Featured Articles – Expert Witness Features – page 34

The expert in maxillofacial legal cases

You may well ask what a retired oral and maxillofacial surgeon with academic interests is doing writing an editorial for Your Witness. It is perhaps to explain what oral and maxillofacial surgery is and what an oral and maxillofacial surgeon does. It may also be helpful to identify some of the troublesome areas and to indicate how some of the problems may be avoided.

The principal aspects of the speciality to be considered are orofacial/ maxillofacial trauma, which includes craniofacial injuries as well as dentoalveolar (dental and jaw) trauma. Craniofacial deformities, both congenital and acquired, are relatively common, as are orthognathic (jaw deformity) surgery and cleft lip and palate correction and post-traumatic deformities. Head and neck surgery is very much a specialised area concerned with the management of tumours, vascular lesions and especially oral cancer – the latter often associated with smoking and excess alcohol consumption.

Specialist plastic surgeons: each has their own field

To most people plastic surgery equates with cosmetic surgery; yet its origins could not be further removed, for it grew out of necessity in the treatment of war injuries.

The traumatic injuries that war causes presented the surgeons of the First World War with cases the like of which they had never seen. Massive facial injuries with underlying facial bone and mandibular fractures stimulated ear, nose and throat surgeons to deal with areas that fell between the specialties as they then existed. Those defects required soft tissue cover and bone reconstruction in a complex series of operations.

With the development of microsurgery a new phase was entered, allowing the immediate transfer of large areas of skin to cover important defects – as in lower limb injuries – the replantation of amputated digits and hands, the transfer of toes to reconstruct amputated digits – especially the thumb – and the reconstruction of congenital hand defects using microsurgical techniques.

And the greatest of these is: RESPECT!

The relationship between doctors and lawyers is based on three 'F' words: Faith, Fear and Finance. Let me expand on those, based entirely on my personal observations – without any tedious references to learned medical or legal journals.

The need for faith is obvious, or should be. Doctors need faith in their legal advisers, whether it be for conveyancing or divorce (probably the two commonest uses of legal advice). Lawyers need almost as much faith when they are ill and require the services of a doctor.

This cosy relationship cannot continue as the second 'F' word comes in: fear. We, the doctors, have a healthy fear of being sued for our errors, although that is not – or should not be – why we try and get it right. The whole process of being sued has become even more tedious and unpleasant. In the 'good old days' our professional indemnity companies took over and dealt with everything.

So how do you find the right expert?

Carefeul selection of the right expert for a case can pay dividends. In the post-CPR climate it is particularly important to make the right selection because of:

The requirement for experts to be independent and to owe their first duty to the court.
The judicial preference for single joint experts – the parties and the court will only have one report and opinion to consider.
The reduced scope for multiple experts and 'expert shopping'.
The need for transparency and the impossibility of 'coaching' an expert in what to write and say.

A client might also judge a solicitor by their choice of an expert.

Asbestos: surely we should know the risk?

In the summer issue of Your Witness Peter Robinson of Bradley Environmental outlined the difficulty of accurately assessing exposure to asbestos in a working environment. As he pointed out, cases arising out of recent events are rare, the great bulk of exposure now reaping its toll having occurred upwards of 20 years ago.

What should be surprising, however, is that there are any prosecutions these days at all. Everyone knows – or should know by now – that asbestos is a dangerous substance when it is disturbed. The law to control the limits of working with asbestos have been long in the formulation and subject to an enormous amount of publicity, both in the trade press (such as Construction National) and on national television.