Andrew Quaile is an Orthopaedic surgeon with the subspeciality of spinal surgery. He qualified from Charing Cross Hospital in 1979, and after serving in the Royal Navy and then the Australian Army, he returned to the UK in 1990 to complete his accreditation as a consultant. After working as a full time spinal surgeon for many years, he left the NHS in 2004 to concentrate on private practice and medico-legal work. He still sees NHS patients via choose and book and at various other NHS hospitals
1. How did you get into this field of work?
I first became interested in medico-legal work in Australia in 1992 when clinical practice involved seeing patients for workers compensation. Reports were regularly required and I gained a lot of experience working with lawyers on cases. On my return to the UK it was easy to continue this work in Somerset and then Surrey.
I wrote expert reports for many years before I undertook and completed the Cardiff University Bond Solon (CUBS) Certificate. To keep abreast of industry developments, I regularly attend conferences on medico-legal training including the Bond Solon annual Expert Witness conference and the ‘conversation between medicine and law’ conference in Cambridge.
Outside of my expert witness practice, I have lectured to law firms and insurance companies on multiple occasions as well as organised a legal conference in the Royal Society of medicine. I am Deputy Editor of the journal ‘International Orthopaedics’ in which I write editorials, compile special issues as guest editor and lecture. This journal is part of the Société Internationale deChirurgie Orthopédique et de Traumatologie for whom I have organised a symposia on medico-legal matters in their international conferences. As well as this, I am a member of a number of organisations such as the first tier of APIL and the publishing committee of the Expert Witness Institute.
2. What does your typical day/week look like?
My weeks now involve driving to Basingstoke from Norfolk on a Monday, and returning on Thursday. They are extremely busy and I tend to spin a lot of different plates! For example, I have operating theatre sessions on Mondays and occasional Wednesdays, see medico-legal cases in my clinics in Basingstoke and Guildford, and then travel to Harley street once every two weeks for a dedicated medico-legal clinic. Joint statements with orthopaedic and spinal colleagues tend to occur in the evenings and barristers conferences are remote these days, requiring some expertise in zoom, Microsoft Teams and Skype. I’m fortunate to have a dedicated medico-legal secretary who deals with reports, joint statements and administration.
Medico-legal opinions mirror clinical practice and I keep up to date with my spinal practice via journals, conferences and multiple disciplinary meetings. As I am not employed by the NHS my annual appraisal is completed via the Circle group and I revalidated with the GMC in February of this year.
3. What is the most interesting matter that you have worked on?
Because my professional interest is in spines, the cases I see are often complex and some are multiple trauma that require many experts from different disciplines. I find these types of cases the most interesting as there is so much to learn from the legal team and other experts.
One particular case comes to mind, in relation to paralysis following cardiac surgery. There were multiple conferences followed by joint statements and a trial. The experience was very taxing but ultimately rewarding as it provided valuable insight into the legal process for high value claims. My role was to examine the paralysis from a spinal perspective and to try to explain that in relation to vascular surgery. The key take away was doing adequate research and preparation.
4. What are the highs and lows of the job?
I provide in the region of 250 reports a year. Some of these relate to low level injuries and symptoms, which appear to be more significant than would be expected from the injury mechanism. This creates difficulties in explaining my opinion to claimants and their lawyers. Ultimately claimants differ in their reaction to trauma and therefore the extent and duration of symptoms. These often exceed my area of expertise and I would therefore defer to the relevant expert.
For the most part, expert joint statements are uncomplicated and most experts are straightforward and reasonable in their opinions. We may not always agree but we can still produce a joint statement, which is helpful to the court.
One of the main highs of job is when I am able to help a claimant understand their injuries, undergo relevant investigations and get the appropriate treatment. Frustrations arise out of the fact that many claimants are under investigated and treated, so by the time I see them it is far more difficult to make a difference.
One of the most difficult problems to overcome from an expert’s perspective is the supply of records and radiology. Records used to be supplied in paper form, which was obviously time consuming to deal with and required the postage of lever arch files between different parties. This has now been replaced by electronic transfer, but unfortunately there are still issues. If records are scanned upside down or in the wrong date order it creates more confusion and is more time consuming, which will reflect in costs. Radiology is similar and often CD’s will not open or the radiology will not download. Experts in other disciplines are not usually experts in computing!
5. What advice would you give to someone wanting to start out?
The most important thing for someone starting out is to undertake as much relevant training, meetings and events as possible. The training provides the framework for the role but the meetings provide the opportunity to network and ask difficult questions, which may not be possible in a more formal setting. It is well worth giving talks at law firms but also attending as a guest, in order to hear and understand what they are looking for. The same applies to insurance companies.
Ultimately remember that you are an independent expert providing your opinion for the court without fear or favour!
Andrew Quaile, Medical Director, Consultant Spinal & Orthopaedic Surgeon