Orthopaedic expert looks further than most into WADs
[
A FULL-TIME secretary and a tape recorder are the total assets of RSW Medico Legal Ltd, a West Midlands-based expert witness consultancy – plus, of course, orthopaedic surgeon Mr Richard ScottWatson. Mr Scott-Watson’s list of qualifications is truly comprehensive. He is a Fellow of the Royal College of Surgeons of Edinburgh in addition to holding Batchelor of Science, Medicine and Surgery degrees. He holds the Diploma in Disability Assessment Medicine and the Certificate in Aviation Medicine. He also holds a law degree and is a Cardiff University-accredited Expert Witness. Based in Stourbridge – referred to lightheartedly by his secretary as ‘Head Office’ – he also runs clinics in Birmingham, Coventry, Bristol, Swindon and Oxford. His work involves producing medico-legal reports in orthopaedic trauma cases for solicitors and insurance companies: a practice he has been in for 25 years, having written over 19,000 reports. Mr Scott-Watson sees his specialism as looking at the whole picture in every case. His main aim is to help maximise the recovery of the claimant, which often leads to further investigation – usually MRI scans – and treatment. Most of the claimants he sees have been under-investigated and undertreated, he says, and most have also never been fully assessed.
the Mayo Clinic (a top neurological institute in the USA), type in thoracic outlet syndrome and see what the first cause is that they mention – it’s road traffic accidents. “How many solicitors have ever seen that assessed or written in a report? I would reckon almost none. I have been assessing and writing it into reports, as well as successfully treating the sufferers, for 25 years and in that time I have seen it put into only three reports written by others – none of them GPs or orthopaedic experts.” He warns that if a claimant’s experts are not assessing and treating the condition, their credibility as experts regarding the condition is questionable. “It occurs in over 80% of the WAD cases I see,” he said, “but you have to ask the right questions and do the correct examination, as often the claimant will not volunteer the symptoms and will frequently either not know they have the condition, or – if they do – that it is related. They just adapt.” The condition, he explains, does not recover if left untreated. It is, however, a condition that forms a starting point in his examination of all the cases he sees; and it is a speciality in itself, quite unrelated to normal, daily NHS orthopaedic work. He concluded: “These are not the cases that turn up in hospital outpatient clinics. Indeed, most orthopaedic surgeons will only see them in their medico-legal practice.”
Whiplash-associated disorder
Qualifications
He freely admits to his ‘hobby horse’ as being the neurological consequences of whiplash-associated disorder (WAD), in particular thoracic outlet syndrome – the pain, numbness and discomfort caused by compression of the nerve cells and/or blood vessels in the passage between the collar bone and the top rib. “Let me take you on a brief journey, if I may,” he told Your Expert Witness. “Look up
Mr Scott-Watson is also concerned about the qualities and qualifications that make for a competent and credible expert witness when it comes to medico-legal issues. Increasingly, he says, experts need to prove that they have the specific qualifications to fulfil the role. Of all the courses available to achieve that qualification, he cites those such as the Bond Solon Expert Witness Certificate
at Cardiff University – which he himself attended – as the only ones he knows that really test all aspects of the legal side. “Far too often,” he says, “I still find reports coming in that have obviously been written for a claimant or defendant instructor. They are fairly easy to counter, but experts should be aware that it should not be obvious, as they are the disinterested finder of the correct answer to the question of injury and disability.” On the issue of determining disability he has this to say: “How many experts have a qualification or experience working in the field allowing them to assess disability? Almost none, but disability is the core of the case. So how can anyone assess disability in relation to daily living and work capability without the experience and training to be an expert?”
Injury cases
So what value is the initial GP report in injury cases? They record events that are usually relatively recent before they are forgotten. Beyond that, says Mr ScottWatson, they have little value. Indeed, he avers, some are written almost entirely by the claimant. He cites the case of one GP expert asking the claimant what they wanted him to put. “The notes will not be examined in almost all cases,” he claims, “and when they are it is rarely adequate, meaning that as an objective assessment of the whole case they have no value at all. They are an incredibly weak link in the chain and encourage fraud.” On consideration of prognosis, he says: “Every piece of evidence – contemporaneous notes, past history, previous reports – has to be considered to build as full a picture as possible about the extent of the injury and the progress up to the point of assessment. People recover at different rates; psychological issues related or unrelated to the injury may get in the way and people with even mild degrees of hypermobility will recover slower from ligament injury than those without. How often have solicitors seen that even assessed, let alone commented upon?” So what of the future? “Well, if MedCo addresses the extreme weakness of the GP report system and looks at the qualifications of experts and not just their NHS position (one agency stops employing experts immediately they retire, which shows a profound lack of understanding), then we may get to a more equitable and honest system. At present it is a mess.” q www.yourexpertwitness.co.uk
49 49