"An expert is a man who has made all the mistakes which can be made, in a narrow field" Niels Bohr
"For every expert, there is an equal and opposite expert." Arthur C. Clarke

Expert input, 'expert opinion', is an essential, vital, though not mandatory requirement for deciding a medical negligence case. However, who is a suitable medical expert for a particular case? How is he selected by the court? Are there any term of references when a case is referred to the expert? In what format it is to be submitted to the court?, are not defined. Expression of subjective impression after examining the complaint and the patient record is not an expert opinion or testimony. These vital issues are discussed her with the help of Artificial Intelligence.

• Q. What is the dictionary definition of Expert? What is legal definition of expert?
• Response: Dictionary Definition of Expert: According to Merriam-Webster, an "expert" is defined as "one with the special skill or knowledge representing mastery of a particular subject."
• Legal Definition of Expert: In a legal context, an "expert" is often defined as a person who, through education, training, experience, or skill, has specialized knowledge that is not common to the average person, and whose opinion may assist the court in understanding evidence or determining a fact in issue. This person is typically called upon to provide expert testimony in legal proceedings.
   
• Q. As per the legal definition of expert, a licensed MBBS-qualified practicing doctor is an expert professional with knowledge and skill in the field of medicine. He is licensed and is entitled to practice for entire human body, its systems, its body part or organs?
• Response: Yes, according to the legal definition of an expert, a licensed MBBS (Bachelor of Medicine, Bachelor of Surgery) qualified practicing doctor is considered an expert professional with the requisite knowledge and skill in the field of medicine.
• This qualification entitles the doctor to practice medicine across the entire human body, encompassing all systems, body parts, and organs. An MBBS degree provides comprehensive training in various medical disciplines, allowing the doctor to diagnose, treat, and manage a wide range of medical conditions.
• As an expert, the doctor can provide professional medical opinions and may also be called upon to offer expert testimony in legal proceedings related to medical issues.
   
• Basic clinical specialists are in Medicine, General Surgery, Obstetrics Gynecology, Ophthalmology ( Eye) and Otolaryngology (ENT)?
  These are the branches in each of which an MBBS graduate was trained in and had to qualify? An MBBS is qualified to practice in all the branches or disciplines? However, if he/she wishes to practice as a licensed specialist, he has to acquire a Masters Degree. An MBBS can practice in any of these branches but he cannot project himself to be a specialist? The basic point is that an MBBS is not barred from practicing in any of these branches simply because he does not have Masters in it?
  
  • Response: Yes, you've captured the essence accurately.
  • Basic Clinical Specialties: Medicine, General Surgery, Obstetrics & Gynecology, Ophthalmology, and Otolaryngology (ENT) are considered core clinical specialties. An MBBS graduate is trained in and qualifies in these areas during their medical education.
  • Scope of Practice for MBBS: An MBBS graduate is qualified to practice in all these branches or disciplines. They have received the necessary foundational training to diagnose and manage a variety of medical conditions across these specialties.
  • Specialist Qualification: If an MBBS graduate wishes to practice as a licensed specialist in a specific branch (e.g., as a specialist surgeon or obstetrician-gynecologist), they need to pursue further postgraduate education, such as a Master's degree or a Doctorate in Medicine (MD/MS), or an equivalent specialty qualification.
  • General Practice vs. Specialization: An MBBS doctor can practice in any of these branches within the scope of their training, but they cannot present themselves as a specialist unless they have obtained the requisite advanced qualifications. This means that while an MBBS doctor is not barred from practicing in any of these fields, they must be clear about their level of qualification and not mislead patients about their expertise.
  • To sum up, an MBBS doctor can provide medical care across various disciplines but needs further specialized education to be recognized and practice as a specialist in a particular field. This system ensures that patients receive the highest standard of care from adequately trained professionals.

Q. Each of these branches are further split into narrower and narrower fields of body systems, organs or organ parts? To profess and practice as super specialist in any of these subdivisions, he has to acquire a MCh or DM qualification? Again, a basic specialist is not excluded from practicing in his field of specialty but cannot project himself as a super specialist? Thus a general surgeon cannot be barred from doing a hernia, appendix or gall bladder surgery simply because he is not an MCh in gastroenterology or a general physician from treating hepatitis or peptic ulcer? The legal requirement is competence i.e. knowledge and skill required for that particular intervention?

