,hospitalnetworksandtreatmentreimbursementagreements,wereidentifiedasmajorcausativefactors.

Thedebate,organisedincollaborationwiththeStentforLifeInitiativeandCypriotMEPAntigoniPapadopoulou,broughttogetherEUpolicymakers,cardiologists,medicalresearchers,industrypartnersandotherconcernedstakeholders.

“Weneedtorememberthatcardiovasculardiseases,whichcanleadtoheartattacks,contributetomorefatalitiesthanallcancerscombined,”explainedMsPapadopoulou.“Thisisaworryingfact–notjustbecauseoftheburdenonhealthsystemsitcauses,butalsoforwhatitmeanstothoseofuswhoselivescanbechangedforeverwhenanacuteheartattackoccurs.”q

SADScampaignsaveslives,despitelackofexpertagreementondefinitionTHE TRAGIC CONSEQUENCES OFsuddenarrhythmicdeathsyndrome(SADS)havebeenthrustintothenewsrecently.

ManywonderedatthemiraculoussurvivalandrecuperationoffootballerFabriceMuamba,whocollapsedduringaPremierLeaguegamebetweenhisBoltonWanderersteamandTottenhamHotspursatWhiteHartLanelastMarch.

AsLauraSharrockofMPHSolicitorspointsout:“FortunatelyforMrMuamba,adefibrillatorwasonhandinhiscase.”Unfortunately,manyyoungpeoplewhoarestruckwiththesyndromeareinvenuesthatarenotsowellequipped.

LauraSharrockcontinued:“Liverpoolschoolboy,OliverKing,wasnotsoluckyandhediedofsuddencardiacarrestafteraswimminglesson.”

HisparentshavelaunchedtheOliverKingFoundationtopressfordefibrillatorstobeinstalledinallschoolsandpublicplacesinthecountry.Ane-petitionhasbeenlaunchedtotrytoforceadebateinParliament.PatriceMuambahimselfhasjoinedthecampaign,participatinginthe‘HeartsandGoals’campaignaswellassupportingtheOliverKingFoundationinitse-petitionpush.

Despitetherecentpublicitysurrounding

thesyndrome,thereisstilllittleconsistencybetweenmedical,pathologyandlegalexpertsaboutwhattheconditionis,accordingtotheorganisersofaone-dayconferenceonSAD Cases in the Coroners’ Courts,whichtookplaceinOxfordinJanuary.

Inthemeantimedefibrillatorsarebeinginstalledinanincreasingnumberofvenues,togetherwithtrainingintheiruse.q

•To sign the e-petition visit http://epetitions.direct.gov.uk/petitions/29399.

Fabrice Muamba – © wonka

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Failedfemalesterilisationestablishing liabilityBy MR ROTIMI A K JAIYESIMI, FRCOG, FWACS, MBA, LL.M (Medical Law)Consultant Obstetrician & Gynaecologist

WOMEN OPT TO HAVEapermanentformofcontraceptionwhentheydecidethattheyhavecompletedtheirfamilies.Sterilisationisachievedbyinterruptionofthepatencyofthelumenofthefallopiantubes,withthesolepurposeofprovidingapermanentandirreversibleformofcontraception.

FemalesterilisationcanbeperformedbylaparoscopicocclusionofbothfallopiantubesusingocclusivedevicessuchasFilshieclipsorFaloperings.SterilisationbylaparoscopicapplicationofFilshieclipstotheisthmicregionofeachfallopiantubeisthemostcommonmethodoffemalesterilisationintheUnitedKingdom.Occlusionofthefallopiantubescanalsobeperformedbymini-laparotomyoratcaesareansection.

Newerapproachestofemalesterilisationincludeocclusionoftheostiumofeachfallopiantubewithmicro-insertsorsilasticplugsusingahysteroscope.Oneoftheadvantagesofthisapproachisthatitcaneffectivelybeusedinanoutpatientsetting,thusavoidingtherisksofgeneralanaesthesiaandlaparoscopicsurgery.Theseadvantagesnotwithstanding,theuptakeofhysteroscopicsterilisationintheUKhasbeenslow,partlyduetoPrimaryCareTrustsnotcommissioningtheserviceandalsotheunwillingnessorinabilityofAcuteTruststoprovidetheservice.Patientsmayalsonotbeawareoftheprocedure.

FailureFailureofFilshieclipsterilisationoccursin

about2to3per1,000casesattwoyears,withalifetimefailurerateof1in2001.Whilepermanenceofcontraceptionistheaimoftheprocedure,thiscannotalwaysbeguaranteedandpatientsmustthereforebemadeawareofthepossibilityoffailure.Theeffectoffailedsterilisationcanbedevastatingandwomentendtoseekcompensationwhenitoccurs.TheLawCourtshavemadeanumberofrulingsontheissuesofcompensationforfailedsterilisation.

Tolaunchasuccessfulclaimitisimperativetoestablishthatthecauseoffailureofthesterilisationwasasaresultofnegligence.Thisisnotalwayspossibleasitisknownthatfailedsterilisationcouldbeasaresultofnaturalrecanalisationofthelumenofthefallopiantube(s).Weareguidedbyastudythatindicatesthatconceptionseveralyearsaftersterilisationtendstoindicatethatthetubeshaveregrownnaturally.Thisisnotconsidered

tobenegligence.Havingsaidthat,anumberofcasesoffailedsterilisationduetonegligencedooccurmanyyearsaftertheprocedure.Failureofsterilisationwithin12monthsofthesterilisationisconsideredtobeduetoerrorsintheapplicationoftheclips2.Thelatterraisesissuesofbreachofdutyofcareandliability.

