Commentary

The learning points from this case can be understood without reading the summary. For the specialists it illustrates how the court investigates case of perplexing presentations in children and the importance of considering as many as possible explanations. This was a case where the medical history was complex and where the material events occurred over a 5 months’ admission, so the volume of medical records must have been immense. The court was obviously greatly assisted by the expert factual evidence of one of the child’s consultants, specifically his summary of the child’s medical conditions and his table of medication. The weakness of one of the experts was that he had not sufficiently familiarised himself with the contents of the medical records and was not as familiar as with the chronology of the case as he might have been if he had created a chronology in his own investigation of the case.   

Learning points

• Conclusions should be sufficiently fully reasoned for the court to understand why they have been reached.

• In a complex medical case, albeit requiring great effort, it is necessary to be sufficiently familiar with the history and the records to understand and respond to as many questions as possible as otherwise the court may place little weight on your opinion.

• Creating a chronology can avoid misunderstanding as to when events took place.      

• Variations in conclusions can likewise result in the court placing little weight on your opinion.

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