• Subspecialties: Each of the primary branches (Medicine, General Surgery, Obstetrics & Gynecology, Ophthalmology, and Otolaryngology) can be further subdivided into narrower fields focusing on specific body systems, organs, or even parts of organs. For instance:
• General Surgery can include subspecialties like Gastroenterology, Cardiothoracic Surgery, Vascular Surgery, etc.
• Medicine can include subspecialties like Cardiology, Neurology, Endocrinology, etc.
• Super-specialization: To practice as a super-specialist in these narrower fields, a medical professional typically needs to acquire advanced qualifications such as MCh (Master of Chirurgiae) or DM (Doctorate of Medicine).
• Practice Scope for Basic Specialists: A basic specialist (e.g., an MBBS with a Master's degree in General Surgery) is not excluded from practicing within their field of specialization. However, they cannot project themselves as super-specialists unless they hold the relevant super-specialist qualifications. For example:
• A General Surgeon can perform surgeries like hernia repairs, appendectomies, or gallbladder surgeries even if they are not super-specialists in Gastroenterology.
• A General Physician can treat conditions like hepatitis or peptic ulcers without being a super-specialist in Gastroenterology.
• Legal Requirement - Competence: The legal requirement for practicing in any medical field is competence, which includes having the necessary knowledge and skills required for that particular intervention. As long as a medical professional meets this requirement, they can legally perform the relevant medical procedures.
• Thus, the emphasis is on the practitioner's competence and ability to perform the required medical procedures safely and effectively, rather than solely on their formal qualifications.

If you need further clarification or have more questions, feel free to ask!

Q: What role does a medical expert play in assisting the court with adjudicating medical negligence cases? On what grounds does the court select such an expert? If the standard for evaluation is that of a physician exercising ordinary prudence, is an MBBS degree sufficient qualification for an expert?

• Response: A medical expert in a medical negligence case is a qualified professional who provides an unbiased, informed opinion to help the court understand complex medical issues and determine whether the standard of care was met. Their testimony can clarify whether the healthcare provider deviated from accepted medical practices, contributing to the patient's harm.
   
• Basis for Choosing an Expert: The court typically selects a medical expert based on their qualifications, experience, and relevance to the specific medical issue in question. The expert should have specialized knowledge in the area pertinent to the case and be recognized as competent by their peers.
   
• Evaluating Criteria: While evaluating criteria, the court considers whether the physician demonstrates the level of care expected from a reasonably prudent medical professional under similar circumstances. An MBBS doctor can be considered an expert if their knowledge and skills are relevant to the case. However, for more specialized cases, a higher qualification (such as an MCh or DM) might be required to ensure the expert's testimony is sufficiently authoritative and relevant.

Q: How is expert opinion defined? When a medical negligence case is referred to an expert, is the purpose to analyze and scrutinize the case to assist the court or to seek the expert's personal judgment on whether the doctor was negligent? If it's the latter, shouldn't the principle of natural justice require the expert to allow the accused doctor an opportunity to be heard before submitting their opinion? Shouldn't an expert opinion be a detailed, speaking opinion that explains the objective basis for their conclusions? Additionally, should the accused have the right to cross-examine the expert in court? Does an expert appointed by the court hold a quasi-judicial status?

• Response: Definition of Expert Opinion: An expert opinion is the informed judgment provided by an individual with specialized knowledge, training, and experience in a particular field. In the context of medical negligence cases, the expert analyzes and scrutinizes medical evidence to assist the court in understanding whether the standard of care was met.
   
• Purpose of Referring a Case to an Expert: When a case of medical negligence is referred to an expert, their role is to provide an objective analysis of the case based on medical evidence and established standards of care. The expert's opinion is intended to help the court understand the medical nuances and determine whether the doctor's actions deviated from accepted medical practices.
   
• Law of Natural Justice: If the expert's role involves making a judgmental opinion on whether the doctor was negligent, the law of natural justice requires that the accused doctor be given an opportunity to present their side of the story. This ensures fairness and allows the accused to be heard before the expert submits their opinion.
   
• Speaking Opinion: An expert opinion should be a "speaking opinion," meaning it should detail the objective basis of the expert's findings. This includes explaining the reasoning, evidence, and medical standards that support the opinion.
   
• Cross-Examination: For a judgmental opinion, it is important that the accused be allowed to cross-examine the expert in court. This provides an opportunity to challenge the expert's findings and ensure a fair adjudication process.
   
• Quasi-Judicial Status: An expert appointed by the court does not have a quasi-judicial status. However, their testimony holds significant weight in helping the court make informed decisions. The expert's role is advisory, and the final judgment lies with the court, which evaluates the expert's opinion along with other evidence.