Establishing liability and causationTortliabilityappliestothosecaseswhere

thereisafailuretocarryoutaprocedureasareasonablycompetentpractitionerwouldhavedone.RelianceisplacedontheBolamtestindefiningwhatconstitutesnegligence.McNairJ.inBolam v. Friern Hospital Management Committee,[1957]1W.L.R.582,586opinedthat‘whereyougetasituationwhichinvolvestheuseofsomespecialskillorcompetence,thenthetestastowhethertherehasbeennegligenceornotisnotthetestofthemanonthetopofaClaphamomnibus,becausehehasnotgotthisspecialskill.Thetestisthestandardoftheordinaryskilledmanexercisingandprofessingtohavethatspecialskill.Amanneednotpossessthehighestexpertskill.Itiswellestablishedlawthatitissufficientifheexercisestheordinaryskillofanordinarycompetentmanexercisingthatparticularart.’

Liabilitywillnotbeimposedincasesoffailedsterilisationunlessitcanbeestablishedthatthefailuretoachievesterilitywasduetomedicalnegligenceintheperformanceoftheoperation,ornegligenceinimpartingtherequisitequantumofinformation.

Proofofinappropriatelyperformedsterilisationcomesfromfindingsatrepeatsterilisationoratcaesareansections.Thefindingsmayincludewrongfulapplicationofthecliporringtotheroundligamentorincompleteencompassmentoftheentirecircumferenceofthefallopiantube.Itisgoodpracticetotakehighqualitypicturesofthesefindingsatthetimeofrepeatsterilisationspriortotheexcisionofthetubesorreapplicationofasetofnewocclusiveclips.Ifthetubeshavebeenremovedatarepeatsterilisation,histologicalexaminationoftheexcisedfallopiantubesmayconfirmorrefuteevidenceofoperatorerror.Iftheexaminationrevealsevidenceofincompleteocclusionofthelumenofthefallopiantube,thisfindingmaybeenoughtoestablishnegligenceandineffectliability.

Liabilitymayalsobeestablishedifitcanbeprovedthatthewomanwasnotinformedoftheriskoffailureoftheprocedure.Itis

thereforeofutmostimportancethatadequatecounsellingandconsentingtakesplacepriortotheprocedurebeingperformedandthatthisisdocumentedintheclinicalnotes.

CompensationTheHouseofLordsin2003ruledin

anappealinRees v Darlington Memorial Hospitalthatthereshouldbeaconventionalawardof£15,000tocompensateawomanfortheinfringementofherrighttolimitherfamilysizeoverandaboveawardsforotherlosses.Acostof£5,000isawardedforthepainandsufferingofpregnancyandlabour,andforherlossofearningsduringthematernityleaveperiod3.

Minimising the risks of failed sterilisation

Femalesterilisationismeanttobepermanentandirreversibleandshouldnotberecommendedforwomenwhoareuncertainaboutfuturechild-bearing.Itshouldbedonebyappropriatelyskilledpersonnelandonlyafteradequatecounsellinganddiscussionsaboutitsintent,therisksinvolvedandallalternativeformsofcontraception4.q

•Mr Rotimi Jaiyesimi is an expert witness in obstetrics and gynaecology. He is the Associate Medical Director for Patient Safety and Consultant Obstetrician & Gynaecologist at Basildon and Thurrock University Hospital, Essex. He can be contacted via email on jaiyesimi@medicalnegligence.org.uk or visit the website www.obs-gyn.org.

REFERENCES

1RoyalCollegeofObstetriciansandGynaecologists

Male and Female SterilisationEvidence-based

ClinicalGuideline,Number4,January2004.

2RajeshVarmaandJaneshK.GuptaPredicting

negligence in female sterilization failure using time

interval to sterilization failure: analysis of 131 cases.

Hum.Reprod.(2007)22(9):2437-2443.

3Rees (Respondent) v Darlington Memorial Hospital

NHS Trust (Appellants),HouseofLords,Session;

[2003]UKHL52,onappealfrom:EWCACiv88.

4JaiyesimiRAK&EedarapalliPFemale

sterilisation.SexualHealthMatters2001;2,42-44.

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AT THE TURN OF THEcentury,Temporomandibular(TMJ)dysfunctionwasthoughttoaccountforalossinproductivityofthirtybilliondollarsand550millionworkingdaysayearintheUSA.TheTMJcomprisesthecondyle(head)ofthemandibleseparatedfromthearticularportionofthetemporalbonebyadisc.

InternalderangementoftheTMJisdefinedasadisruptionwithintheinternalaspectsoftheTMJinwhichthereisadisplacementofthediscfromitsnormalfunctionalrelationshipwiththemandibularcondyleandthearticularportionofthetemporalbone.Itisusuallytreatedwithnon-surgicalmethodsinitially,butshouldthesemethodsproveunsuccessfultheyareoftenfollowedbysurgicalmethods.Muchofthedifficultyencounteredwiththetreatmentofthesecasesisattributedtothephysician’sinabilitytodiagnosethedisorderaccurately.

TodetermineTMJdysfunction,oneneedstocarryoutadetailedphysicalinvestigationandoneormoreofX-ray,CTscan,MRIscanand/orarthro-graphy.Noradiological(X-ray)investigationshouldberequestedunlessitcanbeclinicallyjustified.Amagneticresonanceimage(MRI)scanisanon-invasiveprocedureusingmagneticandradiowaves,meaningthatthereisnoexposuretoX-raysoranyotherformsofdamagingradiation.MRIshowsthesofttissuesofthebodyingreatdetailandissuperiortocomputerisedanatomicaltomography(CAT)scansandotherformsofX-radiation.CATscansareusefulforevaluationofbonydeformities.

