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Medico-legal work

Discussion in 'General Issues and Discussion Forum' started by davidh, Sep 21, 2011.

  1. davidh

    davidh Podiatry Arena Veteran

    Members do not see these Ads. Sign Up.
    This topic arose on another thread, but it got me thinking - how many on here are actively involved in medico-legal work?

    By actively involved I mean writing reports, paid conferencing with fellow professionals and solicitors and barristers, and the occasional call to Court, as opposed to, for example, writing perhaps one letter a year in response to a solicitor.

    I'm in the process of building up my medico-legal practice. I know of one other pod who visits the Arena who does some reportage, and another colleague who is actively involved with the Crown Prosecution Service (CPS) dealing with gait identification - anyone else?
  2. Phil Wells

    Phil Wells Active Member


    After doing some forensic podiatry training with Wesley Vernon, I have realised that I do not have the attention to detail required for this work.
    Good luck to everyone else but it scares the C*$p out of me!

  3. Pod on sea

    Pod on sea Active Member

    I am in private practise and I have no expert witness or forensic training. I do a medico-legal report about every 3 months. It's mainly regarding people who have suffered RTAs.Mostly this work comes to me due to a good professional relationship I have with a foot and ankle surgeon (Orthopod), if he makes a recommendation that the client may need orthoses for their particular injury. I am usually instructed by an intermediary who handles the case and liaises with the solicitors and client. The reports vary in format and I always ask if there is a template that they wish me to follow.If they do have a template it can be useful as it helps to focus me on what exactly I want to say.
    It's all about making a best assessment about the effect of the accident/injury on the clients gait/mobility and what their future footwear or orthotic/Podiatric needs will be. I have to come up with a proposed plan regarding treatment or orthotic provision, and if orthoses will be required for life.If so I estimate at what intervals the client will need reviewing and new orthoses to be provided. The report is usually required urgently so clinic time has to be allowed to write it all up.
    I charge my usual assessment fee plus the same fee pro-rata for my time to write the report. Some companies can be VERY slow to pay, up to 6 months which is annoying.
    There is no initial agreement that the client will return to me for treatment, I am providing the report purely for information, and I may or may not be instructed to proceed with any orthotic provision in the future. I have never been asked to have a face to face meeting with solictors/barristers or to attend court.
    I find this work rewarding as most often the client is just desperate to be able to walk with less pain. I've not ever felt that they were an opportunist trying to get some compensation money.
    I hope this is helpful.
  4. davidh

    davidh Podiatry Arena Veteran

    Very helpful thanks.

    In view of the importance of your reports, and the fact that we (as medico-legal report providers) no longer have automatic indemnity for perjury (intentional or otherwise) you may like to consider adjusting your feescale.

    6 months to be paid? That is very fast for some companies:D.
  5. Pod on sea

    Pod on sea Active Member

    Hi David
    ..could you expand?
  6. RobinP

    RobinP Well-Known Member

    Charge a bit more would be my thought. I would imagine most medicolegal reports for podiatric/biomechanic related cases would be charged at between £1000-£2000?

    If you consider that the lawyer working on the case may be billing at £300+ approx per hour, it should give an idea as to the scales of money involved and the medico legal report is a pretty important bit of documentation for both you and the solicitor. Also bear in mind the time scale to remuneration - it has to be worth it for you to want to write the report and risk all the things that go with it

    Just my 2p

  7. rosherville

    rosherville Active Member

    I`m engaged in quite a number of Medico-legal reports.

    The majority of my work is examining folder fulls of notes, sifting out the irrelevant and commenting on the standard of treatment in relation to Breach of Duty, Negligence with Causation. The reports have to conform to Civil Procedure Rules (making report ready for court) and involved training to become familiar with the whole legal process. Often a patient is never examined. The current rates people charge ranges between £150-£250 hour; lawyers expecting to be billed 2-4 hours.

    This is different from simply writing a report on a patients condition/injuries.

    The one quality required is the ability to give 'attention to detail', reports should be clear, concise and no waffle. Unless you can do that you won`t be asked again.

    You may have to attend court and be cross examined by a barrister whose purpose in life is to reduce you to feeling an incompetent fool !
  8. Pod on sea

    Pod on sea Active Member

    ..could you expand on the risks?
  9. davidh

    davidh Podiatry Arena Veteran

    Like most things in life, if it's worthwhile it will carry risks;).

    If you, as an Expert, are providing a document which may be used in Court it has to be accurate.
    If it is not accurate, even through no fault of yours, and the case is subsequently challenged, you can be held to account for providing information which is not accurate.
    Since we no longer have immunity from prosecution for perjury the worst case scenerio is that you can be prosecuted.

