Commentary

This is a case which will assume much greater importance for the 15 points of practice and practical steps that the judge decided can help reduce the risk of well-meaning professionals falling into pitfalls that hinder the identification of safeguarding issues at an early stage than as a case with learning points for experts.

For some of the experts in the fields from which jointly appointed experts were instructed, it illustrates how their evidence is tested and applied in a case of suspected fabricated or induced illness (FII).

The evidence of two of the experts illustrates the importance of healthcare experts having regard to the reliability of the evidence on which they rely. The toxicology expert raised some concerns about the accreditation of the hospital laboratory where tests had been carried out. He was clear that the process adopted was entirely appropriate for clinical purposes and the purposes of the court but described “the analysis as not being 'good' but 'not bad'” leading the court to acknowledge that the testing was not forensically robust. Likewise, the respiratory expert was quick to recognise the limitations in commenting on still bronchoscopy images as supplemented by a thorax CT scan. It is for the court to decide on the reliability of evidence but in doing so the court requires the assistance of experts who can identify matters relevant to reliability that would otherwise be beyond the knowledge and understanding of the court.

It appears that the cross-examination of some experts lasted for days. For those whose reports addressed the reliability of the evidence on which they relied their cross-examination might have lasted longer and their evidence carried left weight had they not addressed the reliability of the evidence.

There were a number of experts in this case but they did not include an expert in paediatric gastro-enterology. When an issue arose as to the connection between cystic fibrosis and pancreatic insufficiency, the court accepted the evidence of the paediatric respiratory medicine expert, even though he made it clear that he is not an expert in paediatric gastro-enterology. This can be regarded as an example of the court relying on an expert’s working knowledge of a matter on the border or outside their field of expertise.  

Learning point

• An expert’s report should include a consideration of the reliability of the evidence on which they rely.

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