Arthroscopyisoftenalsoemployed.ArthroscopicsurgeryappearstobeasafeminimallyinvasiveandeffectivemethodfortreatinginternalderangementsoftheTMJ,andusuallyfillsthevoidbetweenfailed

TMJdysfunctionits diagnosis and treatmentBy DR EDWIN BONNER BDS MDent

non-surgicaltreatmentandopensurgery.Itisassociatedwithfewercomplicationsandashorterhospitalstay.

Traumaticinjuriestothecondylearecommon.Thediagnosisofacondylarfractureisusuallymadebyphysicalexaminationandradiographic(X-ray)studies.Aunilateralcondylarorsubcondylarfractureresultsindeviationofthejawtowardsthesideofthefracturewhenthejawisopened.Ifdiagnosedearly,itcanbetreatedwithintermaxillaryfixation(IMF).

SpecialistdentistshavetherequisitetrainingandknowledgetodiagnoseandtreatTMJ-relatedproblems,andshouldbethefirstportofcallforsomeonewhohassufferedinjury.Itisonlywhentheproblemisinanadvancedstageofdegenerationthatsurgeryisnecessary.Treatmentinthefirstinstanceispalliative,andimprovementcanbeeffectedbyconservativeuseofbitesplints.q

•For further information, contact Dr Edwin Bonner. Email bonner.edwin@gmail.com. Dr Bonner is an experienced expert witness, having prepared more than 2300 personal injury reports in a dental career spanning 45 years.

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Newcommissioningarrangementsspell change for speech & language therapists

ONE OF THE KEYchangesthatspeechandlanguagetherapistsarefacingin2013ishowtorespondandadapttothenewcommissioningarrangements.ThesearestartingtoaffecttherapistsinboththeNHSandtheindependentsector.

Commissionersare–quiterightly–lookingatthedesignofservicescurrentlyprovidedandseeingiftheycanbeprovidedindifferent,moreefficientways.IntheareaswhereSpeechLanguageTherapyLtdoperates(adultacquiredanddegenerativeneurologicalconditions,andadultstammering)thereisincreasingfocusonpromotingandmaintainingindependence,improvingaperson’squalityoflifeandensuringthatpatientscanaccesstheirlocalcommunity.Somenewcommissioningcontractsexplicitlytargettheseareasastheyuseoutcomesbasedcommissioningtoachievespecificresultsfortheirlocalcommunities.OpeningupservicestoAnyQualifiedProvider(AQP)bringsnewchallenges,notleasthowtomarkettocommissionersandtodemonstratequalityservices.

Moreattentionisbeingdevotedtoclinicaloutcomesi.e.whatisthepatient’sleveloffunctionandcanweattributethistothespeechandlanguagetherapyprovided?Commissionersandpatientsarealsobecomingincreasinglyinterestedinexperiencemeasuresasreportedbythepatients.Thefocushereislessontheclinicalinterventionortreatmentbutonissuessuchasweretheyseeninatimelyfashion,didthetherapistlistentotheneeds

andwishesofthepatient,werejointtherapygoalssetandreviewed?Itisimportantthatanyinterventioncarriedoutwithpatients(orwiththeirfamilyandcarers)demonstratesclinicaleffectiveness,butalsoallowsthepatientstofeelthattheywerewellsupportedandwerefullyengagedinthetreatment.

Incommonwithmanyhealthprofessionals,speechandlanguagetherapists(SLTs)sometimesfindpresentinginformationtothoseprocuringtheirservicesachallengebuttheydohavetheskillstoshowcommissionershowtheyarealreadymeetingthedemandsofthenewcommissioningarrangements.Itisimportantfortherapiststogathertheevidencefromtheirtreatmentprogrammesandpresentthistothecommissionerstoshowthatspeechandlanguagetherapyworks,itissafe,ofhighqualityandsupportspatientstryingtoachievetheirgoals.

SLTshaveformanyyearsbeenskilledinusingarangeofclinicaloutcomemeasurestodemonstratetheeffectivenessoftheirtreatmentprogrammes.Clinicaloutcomemeasureshavebeendevelopedforarangeofspecificcommunicationandswallowingdisordersandthesehavebeenpartofstandardtherapypracticewithpatients.Recentlymoreattentionhasbeenplacedongoalsettingwithpatients,wherebytheareasoftreatmentarelinkedtotheareasthatthepatientwishestoworkon.Goalbasedtherapyhasbeenshowntobemoreeffectiveasthepatientsaremoremotivatedtoworkongoalswhichareimportanttothem.

Oftenthefocus,whentryingtodemonstratetheeffectivenessofservices,istouselotsofprocessdriveinformationanddata–forexamplenumberofpatientsseenandforhowlong.Increasinglyqualityisbecomingmoreimportantbuthowisthisdemonstrable?Feedbackfrompatients–usuallyintheformofquotations–hasbeengatheredbysomeservicesforawhile,butnowwholepatientstoriesarebeingobtainedtoprovideapatient’sviewoftheirtreatmentoroftheservicestheyhavereceived.Patientstoriesaretakenbyaclinician–notusuallythetreatingclinician–andareoftenrecordedsothatcommentscanberecordedandorderedintothemes.Sometimesagroupofpatientstoriescantellcommissionerswhathashappenedacrossaservice,oralongawholepatientpathway–ifpatientstraditionallymovefromacute,throughinpatient,tocommunitycareasinstrokesurvivors.