    The law was changed relatively recently on this. Before the change we had automatic immunity from prosecution for evidence which was incorrect. The test-case after the law was changed involved, if I remember correctly, a psychologist changing her mind after a case had been proven.

    It's no great burden. You may remember high-profile cases involving child abuse where the "expert" was later found to be spectacularly wrong.
    I feel happier that the onus is on us to be very careful about the accuracy of our evidence.
  10. davidh

    davidh Podiatry Arena Veteran

    A podiatrist or orthotist in the UK is expected to charge less than a Specialist. We are about on the same level as GPs, pharmacists, osteopaths etc. Certainly less than £1000 per report.

    Bear in mind that the first Report can be followed by a supplementary report, telephone conference, and joint report (if, say, the other side have also brought in a podiatrist) all of which are charged for seperately.

    A day at Court (whether called to give evidence or not) is generally charged out at around £1000, + expenses.
    However as Mark Russell has already pointed out on another thread, the job is no sinecure. You may be able to get by with just a degree and brass neck, but sooner or later you will come across someone who disputes your opinion, and you had better be very sure of your ground if you want to disagree.
    I would be unhappy setting myself up as an Expert Witness without at least a higher degree and membership of one or other of the various legal training establishments.
    Find out, too, about Part 35, a statement about which must now be included as part of your Report.
  11. Pod on sea

    Pod on sea Active Member

    Mmm perjury sounds scary though!
  12. RobinP

    RobinP Well-Known Member

    Despite the attractive looking remuneration, it is certainly not an area that I would be keen to get into without some serious training as pointed out by David.

    I did investigate it once but like Phil, i thought it was a little scary and decided that I needed to be far better educated before taking anything like that on.

    There are several companies that specialise in preparing clinicians for medicolegal work - one of them (I can't remember which) wold have a trade stand at our professional body's conference.

    Apparently well worth going on these courses even from the point of view of how you conduct your own practice!

  13. Ian Linane

    Ian Linane Well-Known Member

    In terms of courses Bond Solon provide a 5 module course which is applicable to both Civil and Criminal legal work matters. There are at least 2 venues where they are held in the country. Importantly they are linked in with Cardiff University and provide at the end a Uni' accreddited qualification.

    They are not cheap at just short of £500 per module but they are valued by commissioning solicitors and the like. Some expert witness organisations also provide similar courses.
  14. RobinP

    RobinP Well-Known Member

    Thanks Ian

    Bond Solon was the one.

  15. DTT

    DTT Well-Known Member

    Hi All

    I believe David Smith was at one time involved and was / is a very well respected Pod (amoungst others) in this field.

    A more exacting scrupulous methodical pod would I believe be hard to find, and as a bonus a very nice guy ;)

    Not heard much from him of late but I'm sure he is lurking somewhere in the background :rolleyes:

    Cumon smiffy this is one for you mate :drinks

  16. Pod on sea

    Pod on sea Active Member

    I'm so grateful for this thread as I didn't know about the law change re liability. Would anyone who has done the Bond Solon courses comment on if they are all necessary (thinking family law, maybe not relevent- I could be wrong)? I'd definitely start with the report writing one.
    Leading on from this, whilst picking all your brains. I spotted theat Huddersfiled uni has a Forensic Pod PG Cert course. Does anyone know of any others south of Watford Gap?
  17. Griff

    Griff Moderator

    This is the only formal qualification (university led PGCert) in Forensic Podiatry currently on offer in the UK to my knowledge. I did a fair bit of research into this recently as I am thinking of enrolling on this course myself. Ian Linane is the man to speak to - he sent me a great email with loads of information about forensic work.
  18. Griff

    Griff Moderator

  19. Pod on sea

    Pod on sea Active Member

    Ooooh sounds like one for the Xmas list. Thanks for that.
  20. davidh

    davidh Podiatry Arena Veteran

    I think if you are unfamiliar with formal report-writing then that is a good place to start.
    You will also need to join an expert witness body - I believe Bond Solon offered free membership of one at one time (once you signed up for a course) but I'm not sure if they still do. An expert witness professional body will place your name on a register, which lets solicitors know you are open for business.

    Forensic podiatry is very different to being an expert witness. It is very specialised and deals with mostly criminal law.
    In contrast, my expert witness work is based on my professional training and deals with civil law - mostly trip-and-slip incidents affecting the lower limb, and clinical negligence of course.

    If you are interested in forensic podiatry, as Ian G said, pm Ian Linane who is a nice chap and has a good deal of practical experience in this area working for the Crown Prosecution Service.

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