MEDICO-LEGAL REPORTS · HARLEY STREET LEGAL
Medico-legal reports from a consultant plastic surgeon
A medico-legal report is an expert's written opinion on an injury or on medical treatment, prepared for the court in a civil or criminal case. Prof. Sandip Hindocha, a consultant plastic surgeon on the GMC Specialist Register, writes CPR Part 35 reports on scarring, burns, hand injuries and plastic surgery negligence for claimant, defendant and single joint instructions.
UNDERSTANDING THE REPORT
What is a medico-legal report?
It is expert evidence on the medical issues in a claim. In civil cases in England and Wales, expert evidence is given in a written report unless the court directs otherwise, and no party may rely on an expert's report without the court's permission under CPR Part 35.
The report is addressed to the court, not to the solicitor who commissions it. The expert's duty is to help the court on matters within their expertise, and that duty overrides any obligation to whoever instructs or pays them. For the wider meaning of the term, see what medico-legal means.
Condition and prognosis
The injuries, the treatment so far, the current condition and the likely course from here, including any future surgery. Most personal injury claims need this report to value the loss.
Breach of duty
In clinical negligence, whether the care given fell below the standard a responsible body of surgeons in the same field would accept. The Bolam test, and Montgomery for consent, set that standard.
Causation
Whether the injury, or the breach, caused the harm claimed, judged on the balance of probabilities. Causation in medico-legal cases explains the but for test.
Single joint expert
One expert instructed by both parties, or directed by the court under CPR 35.7, instead of an expert for each side. See single joint expert instructions.
CLAIMS COVERED
Which claims need a plastic surgeon's report?
Professor Hindocha reports on injuries and treatment within plastic, reconstructive, aesthetic and hand surgery. Questions outside that field, such as orthopaedic or psychiatric opinion, need an expert from that discipline.
Burns and scarring
Burn injuries, traumatic and surgical scars, keloid and hypertrophic scarring, assessed in detail with photographic evidence. See scarring and burns reports.
Hand and upper limb
Nerve, tendon and bone injuries of the hand and arm, and their effect on grip, sensation and function. See hand and upper limb reports.
Facial injury and disfigurement
Facial lacerations and scarring, how visible they are and the prospects for revision surgery. Facial disfigurement claims explains how they are valued.
Surgical complications and negligence
Complications after reconstructive or plastic surgery, where the questions are the standard of care, consent and causation. See medical negligence reports.
Cosmetic surgery claims
Aesthetic procedures of the breast, body and face, where the claim concerns consent, technique or aftercare. See plastic surgery expert witness.
Personal injury
Road traffic, workplace and public place injuries where scarring, burns or hand function form part of the loss. See personal injury reports.
WHO WRITES THE REPORT
Who writes the report?
Each report is the expert evidence of Prof. Sandip Hindocha, a consultant plastic, reconstructive, cosmetic, laser and hand surgeon in current NHS and private practice. Read his full profile.
- GMC Specialist Register, Plastic Surgery (GMC No. 6122218)
- Member of the Faculty of Forensic and Legal Medicine (MFFLM)
- National Lead Forensic Medical Examiner
- Visiting Professor, University of Bedfordshire
- Member of BAPRAS and BAAPS
Instructions from either side
Claimant, defendant and single joint instructions are accepted from solicitors, barristers, insurers, coroners and courts across the UK. Whoever instructs, the report is written for the court.
Civil and criminal
Civil reports comply with CPR Part 35 and its Practice Direction. Criminal reports comply with the Criminal Procedure Rules.
Examined in clinic
The claimant is examined in person and the medical records are reviewed before an opinion is given. Clinic addresses are on the locations page.
After the report
Answers to written questions, experts' discussions and joint statements, supplementary reports and addenda, and attendance at court.
COMMISSIONING A REPORT
How do you commission a medico-legal report?
01
Send the instruction
Email or call with the claim reference, what the instruction is for, the questions to be answered, the medical records and the timescale you are working to.
02
Records reviewed
The medical records, photographs and any previous reports are reviewed, so the history in the report can be checked against the notes made at the time.
03
Examination
The claimant is seen in clinic for a full history and an examination of the injured area, including scars, movement and sensation where relevant.
04
Report served
The report is sent to those instructing in Part 35 form. Written questions may follow once, within 28 days of service, under CPR 35.6.
INSIDE THE REPORT
What does a medico-legal report contain?
What the report covers
What the report does not do
PART 35 COMPLIANCE
What makes a report Part 35 compliant?
Practice Direction 35 sets out what an expert's report must contain. How an expert witness report is written covers the structure in more detail.
Addressed to the court
The report is addressed to the court, not to the party instructing, and gives the expert's qualifications and any literature relied on.
Instructions stated
It sets out the substance of all material instructions, written or oral, on which it was based (CPR 35.10(3)).
Facts and opinion separated
It makes clear which facts are within the expert's own knowledge and, where there is a range of opinion, summarises the range and explains the view reached.
Declaration and statement of truth
It ends with a summary of conclusions, a statement that the expert understands and has complied with the duty to the court, and the statement of truth the Practice Direction requires.
FREQUENTLY ASKED QUESTIONS
Questions solicitors ask
Who can write a medico-legal report?
A doctor with expertise in the field the claim turns on. For scarring, burns, hand injuries and plastic surgery, that is usually a consultant plastic surgeon. The court decides which expert evidence it will allow, and in which field.
What happens at a medico-legal examination?
The claimant is asked about the accident or treatment, their symptoms and how the injury affects daily life and work. The injured area is then examined: scars are described, measured and photographed, and hand function is tested where relevant. It is an assessment for the court, not a treatment appointment.
What does a scarring report cover?
Each scar's site, size and type, how it looks and feels on examination, and photographs taken at the appointment. The report then gives an opinion on how far the scar has matured, whether it is likely to change, whether treatment or revision surgery would help, and any effect on movement, as with a contracture scar after a burn, which can leave the area tight and difficult to move. NHS guidance on scars says most fade over time and that this can take up to two years or more, so a report on a recent scar may give an interim prognosis and say when a re-examination should take place. Scales such as the Vancouver Scar Scale record features that change as a scar matures. How the courts value scarring is set out in the Judicial College Guidelines on scarring. Psychological injury, if claimed, needs a separate expert.
Can the other side put questions to the expert?
Yes. Under CPR 35.6 a party may put written questions about the report once, within 28 days of service. They must be for clarification only, unless the court gives permission or the other party agrees, and the answers are treated as part of the report.
Is it medico-legal or medicolegal?
Both spellings are in use and mean the same thing: medical evidence prepared for a legal purpose.
Does Professor Hindocha act for claimants or defendants?
Both, and as a single joint expert. Whichever party instructs, the report is written for the court.
INSTRUCT PROFESSOR HINDOCHA
Ready to commission a medico-legal report?
Send the claim details and records through the instruction page, or call to check whether the case falls within plastic surgery.