Speechandlanguagetherapyprovidersalsoneedtoensurethatrisksareminimised,andthattheyhaveeffectivestructuresinplacetodealwithissueswhentheyarise.Reportingstructuresandsafeguardingpoliciesarevital,buttherapistsmustalsodemonstratetocommissionersthatrobustsupervisionarrangementsareinplacetofacilitateclinicaldiscussionofrelevantissues.q

By MARTIN SAMUEL of Speech Language Therapy Ltd

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Cosmeticsurgeryresponsespublished

•Imposingtighterrestrictionsonadvertising,includingbanning‘two-for-one’,time-limiteddealsandcosmeticsurgeryascompetitionprizes.

•Requiringatwo-stagewrittenconsentforsurgerysopeoplehavetimetoreflectbeforemakingadecision.

•Providingbetterinformationforpatients,includingphotosofexpectedbruisingandscarring,andmoredetailontherisksassociatedwithsurgery.

ThepublicationwaswelcomedbytheBritishAssociationofAestheticPlasticSurgeons(BAAPS),whichsaidithadarguedformanyoftherecommendationsoveraperiodofyears.

Itspresident,RajivGroversaid:“Whilstwearedelightedthatthemajorityofthepublicagreeswithwhatwehavebeensayingforyears–namely,thatthislargelyunregulatedsectorleavesvulnerablepeopleopentobeingtakenadvantageofthroughaggressivesales

techniques–sofarthereisstillamajor,gapingloopholethathasclearlynotbeenaddressedfully.

“Inparticular,thecallfora‘medicalprofessional’ratherthan‘asalesperson’toholdtheinitialconsultationwithprospectivepatientsisadangerouslybroadandinadequatedefinition.Unequivocally,theonlypersonholdingaconsultationwithapatientshouldbethesurgeonwhowillbeperformingtheprocedure.Otherwise,the‘professional’couldstillbe,forexample,anurseworkingoncommissionforpractitionersbasedeitherhereorevenabroad.

“Recognisedmedico-legally,informedconsentisessentialforpatientsafetyandonlythesurgeoncarryingouttheactualoperationshouldbeinvolvedintheprocess.Achievinganythinglessattheendofthisexercisewouldmakeamockeryofthereview,ifnotanoutrightsham.”q

LAST SUMMER SIR BRUCE KEOGH issuedacallforevidenceinhisreviewoftheregulationofcosmeticintervention.On31Decembertheresponsestothatcall–whichallowedexpertsinthecosmeticinterventionsindustryandpatientgroupstocontributetothereview–werepublishedbytheDepartmentofHealth.

AccordingtoastatementfromtheDepartmentofHealth,whiletherewasawiderangeofviewsonthefutureregulationofcosmeticinterventions,someconsistentkeymessagesemergedfromrespondents.Recurrentthemeswere:

•Thecurrentregulatoryframeworkwasinconsistentanddidnotreflectthemanychangesandinnovationsinsuchafast-growinganddynamicsector.

•Trainingrequirementswerefeltbymanytobedisproportionatelyweakcomparedtothepotentialrisksofaprocedureandmorespecialisedtrainingwaswelcomed.

•Dermalfillersandintensepulsedlightandlaserprocedureswerehighlightedbymanyasanareawheretherewasinsufficientlegislationtoprotectthepublic.

Manyrespondentswereconcernedaboutthelackofdatabeingcollectedonimplants,procedures,adverseincidentsandoutcomesandtheviewwasthatthereviewwastimelyandanimportantpartofrestoringpublictrustinthecosmeticinterventionssectorfollowingtheissueswithPIPbreastimplants.

Suggestionsthatrespondentswantedtoseeimplementedincluded:

•Banningfreeconsultationsforcosmeticsurgerysothatpeopledon’tfeelobligedtogothroughwithsurgicalprocedures.

•Ensuringconsultationsarewithamedicalprofessional,notasalesadviser.

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The claimant’s perception of what has happened may be misleadingby MR IAN FORSTER MBBS FRCS FRCS(Ed), Consultant Orthopaedic Surgeon

HERE ARE TWO INTERESTINGcaseswhichproceededinitiallyonthebasisoftheclaimant’sstatement.Thereisnodoubtthatthetwopeopleinvolvedintheseclaimswerebothadamantaboutwhattheybelievehadhappened–andtheirviewswerecertainlyacceptedandassessedinitially.Inbothcases,however,theclaimshavebeendiscontinued.

Case oneThefirstcaseconcernsaladywhoatthetimeofhersurgerywas

aged56.Shehadsufferedfromarthritisinthekneeforsomeyearsandindeedhadundergoneanarthroscopyandanumberofinjections.Becauseofhercontinuingpainaperfectlyreasonabledecisionwasmadetoperformakneereplacement.

Thenotesindicatedthattheoperationwascarriedoutbyaregistrar,butsuperviseddirectlybytheconsultant,andshowednothinguntowardhadhappenedintheoperation.Thepatientdid,however,haveconsiderablepain.Thephysiotherapistexaminedhersometwodaysaftertheprocedure–aperonealnervepalsywasdiagnosedandafootdropsplintwasapplied.Thatday,whichhappenedtobeaSunday,shewasseenbytheconsultantonthewardwhoassessedher.Thenotesindicatethathefelteverythingwasgoingfinealthoughhedidnotetheneurologicaldeficit.

