Dr Samah Boulis is a very experienced General Practitioner who provides expert evidence in medico-legal proceedings. She works as a full time NHS GP and is fully registered with the General Medical Council and is also on the Medical Performers list for GPs.

Summary

The decision in Evie Toombes v Dr Mitchell [2021] EWHC 3234 (QB) offers important lessons for expert witnesses across all disciplines. Although the case arose from a routine primary care consultation on pre-conception folic acid advice, the legal principles extend well beyond general practice. The case centred on an apparently straightforward clinical encounter that raised significant issues of duty of care, foreseeability, causation, and the standard of care. 

For expert witnesses, the judgment reinforced the importance of objective, evidence based opinions, careful analysis of contemporaneous records, and clear reasoning. 

Learning Points for Expert Witnesses

• Historical standards must be judged by the standards of the time. Experts should assess conduct against the guidance, standards, regulations, and accepted practice that existed at the relevant date. 

• Where events are examined many years later, records frequently become the most reliable evidence available to the court. Expert witnesses should carefully analyse contemporaneous documentation and recognise its importance when evaluating disputed facts.

• A lack of documentation is not always neutral. Courts may draw conclusions from what was not recorded, particularly where important information would ordinarily be expected to appear in contemporaneous records. Experts should consider both what is present and what is absent from the available evidence.

• Witness credibility can be highly influential. The court preferred the claimant's mother's clear and credible evidence over the defendant's reconstruction of usual practice. Do not assume evidence of usual practice will outweigh reliable factual testimony. Base your opinion on the facts accepted by the court.

• Stay within your expertise. The court determined how the claimant's mother would likely have acted if proper advice had been given. Distinguish between matters requiring expert opinion and issues of fact, such as witness behaviour or credibility, which are for the court to decide.

• Establishing that conduct fell below an expected standard does not automatically establish liability. Experts should separately analyse whether the alleged breach caused the claimed loss or harm. A clear distinction between breach and causation remains fundamental in expert evidence.

• A notable feature was the court's detailed assessment of what the mother would have done had proper advice been given. The judge relied heavily on observed behaviour patterns rather than speculation. When considering causation, experts should distinguish clearly between medical probabilities and behavioural probabilities. The latter often fall within the court's domain rather than expert opinion.

• The judgment emphasised that a patient cannot make an informed choice unless they are told: the recommendation, the rationale, the timing and the consequences of non-compliance. In consent and counselling cases, experts should assess not merely whether advice was mentioned but whether sufficient information was provided for meaningful patient decision-making.

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