Overall, the expert's opinion is crucial in providing clarity and insight into complex medical issues, helping the court deliver a fair verdict.

If you need further clarification or have additional questions, feel free to ask!

Q: If expert opinion is considered "informed judgment," wouldn't that imply a comparison between the expert's judgment and the treating physician's judgment—essentially a judgment of judgment? Since all acts of patient treatment are clinical judgments, whether right or wrong, and considering that an error of judgment is not a crime, does testimony then equate to the expert's judgmental opinion? Shouldn't there be a specific format for submitting testimony? Shouldn't there also be defined terms of reference?

• Response: You've highlighted some very important points about the nature of expert opinions in medical negligence cases.
   
• Informed Judgment vs. Clinical Judgment:
  • Indeed, an expert's opinion is an informed judgment based on their specialized knowledge and experience. This may sometimes seem like it is a judgment on the treating physician's clinical judgment. However, the goal is to provide an objective analysis rather than to pit one judgment against another.
  • All acts of treatment involve clinical judgment, and an error in judgment alone is not necessarily considered negligence. For it to be deemed negligent, the judgment must significantly deviate from what is accepted as standard practice and result in harm.
     
• Nature of Testimony:
  • Testimony provided by an expert should be an objective analysis rather than a purely judgmental opinion. It should explain whether the actions of the treating physician were in line with standard medical practices.
  • There should be a clear and detailed basis for the expert's opinion, outlining the evidence and reasoning behind their conclusions.
     
• Format and Terms of Reference:
  • It is indeed beneficial to have a definite format for submitting expert testimony. This ensures that the opinion is structured, comprehensive, and addresses all relevant aspects of the case.
  • Specific terms of reference should be provided to the expert to guide their analysis and ensure that they focus on pertinent questions related to the case. This helps in maintaining clarity and relevance in their testimony.
     
• Procedural Fairness:
  • To adhere to the principles of natural justice, the accused doctor should be given an opportunity to respond to the expert's opinion, and cross-examination should be allowed. This ensures a fair and balanced evaluation of the case.

In summary, expert testimony should be well-founded, clearly presented, and subject to scrutiny to ensure fairness and accuracy in adjudicating medical negligence cases. If you have more questions or need further information, feel free to ask!

Q: Since no two medical cases are the same, and each situation is unique, real-time clinical judgments are inherently case-specific and context-specific. Can the bedside clinical decisions of a treating physician be effectively substituted by the retrospective judgment of an expert? Given this variability, is it feasible to rely on a standardized approach or "cookbook" decisions?
Response: You raise a vital point about the nature of medical practice. Here are some key considerations:

• Uniqueness of Medical Cases: Each medical case is unique, influenced by the patient's specific conditions, the context, and the situation at the time of treatment. The real-time judgment of a treating physician is shaped by these unique factors and cannot be entirely substituted by a retrospective analysis.
   
• Clinical Judgment: The bedside clinical decisions made by a treating physician are based on immediate observations, patient interactions, and situational factors. These decisions are context-specific and require the physician to consider various dynamic aspects that may not be fully appreciated in hindsight.
   
• Standard Practice: While there are guidelines and best practices to guide medical professionals, the concept of a "cookbook" approach to medicine is unrealistic. Medical practice requires adaptability and personalized care, as no two cases are exactly the same. Standard practices serve as a framework, but clinical judgment is essential in applying these practices to individual cases.
   
• Role of Experts: An expert's retrospective analysis should be aimed at understanding whether the physician's actions were within the bounds of reasonable and accepted medical practices, given the unique circumstances of the case. The goal is not to second-guess the physician's real-time decisions but to assess whether those decisions were justifiable based on the information available at the time.
   
• Judicial Fairness: Ensuring that expert opinions are well-informed, objective, and based on medical evidence is crucial for fair adjudication. Additionally, providing the accused physician with an opportunity to be heard and to cross-examine the expert helps maintain the principles of natural justice.

In summary, the complexity and uniqueness of medical cases necessitate a balanced approach that respects both real-time clinical judgment and the need for objective evaluation in legal proceedings. If there's more you'd like to explore on this topic, feel free to share!

Further Reading:

• Clarifying Uncertainties: Expert Testimony in Medical Negligence Adjudication
• From Practice to Court: The Critical Role of Medical Experts in Negligence Cases
• The Intersection of Law and Medicine: Expert Testimonies in Negligence Trials

Written By: Dr Shri Gopal Kabra, MBBS, LLB, MSc, MS(Anatomy), MS(Surgery)
Ph no: 8003516198 email: [email protected]