Theladyherselfrecallsthatconsultationverywell.Sheisadamantthatthesurgeontoldherthathehadcutthenerve,forwhichheapologised.Thepatient’shusband,whowaspresent,wasnotquitesoadamantbuttheladymaintainedherviewthroughoutthatshewastolddirectlythatthenervehadbeencut.

Therewasverylittlerecoveryfromthisdropfootdespitecontinuingphysiotherapyandsplintage.Shehadnerveconductionstudiescarriedout.

Therewereconcernsaboutthiscasefromtheverybeginningasitisverydifficulttocutthepoplitealnerve.Theanatomyofthepoplitealnerveisquitevariablebutitstartsfromthesciaticnerveatthecentreofthebackofthethighandjustabovethekneethissplitsoffintoitstwobranches.Thepoplitealcomeslaterallytowardstheoutsideofthekneeandthengoesroundbehindthehamstringmusclesandthefibulaheadanddownthelateralsideoftheknee.Itisthereforeverydifficulttoactuallycutthenerveinatotalkneereplacementoperation.ForthisreasonIwasconcernedaboutthepossibilityofacutnervefromthebeginningandmentionedsoinmyreport.

Damagetothenervesaroundthekneeisnotuncommonfollowingkneereplacementandtheconsentformshouldnormallycontainastatementthatthishasbeenexplainedtothepatient,particularlywhenthekneeisinvalgusorknockkneeposition,asthetightscartissueontheoutsideofthekneeisstretchedwhenthekneeisstraightenedatthetimeofreplacementandthenervecanbecomedamaged.Thatisamuchmorelikelyaseriesofeventsfornerveinjurythanadirectcuttingwithaknife.Thekneewasstraightandwasnotdeformedpre-op.

Thereareotherreasonswhythenervedamagecouldhaveoccurredawayfromtheareaoftheoperation.Forinstancepeoplewhohavehadbackpainandsciaticapreviouslycandevelopanervelesionaftersuchsurgery.Indeed,Ihadacasewherefollowinganarthroscopicprocedureapoplitealnervelesionoccurredwhentherewasclearlynoinjurytotheareawhatsoever.Againthisproducedaletterofclaim,whichwasfortunatelydismissedquiteeasily,butitstillisaworryingtimeforbothsurgeonandpatient.

Theregistrarwastracedandgavetheviewthatnoinjuryhadoccurredatthetimeoftheprocedure.Hehad,afterall,beentheoperatingsurgeon.Theconsultant,whohadbeenalocum,waseventuallytracedtotheUnitedStatesandlikewisedeniedthathesaidanythingaboutcuttingthenerveandthatthenervewasindeednotcut.Thereaftertheclaimwasdiscontinued.

Case twoThesecondcaseisofayoungcommercialpilot,42yearsofageat

thetimehewasseen.He,likemanycommercialpilots,hadbeenintheRAF.Hewasanextremelyphysicalperson,andwasdoingtriathlons,buthehadpaininthekneeafterrunning.HewasreviewedandhadanMRIscanwhichwasratherinconsistentanddidnotshowanyspecificlesion.

ArthroscopywascarriedoutinOctober2008whichshowedapossiblemeniscusflaptear.Therewasgrade3-4chondraldamagetothetrochleargroove.Therestofthekneewasquitereasonable,exceptfortwosmallareasinthefemoralcondyle,anditwasinitiallydecidedthattheseshouldbeleftalone.Hissymptomssooncompletelysettled,howeverbyMarch2009therewasfurtherdeteriorationandafurtherscanwascarriedout.Itwasdecidedheshouldhaveamicrofractureorosteochondralgrafting.

Hewastoldthatthiswouldneedasixweekperiodofnonweightbearing.Afurtherarthroscopynotedthathehada2cmby3cmfullthicknessarticularcartilagelesionofthemedialfemoralcondyle.Amicrofractureanddebridementoftheareawascarriedout–asimilartreatmenttothechondraldamageinthetrochlear.

Fourweeksafterwardshehadfivedaysofpleuriticpainandwasadmittedandfoundtohaveadeepveinthrombosis(DVT)andpulmonaryembolus(PE).Hewasanticoagulated,aswouldbenormal,includingWarfarinandthiswasadvisedforsixmonths.BecausehewasacommercialpilotandonWarfarinforsixmonthshewasunabletoworkforthatperiod.Thiswasthereasonforhisconcernandhisinvestigationintothepossibilityofdamages.

Oneoftheproblemswasthattheclaimantbelievedhehadbeentoldtheoperationhadtakenanhourandahalf,whichwasparticularlylong.HehadinvestigatedtheincidentingreatdetailandalreadygotouttheNICEguidelinesforprophylaxisagainstpossibleDVT.TheriskofapossibleDVTafterarthroscopyisveryvaried,dependingonwhichreportyouread,witharangefrom6%to18%.Oneofthereasonswhythefigureissovariableisthattheyareoftenasymptomaticandthediagnosiscanbemissed.Thetruerateisprobablyunknown.

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Overthelastfewyearsvenousthromboembolism,whichinvolvesDVTandPE,hasbecomeverytopicalwithintheorthopaedicworld,particularlyinkneeandhipsurgery.

NICEhaveproducedanumberofguidelinesmanyofwhichweredisputedbecauseitwasfeltthatthesideeffectsoftheanticoagulationoutweighedthepossibleriskfromtheDVT.OvermanyyearswehaveusedAspirinprophylactically,howeverthishasbeenshownnottobeeffectiveandnowoneisexpectedtousesomethingchemicallyabitmoreprovensuchaslowmolecularHeparin.

