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Professional prologue
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My medico-legal practice  
'Nephrology for Lawyers'  


I have been involved in Medico-Legal practice for about fourteen years and have prepared nearly 1000 reports during that time. I have formal training in and experience of report writing, giving evidence and acting as the single joint expert. I received Cardiff University Expert Witness Accreditation in 2005.  I am a Council Member of the Medico-Legal Society and Deputy Editor of the Medico-Legal Journal. I am a member of the Expert Witness Institute and Academy of Experts and am also an Accredited Expert for AVMA and APIL. I was a member of the Clinical Claims Review Group of the UCLH Trust, which aimed to settle meritorious claims as expeditiously as possible. I have given evidence as an independent medical expert in the Coroner's Court, and have also served on several Independent Review Panels. 

The balance of my expert reports are about two thirds Claimant and one third Defence. My areas of expertise include specialist nephrology such as acute renal failure, renal transplation, haemodialysis and chronic ambulatory peritoneal dialysis. I am familiar with the sort of renal problems which are commonly encountered in general medical practice such as those related to diabetes, hypertension and urinary tract infection. Because of my appointment at the Institute of Urology and Nephrology I have particular experience of nephro-urological problems such as renal calculi, pre- and post-operative renal impairment, urinary tract diversions and other complex urological problems. A typical medical report is available within two to three weeks of receipt of the complete medical records, which I expect to be bound, indexed and paginated appropriately. In very urgent cases reports can be prepared within a few days. If I need to see the patient to prepare a Condition and Prognosis report the outpatient consultation can usually be arranged in no more than seven days. 

My medico-legal reports can be divided into three broad categories including specialist nephrology, general medical nephrology and surgical nephrology and further details are given in the following sections. 

(1)    Specialist nephrology

This covers the care of patients with acute renal failure, often in an intensive care unit, together with those suffering from end stage, irreversible chronic renal failure. This latter group comprises patients being treated with maintenance haemodialysis or chronic ambulatory peritoneal dialysis, together with those who have functioning renal transplants.

Patients with acute renal failure have commonly undergone major surgery, either cardiac or abdominal, and a number of obstetric and post-partum cases are included in this category.

Dialysis-related problems include complications of vascular access, peritonitis in CAPD (chronic ambulatory peritoneal dialysis) patients and side-effects of immunosuppressant medication in patients with vasculitis, SLE (systemic lupus erythematosus) and renal transplants.

(2)    General medical nephrology

Serious renal involvement may accompany such common general medical problems as diabetes, hypertension and urinary tract infection. Recurring medico-legal topics include;-

(a) adequacy of hypertensive and diabetic control,
(b) suitability of long-term medication, and
(c) inappropriate investigation of proteinuria and haematuria

I am happy to consider cases of possible sub-standard care involving general medical problems where a dominant speciality involvement is not apparent.

(3)    Surgical nephrology

This usually relates to complex urological cases dealing with, for example, renal calculi, urinary tract Infection, urinary diversion and cancer.

Preoperative renal function is commonly impaired in these cases and the assessment of postoperative condition and prognosis may be the key question. Damage to a ureter at hysterectomy, with consequent loss of kidney function, is a recurring theme.

The assessment of residual function and the prognosis for its preservation are complex issues which require the opinion of a nephrologist rather than a urologist.

More detailed information is given in the next section, 'Nephrology for Lawyers', on the following page.

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