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As a clin neg lawyer who has undertaken claimant and defendant work:

If there were, genuinely, no issues on causation / C&P then a £72k bill is ludicrous. A £32k ATE premium on a post-LAPSO case is crazy, as are the £18k experts' fees (if the figures below are correct).

The problem with reporting is sometimes things get missed. I don't feel that there is sufficient info in the article to really form a view.

If causation / C&P were at issue (which, as any clin neg practitioner will know, are often the bigger issues in cases of delayed diagnosis - particularly with pituitary tumours), the experts' and solicitors' fees are understandable for settlement reached at / near Trial. The ATE premium, however, still seems ridiculously high.

For those that have recommended costs be shaved by instructing a Registrar: instructions for breach of duty reports need to be made on a like-for-like basis - i.e. if the alleged negligent treatment was provided by a consultant, a consultant must be instructed to report, as the standard applied is that of a practicing consultant in the same discipline.

Expert fees in these types of cases are high: pituitary tumors are relatively rare and experts prepared to criticise their colleagues (in (what is still a relatively close-knit field) even rarer. Because demand significantly outstrips supply for both expert Endocrinologists and expert Neurosurgeons, it inevitably leads to having to pay high fees simply to secure the evidence required to prosecute the case.

What I think we miss is the conduct of the NHS Trusts / NHSLA in all of this: despite the Duty of Candour, denials of liability remain the norm, even in the face of compelling evidence. The application of a retrospective test of proportionality does nothing other than perpetuate the problem - Defendants are encouraged to deny liability, safe in the knowledge that it is unlikely to cost them much more money and if they push the agenda, eventually claimant firms will stop taking these cases on.

It will always be in the wider public interest to ensure that healthcare is provided safely. Unless and until the system changes, a clin neg claim is often the only recourse for redress a patient has. We need to recognise this and look at ways to make the system better and fairer for all who use it. This includes defendants not denying the indefensible and putting claimants to unnecessary (and costly) proof; claimants ensuring that they are only incurring costs that are absolutely necessary; and, engaging experts and ATE providers to look at ways to (fairly) reduce their charges. Solely persecuting claimant lawyers, however, needs to stop - this is a far wider issue.

On a separate note: I am appalled at the comments concerning the LSF; I think it is wrong to assume that all who have qualified under the post-LSF finals system are in any way less capable as lawyers, or lacking in intelligence.