Patientactivityis,ofcourse,oneofthebestwaystoreducetheriskofthrombosisandstockingshavebeenshowntobeverysuccessful.

TheeventualconsensusofopinionfromNICEwasthatifthereisanoperationlastingmorethanonehouronthelegthenprophylaxisshouldbeconsideredbywhatevermeans.

Thetimingoftheoperationisfromtheinductionofanaestheticactuallyintheanaestheticroomtocomingoffthetable.Clearlyin

thiscase,ifthepatient’soperationhadlastedforanhourandahalf,itwouldhavebeenoutsidethehourandcouldhavebeenconsideredforprophylaxis,thoughIamnotsurethatmanyorthopaedicsurgeonswouldhavedonethat.

Ithinkitveryunlikelythatorthopaedicsurgeonswouldhaveconsideredprophylaxisnecessarilybeforetheoperationbutiftheoperationhadgoneonlongerthanexpectedthenitmighthavebeenconsidered.

Thiswasobviouslythepointtheclaimantwasmakinginthathecouldhavegonetoworkforanextrasixmonthsandthereforenotsufferedthefinancialconsequencesofhisoperation.

Unfortunately,furthernotesfromthehospitalappearedlaterwhichshowedtheoperationactuallytakingthreequartersofanhour.Itwascleartherewasnocasethatcouldsensiblybeansweredandtheclaimwasdiscontinued.

Generally,Ithinkitsimportanttotakenoteoftheclaimant’sviewsbutonehastobecarefultoweighupalltheodds.q

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AT PRESENT I AMpreparingamedicalreportfortheCourtrelatingtoaroadtrafficaccidentallegedlyresultinginasignificantbackinjury.Asisoftenthecase,Ifindmyselfpreparingareportlateinthelitigationprocessandhaveavailabletomeanumberofreportspreparedbyotherexperts.Thefirstinthiscasewasbyasurgeonwho,inhisreviewofthepastmedicalnotes,devotedfourandahalfpagestothepsychiatrichistory.Hisfinalconclusionwasthattheclaimant’ssymptomswereentirelyphysical,eventhoughalltheotherexperts(includinghistreatingdoctors)couldfindnoevidenceofasignificantpathologicaloranatomicalabnormality,andthepsychologicalreportspointtoseveredepressionandachronicpainsyndrome.Whyreviewthepsychiatricnotes(inmoredetailthanthepastlocomotorincidents,forinstance),whenclearlyyoudonothavetheexpertisetointerpretthesignificanceofthepastpsychiatrichistory?ThissetmethinkingaboutotherexamplesIhaveseenofexpertsstrayingoutsidetheirarea(s)ofexpertiseandtheconsequencesofthat.

ThemostcommonthingsIseeinreportsarepsychiatricopinions,especiallyoverthepastcoupleofyearsinrelationtopost-traumaticstresssyndrome,butalsoopinionsrelatingtothecausationofpainwhichappeartohavenocognisanceofthepresentevidence-basedthinkingonthenatureofpainandpainbehaviour.Asfarasthewitnessboxisconcerned,onthreeoccasionsIhaveseenveryseniordoctorsgiveopinionsonmattersonwhichtheywerenotcapableofgivinganexpertopinion.Eachtimethewitnesswaschallengedandhadtoadmitlackofexpertise.Notsurprisingly,theCourtappearedtotakeascepticalviewoftherestoftheevidenceofthoseindividuals.

ThenewlyissuedGuidance for the Instruction of Experts to give Evidence in Civil Claims1makesanumberofissuesclear,including

Strayingoutsidetheboundariesby DR ANTHONY CLARKE, BSc MB BS FRCPConsultant in Rheumatology and Rehabilitation, Bath

sayingthatexpertsshouldindicatewithoutdelaywhereparticularquestionsorissuesfalloutsidetheirexpertise.Moreimportantly,expertsmustnotexpressanopinionoutsidethescopeoftheirfield.

Ofcourse,therewillbeoccasionswhenaspecialistinonefieldhasspecificexperiencethatallowshimorhertoofferanopinioninadomainnormallyseenas‘belonging’toanotherspeciality.Thusifaninterventionalanaesthetistisworkingwithamultidisciplinaryteam,whichincludesapsychologicalinputdealingwithchronicpain,thenheorsheisentitledtocommentonthenegativeeffectsofclinicaldepressiononpainperception.Thisistheoneissueinpainrecognisedbyallcliniciansinthefield.However,thatanaesthetistwouldbewelladvisednottoofferanexpertopiniononthediagnosis,severityorprognosisofdepression,butdefertoapsychiatristoraclinicalpsychologist.

Theexpertmustrememberthatatsomepointheorshemayundergohostilecross-examination,underoath,inthewitnessbox.Beforesigningtheirreport,theexpertshouldbecertainthateverythingintheiropinionisdefensible.Questionstoaskoneselfinclude,“Doesthisopinionreflectmypersonalknowledgeofthesubjectmatterbeingtested?”and“Isthemattercontroversialand,ifso,haveIexplainedtotheCourtwhyIhaveadoptedmyopinion?”

