Commentary

For paediatricians this is an example of how not to conduct an expert paediatric assessment and present the results to the court. It also illustrates some basic points applicable to all experts.

Learning points:

General

• An expert report should address all the issues in their instructions.

• If an expert is unable to assist as to an issue, the instructing party should be informed as soon as possible, the reasons should be stated and, if the expert is able to do so, advice given as to who might be instructed or the appropriate professional discipline.

• Unwillingness to make any concessions and defensiveness in cross-examination can call into question an expert’s independence.

• An opinion on a matter not in issue and, especially with a slim evidential basis, risks judicial criticism.

• Experts should be curious and able to apply forensic scrutiny to evidence that may not be understood sufficiently, or at all, by the court without their assistance.

• If potentially significant evidence in medical records is disregarded, the expert should explain why.

Paediatric cases

• Paediatricians acting as expert witnesses in family cases should be familiar with the RCPCH Perplexing Presentations (PP)/Fabricated or Induced Illness (FII) in children – guidance (https://childprotection.rcpch.ac.uk/resources/perplexing-presentations-and-fii/ ), able to recognise them, able to assess risk and know what the managements are for the different types of presentation so as to assist the court as fully as possible.

• In a case where an issue is the allegations that the parents make against each other, what is required of the expert is a careful, chronological, objective and neutral analysis of a parent's interactions with the medical professionals in the child's life. It is necessary to compare and contrast what, for example, the parent had reported with that which had been observed by the professionals. It is necessary to attempt to identify patterns or habits and to consider the challenge that may have been made by the parent to the views of the professionals (and, indeed, which on the evidence may have been made). A detailed analysis is required.

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