Expert Witness Features – page 32

Risks and complications in craniofacial surgery

Craniofacial surgery is very much a special interest that has emerged out of neurosurgery, maxillofacial and plastic surgery for the management of head and neck problems that involve the brain and cranial cavity and complex facial structures and sometimes the neck.

Other specialities such as ophthalmology, ENT and paediatric surgery, speech and language therapy, genetics and the dental surgical specialities will be variably involved according to the nature of the individual problem.

Geriatric medicine, the law and GPs

The medico-legal issues relating to geriatric care in general practice are much the same as those affecting any other medical speciality or age group. It is however important to understand that older patients often have multiple problems and multiple treatments, and so the risks to them and of the clinician making mistakes can be higher.

Notwithstanding, there are some important areas of medico-legal complexity worthy of discussion.

Vital signs

An estimated 50,000 people in the UK who were born deaf or became deaf at an early age use British Sign Language (BSL) as their preferred language. BSL – the language of the british deaf community - is one of many sign languages found throughout the world.

Although signers also use fingerspelling – the representation of letters of the alphabet on the hands to represent ‘foreign’ words (i.e. words from written english), BSL is not ‘english on the hands’ – it has a very different grammar and there is no one-toone correspondence between BSL signs and english words, any more than there is such a correspondence for any two unrelated spoken languages.

Putting pain into perspective

According to the British Pain Society, health professionals use different terms for different types of pain.

Short-term pain is called acute pain – from a sprained ankle, for instance, whilst long-term pain is called persistent or chronic pain – resulting from back trouble or arthritis, for example. Pain that comes and goes is called recurrent or intermittent pain – such as tooth ache.

Many acute pains are like an alarm indicating that something is wrong. Most minor ones are easy to treat; others may be a sign of something more serious. For example the pain of a broken leg will enforce rest until it heals. Here the pain is helping.

A&E: the first port of call when there is an injury

There are two main areas of the work of the specialist in the accident and emergency department (casualty) of a hospital that may involve them in acting in an expert capacity in court: one is in the field of personal injury cases and the other is in criminal cases.

Personal injury cases

As far as personal injury cases are concerned, the most common arise from road accidents – where neck injury or 'whiplash' is most likely to have given rise to a claim – or accidents at work, where fractures and soft tissue injuries are most common.

Health and Safety Executive figures show that 137,000 injuries were reported under the RIDDOR regulations during 2007/8, the most recent period for which figures are available, while the Labour Force Survey for the same period shows 299,000 reportable injuries as occurring, a rate of 1,000 per 100,000 workers. Of those injuries, 229 were fatal.