TheroleoftheexpertistoassisttheCourt,nottomakeitmoredifficulttoarriveatafairdecision.q

REFERENCE1Guidance for the Instruction of Experts to give Evidence in Civil Claims

(2012)www.judiciary.gov.uk/resourses

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Expert Profile

MR JARI IS AConsultantTrauma&OrthopaedicSurgeonatHopeHospital,SalfordandalsoanHonoraryClinicalLecturerinOrthopaedic&TraumaSurgeryattheUniversityofManchester.Hehasbeenpreparingmedicalreportssince1996andundertakesbetween600-800reportsperyear.HereceivesinstructionsforreportsonRTAinjuriesrangingfromlowvelocityimpactcasestomultipleinjury,highvalue,multitrackcases.Healsopreparesreportsontrips,falls,slipsandworkplaceinjuriesandhasanincreasingnumberofinstructionsonclinicalnegligencecases.

MrJariisalsopreparedtoundertakehomevisitsandprisonvisits.Costsarebasedonhishourlyrateasperagreedtermsandconditions.

HeisamemberoftheUKRegisterofExpertWitnesses,TheAssociationofPersonalInjuryLawyers(whereheisa1sttierAPILmember)andtheManchester&DistrictMedico-LegalSociety.HehasalsosuccessfullycompletedCertMRparts1and2togetherwiththeBondSolonCertificateCivilProcedureRulesforExpertWitnesses.

Currentwaitingtimeisaround1-3weeksforanappointmentwithareportturnaroundtimeof3-5workingdays.

Orthopaedic&TraumaServicesisalsoabletoofferacompleteserviceforsolicitorsincludingarrangingmedicalimagingortreatments.q

•Please contact Allison Ellis on 0161 445 9885 for further information.

Mr. Sanjiv JariConsultant Trauma & Orthopaedic SurgeonBsc (Hons), MBChB, FRCS (Eng), FRCS (Tr & Orth)Orthopaedic & Trauma Services Ltdwww.oatsltd.com info@oatsltd.com

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POLITICS, ECONOMICS AND LAWareasimportantinpatientcareasmedicine.Itismyexperiencethatsomeacademicsbelievethathealthprofessionalsshouldnotconsidertheabovethreedisciplines.Somemayrecogniselawbutmightconsiderthatpolitics,economicsandreligionaretaboos.Infact,politicsisasciencedealingobjectivelywithrealities.Disabilityassessment,managementandfinancialsupportneedinputfromallfourdisciplines–politics,economics,lawandmedicine.

What is the issue in disability assessment?IthasbeenrecognisedbytheBritishGovernmentthatthe

financialcostofcarefordisabledpeopleandsocialwelfarebenefitsisveryhigh.Itneedstobetrimmeddownfairlyandgently.Therearegenuinelydisabledpeople,fakedisabledpeopleandmanygradesinbetween.Similarly,therearelegalandillegalimmigrants.Someindustrialemployersemployindependentoccupationalphysicians,whoexaminetheemployeesforfitnessforappropriatework.Theseoccupationalphysiciansmaynothaveanyconflictofinterestastheyareemployedasdoctors.Astheirfeesandsalariesarehigh,theymaynotbeemployedbySocialSecurityandDisabilityAssessmentAuthorities.Ingoodfaith,theytakeacheaperandeasieroption.TheyaskthepatientstogototheirownGPsforassessmentofdisability,sickness,driving,housing,childabuseandahostofotherphysical,psychologicalandsocialconditions.DoeseveryGPwhoexaminestoassesshis/herpatientsfordisabilityhaveaconflictofinterest?Thisisafundamentalquestionwhichrequiresevaluation.

Why every GP has a conflict of Interest?PrincipalGPs,whorunGeneralMedicalServices(GMS),areself

employeddoctors.ForthisreasontheircontractsofservicearecheaperfortheNHSthaniftheywereemployeddirectlybythem.SalariedorLocumGPsareemployedbytheseGPPrincipalsorbythePrimaryCareTrusts.EveryPrincipalGP’sincomedependsuponhowmanypatientsthereareonhisorherlist.SomeGPsearnmore,somewouldearnless.Inmyopinion,everyPrincipalGPislikelytofaceadilemmaofconflictofinterestbecause:

•EveryGPisrequiredbylawtobeefficient,factual,truthfulandimpartialinwritingareportoracertificate–asifhe/shewereaLocoMagistrate.

•EveryGPisadvisedbytheGeneralMedicalCouncilandRoyalCollegeofGeneralPractitionerstoprovidethehighestqualityofcareandsupporttoeachpatientineveryway.Indeed,GPsintheUKtrytheirbesttodojustthat.

•EveryGP’sfeeispaidbythepatientortherequestingauthorityortheNHS.

•AGPisusuallyobligedtogiveordisclosethereporttothepatient.Computerrecordsmakeaccesstoadisabilityassessmentreporteasy.Onlyinexceptionalcases,suchascrime,wouldthereportbehiddenfromthepatient.

•Ifthereportisinfavourofthepatient,heorshewouldstayonthatGP’slist.However,ifthereportisagainstthepatient,whowouldlosebenefits,thepatientwouldbeangrywiththedoctor.HeorshemayleavetheGP’spractice.InAsian,blackandcatholiccommunitiesthefamilybondisstrongandthewholefamilymayleavethatGP’spractice.SuchaGPhasnoonetoturntoinordertocompensateforabigfinancialloss.Thereisnogovernmentresourceorinsuranceavailable.Justimaginethefinanciallossandshock.

How every medical expert also has a conflict of interest?

