Medico-legal Reports

Medico-legal reports

Specialist Medico-Legal Report Services

Contact 02 8850 8100

Specialist Services offers a comprehensive medico-legal report service by many of its specialists. We follow the following principles[1]:

  • We prepare reports for both the plaintiff and the defendant
  • Many doctors quite naturally feel uneasy about criticising colleagues. However, in fairness to both patients and professional colleagues, it is vital that independent, fair, impartial expert opinion from practitioners in active clinical practice is obtained.
  • We all have a duty to enforce high standards of care and, equally to support colleagues when appropriate. The preparation of medico-legal reports, in addition to any financial benefits that accrue, is mentally stimulating, interesting and educational.
  • We mentor our doctors to prepare detailed reports supported by published material from textbooks and the medical literature.
  • We follow appropriate standards and instructions issued by lawyers and abide by relevant legislation (e.g Supreme Court, State Courts etc)
  • It is the duty of an expert to help the Court on the matters within his expertise.
  • This duty overrides any obligation to the person from whom he has received instructions or by whom he is paid.

Your instructions

Please include:

(a) Initial Instruction prior to acceptance of Case

  • Your Legal Firm
  • Responsible Partner
  • Responsible Contact Name
  • Contacts e-mail address is essential
  • Fax number
  • Contact’s telephone number
  • A brief summary of the case (e.g a delay in the diagnosis of a breast lump- saw Dr Smith in Jan 03 with a breast lump, was reassured and patient presented with an advanced cancer in Dec 05)
  • Preferred expert – e.g oncologist (see our list)
  • Fax to 02 9635 9518

(b) Detailed Instructions after acceptance of Case

  • Time frame
  • Specific questions to be addressed in report
  • Medical case notes
  • X-ray, blood and pathology reports
  • Copies of x-rays if relevant to the case
  • A detailed chronology-costs are reduced if a details chronology is documented in a tabular format (including date; event (e.g lump first noted); Outcome – pt decides to watch lump)
  • A signed patient authority (or from next of kin)

Structure of Our Reports

A covering letter indicating our consultants fee schedule and the number of hours taken to review the case and complete the report with appropriate research.

  • A statement that an invoice will be sent from our head-office
  • Whether the report will be issued before payment
  • A brief biography will be attached with a detailed CV e-mailed only if required
  • Compliance with relevant Court standards, code of conduct and duties to the court
  • We generally favour PDF documents for easy transfer and digital signatures An expert's report should be addressed to the Court and not to the party from whom the expert has received his instructions.
  • Give details of the expert's qualifications.
  • Give details of any literature or other material that the expert has relied on in making the report.
  • Give details of missing information
  • Summarise the case in chronological order
  • Answer specific questions
  • Summarise the range of possible treatment outcomes
  • Give reasons for his/her own opinion.
  • Contain a summary of the conclusions reached.
  • All reports will be formatted by our head-office staff to include enumeration of lines or paragraphs for easy review by legal teams
  • We note that the medico-legal report is for the benefit of lay people, the report will be written with that in mind.
  • Medical terminology, jargon, abbreviations and an unduly technical description of events will be avoided. Where, by necessity, medical terminology or a detailed description is required, a lay explanation should be given. Reports will be proof-read by experienced report writers.
  • In giving an opinion, we will note the standard of care at the time of the alleged negligence is stressed; this may be quite different from current practice because of changes in technology.

Some useful Definitions

  • A dictionary definition of the word ‘negligence’ is ‘lack of proper care or attention’ (Oxford English Dictionary). Medical negligence is generally governed by the ‘Bolam principle’, where Mr Justice McNair, in directing the jury in the case of Bolam v Friem Hospital Management Committee, in explaining what was meant by medical negligence, stated: ‘The test is the standard of the ordinary skilled man exercising and professing to have that special skill and need not possess the highest expert skill to be at risk of being found negligent, it is well established law that it is sufficient if he exercises the ordinary skill of an ordinary competent man exercising that particular art’.
  • The Bolam test does not apply in deciding causation. Thus, the Courts retain the final decision on the standard of care to be imposed. For a claimant to be successful in a medical negligence case they not only have to show that there was care below the level that could have been reasonably expected but that a duty of care was owed to the claimant and that there was damage directly consequent to the substandard care – what is referred to as ‘causation’. Care may have been substandard but, without direct damage as a consequence of that, there is no legal negligence and a claimant is unlikely to succeed in their case.
  • In civil law, causation need only be proved on the ‘balance of probabilities’ – that is, greater than a 50% chance that the negligence caused the damage. There is no requirement to prove ‘beyond reasonable doubt’ as in criminal cases.

Sourcing our experts

  • Call our head office and speak to the Medico-legal report coordinator
  • Our Medico-legal report medical advisor will review details and direct coordinator to appropriate expert.
  • Our fee schedule will be explained—this involves a combination of a minimum fee and an hourly rate whichever is highest.
  • Our minimum fees range from $1500 to $3000 per report
  • Our hourly rates range from $400 to $600 per hour (GST exclusive)
  • We are not inexpensive but provide high quality, fair and detailed reports supported by data

Our Do’s and Dont’s:

  • We don't prepare a report if there is a conflict of interest where the independence of our specialist could be questioned.
  • We judge on reasonable practice, not on ‘best practice’. Not every doctor or hospital can aspire to the best standards of care.
  • We accept and acknowledge that in medicine there are differing opinions, that the way we manage patients may not be the only acceptable way.
  • We separate evidence from our own opinion particularly as opinion may need to be defended in court
  • We write in plain English and do not use emotive or derogatory language
  • We address the issues raised by your instructions and comply with Civil Procedure Rules.
  • We do not express an opinion outside the specialist’s field of expertise.
  • We are not to be pressurised into expressing opinions that we do not truly believe.
  • We are impartial.

Time-Frames

  • Vary depending on report complexity and urgency of the matter
  • In general, if our specialist will not provide a report within 8 weeks from the date of receipt of information we will ask another specialist or not accept the case.
  • A 10% discount will be given if we cannot produce an electronic report within 8 weeks of document receipt.

References:

http://www.unitedmp.com.au/0/0.13/0.13.4/MedicoLegalReports.pdf

http://www.drs.org.au/new_doctor/81/81.28-29.pdf

[1] A beginner‘s guide to writing medico-legal reports; Obstetrician & Gynaecologist October 2000 Vol. 2 No. 4