Lessons for Expert Witnesses from O'Neill v Scottish Ambulance Service Board: Independence, Expertise and the Boundaries of Expert Opinion in Remote Clinical Triage

 

Dr Samah Boulis is a very experienced General Practitioner who provides expert evidence in medico-legal proceedings. She works as a full time NHS GP and is fully registered with the General Medical Council and is also on the Medical Performers list for GPs.

Introduction

The decision in O'Neill v Scottish Ambulance Service Board [2025] CSOH 17 provides important guidance on the legal and professional standards applicable to remote clinical triage. The court reaffirmed that clinicians conducting telephone assessments are held to the same professional standards as those undertaking face-to-face consultations.

The judgment emphasises the importance of adequate information gathering, compliance with clinical guidance, sound clinical reasoning, accurate documentation, and separate consideration of causation. It also confirms that responsibility for clinical decision-making remains with the assessing clinician, even where information is provided by another healthcare professional.

Learning points for expert witnesses

• Remote assessment requires the same standard of care: As remote consultations become increasingly common in healthcare, courts are placing greater scrutiny on the adequacy of history-taking, risk assessment, and clinical decisionmaking.

• Guideline Compliance remains central: The judgment reinforces the importance of clinical guidelines in determining whether a practitioner acted reasonably.

• Credentials alone are not enough: The court evaluated expert evidence based on the strength of the reasoning rather than the reputation of the witness. Although Professor D was highly experienced, the court preferred the evidence of Mr J and Dr H on key issues because their opinions were more closely aligned with the wording and purpose of the relevant ambulance triage guidance.

• Documentation remains critical: Experts should assess contemporaneous records and the telephone recording.

• Responsibility cannot be delegated: A particularly important aspect of the judgment is the court's conclusion that responsibility for the final decision remained with the clinician conducting the assessment. 

• Independence enhances credibility: the judgment demonstrates the value courts place on balanced and consistent evidence. Experts who acknowledge limitations, make appropriate concessions, and avoid advocacy are often the most persuasive witnesses. The court was critical of inconsistencies in the evidence of one witness and noted concerns regarding the evolution of that witness's account over time. In contrast, Dr R was regarded as a credible and reliable witness because her evidence remained measured, balanced and consistent despite rigorous challenge. Although Dr R was a factual witness rather than an expert witness, the court's observations are equally applicable to expert evidence.

• Beware of hindsight bias: courts are alert to retrospective rationalisation. Expert opinions should assess decisions based on the information available at the time, rather than being influenced by the outcome that later occurred.

• Explain your reasoning: the court placed greatest weight on evidence that clearly explained how conclusions had been reached. A persuasive expert report should provide a transparent analytical pathway, not simply a statement of opinion.

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