Asanexpertwitnessinmedicalissuessuchasdisabilityamedicalexpertalsohasnotonlyafinancialandmoralconflictbutalsoalegalconflictofinterest.Everypractisingdoctor,GPornonGP,hasbeentaughtbytheireducationalandregulatorybodiesthattheirdutyisonlytotheirpatient.However,CivilProcedureRulePart35.3requiresthateveryexpert’soverridingdutyistotheCourt.Itclearlystatesthatitisthedutyofanexperttohelpthecourtonthematterswithinhisorherexpertise.Thisdutyoverridesanyobligationtothepersonfromwhomhehasreceivedinstructionsorbywhomheispaid.Theseconflictsofinterestarecomplexandneedtobeunderstoodandresolved.

How can there be a fair play?Politicsisasciencedealingwithrealities.Indeed,bothpatients

anddoctorsareimportantinmedicineandpolitics.Theconceptofa‘FairSociety’canonlybesuccessfulifpoliticiansandparliamentprotectalldisabledpersonsandprovidefortheircare,welfareandfinancialneeds.Wecanonlysolveproblemsifwecantalkaboutthemcalmly.Therefore,Iproposewetalkaboutthisissueandreachafairdeal.ParliamentcouldconsiderwaysofremovingtheconflictsofinterestofGPswhomayhavetoassesstheirpatientswithdisabilities.Thesemeasuresmayinclude:

•GPsbeingaskedforamedicalrecordssummaryrelatedtothedisabilityandbeingappropriatelypaidforitwithnolossofincometothem.

•DisabilityassessmentsshouldpossiblybecarriedoutbynewlycreatedSalariedDisabilityPhysicians,similartoOccupationalPhysicians,whoassessfitnessforoccupations.Disabledpeoplemayormaynothaveoccupations.Moreover,thereshouldbesomemechanismforappealsasfairplayisessential.

•TheseindependentSalariedDisabilityPhysiciansmaybebasedinlocalPolyclinics,DayCentresorHealthCentreswhichhaverecentlybeenestablishedinmanylocalities.

•Inthemeantime,ifaGPlosesafamilyfromhis/herlistbecauseofanaccurateassessmentthereshouldbesomepaymenttocompensateforthefinancialloss.

Everythingchangeswithtime.TheNationalHealthService,nationalorlocalfinancesandpoliticsarechanging.Parliamenthaspassedanewbillaboutbenefitsforeligiblepeopleandlitigationaboutbenefitsislikelytoincrease.Thesedays,itisappropriatetorevisitthedisabilityassessmentissuesinHouseofCommonscommitteesandinLocalCouncilWorkingParties.q

•Dr Qureshi is an expert witness in cultural, religious and ethnic issues in litigation and also in GP clinical negligence. He is also the author of ‘Transcultural Medicine’ and can be contacted via email at drbashirqureshi@hotmail.com.

Disabilityassessmentforbenefitclaimsand UK GPs’ conflict of interestBy DR BASHIR QURESHI FRCGP, FRCPCH, FFSRH-RCOG, AFOM-RCP

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Four legs better!The joys of horse ownership

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DESPITE THE ECONOMIC WOES that beset the world, the marketsegment that is a traditional marker of international success – theluxury car market – is booming. And one of the biggest beneficiariesof that boom is the UK, with both Rolls Royce and Bentley chalkingup record global sales last year.

Bentley’s growth hit 22% as deliveries to customers increased to8,510 cars, maintaining its position as the leading manufacturer ofluxury vehicles in the world. Meanwhile, Rolls Royce revealed a thirdconsecutive record sales year, with 3,575 cars sold globally – thebest sales result in the marque’s 108-year history.

The US was the top market for both companies. In the case ofRolls Royce that position was regained from China. The Chinesemarket remains an increasingly significant one, however, with

Luxury car sales hit record highsBentley increasing its sales there by 23%.

Unsurprisingly, a buoyant European market was led by Russia, withthe traditional Western Europe economies still in the doldrums.

The Middle East remained another strong market for bothmanufacturers. Bentley capped the year with the announcement thatits Continental GT V8 model (pictured) had been named winner of theprestigious Middle East Motor Award in the Premium Luxury Coupecategory. The award is judged by 17 highly regarded automotivejournalists from 10 countries that collaboratively represent the MiddleEastern automobile industry.

Bentley even managed a modest 7% increase in UK sales lastyear. With the increase in employment prospects among lawyers inthe City, maybe that is a trend that is set to continue.

REBEKAH BROOKS GOT INTO trouble for borrowing one from the PM, Dame Judi Dench playedone of her most memorable scenes on one and waxes lyrical about owning one – and millions arewon and lost betting on them! Horses are the ultimate pet of the rich and famous and riding them isa highly popular activity.

Despite recent grizzly news stories about what happens to them after their careers are over,racehorse ownership is also a growing sport in itself.

There are a number of ways of becoming the proud owner of a racing thoroughbred. For the richand daring there is outright ownership – all four legs are yours, as is all the expense of housing,feeding, vets’ bills, transport etc, etc.

Then there are various types of joint ownership. According to the British Horseracing Authoritythere are four routes to co-ownership:

• Company ownership – where the parties are shareholders in a company that owns the horse.• Joint ownership – where all the owners are equal.• Leasing – which can be for one race or for the horse’s racing career.• A racing partnership – which itself can take various forms.Whatever the route to ownership, the thrill of watching YOUR horse crossing the finishing line at

one of the country’s major racing venues is one that is becoming increasingly popular.

• To find out more visit www.britishhorseracing.com.

Life’s not all work for the legal fraternity. In this new ‘lifestyle’ section we look at some ways of spending precious leisure time – and that hard-earned cash!

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