Expanding MedCo could seriously compromise the quality of medical expert evidence


11 July 2016

"Specialists experienced with dealing with trauma victims, such as psychological or orthopaedic consultants, are not incentivised enough to commit time or expertise."

This post has been adapted from an original article featured in The Law Society Gazette

With MedCo already in its second year, there has been talk of expanding the system for sourcing medical reports on soft-tissue and whiplash claims from road traffic accident (RTA) cases to other types of cases.

MedCo is a system that facilitates the sourcing of medical reports by providing a framework to connect law firms with independent medical experts in a narrow field of personal injury claims, in which concerns have been voiced by both government and the insurance industry.

The system is designed to deal with a section of the RTA claims sector involving the very simplest cases, both in terms of the mode and extent of any injury consequently sustained. The system is not for all types of RTA case, nor any personal injury occurring in another case type.

Since 1 June 2016, only accredited MedCo medical experts can receive instructions through the system. To achieve accreditation, training focused on RTA cases and the injuries caused by these accidents is undertaken by the experts.

“The fee for preparing a first report and updating the MedCo portal is set at £180, with many Doctors who deal with medico legal cases having the luxury of choice about how they spend their time. Our experience is that many have decided it is no longer worth their while to do this work. Specialists experienced with dealing with trauma victims, such as psychological or orthopaedic consultants, are not incentivised enough to commit time or expertise,” says David Stothard, managing director at MAPS Medical Reporting.

“These Doctors are usually unwilling to work for the fixed fee to provide a first report in such cases. Even if they are willing to work for the higher fixed-fee available for a second medical report, the low number of requests results in them believing that the time investment in achieving their accreditation is not worthwhile.

“The outcome is that the expert witnesses best suited to provide medico legal reports in these trauma cases are less likely to do so.”

However, the gap has largely been filled by GPs, with some excelling at this type of work. But the comprehensive nature of the training required suggests that there was little confidence from MedCo that most GPs possess the basic medical skills, or the knowledge and experience of the law and procedure associated with providing expert evidence, to the standards required.

The outcome of too many GPs undertaking this type of work is that the unfamiliarity with the subject matter, compared to trauma experts well-versed in medico legal work. If this proposed expansion of MedCo comes to fruition, this will present an ethical challenge to lawyers whose professional obligation is to act in the best interest of their client.

In cases other than the most simple and low-value RTAs, that obligation cannot easily be met if the instructing lawyers are required to select an expert witness they do not know, and without the confidence that the witness has the knowledge, skills and experience to properly prepare the required evidence.

“The enormous variety of injuries which fall outside the simple MedCo procedure would make it impossible to devise an expanded system of training and accreditation which guaranteed the quality of evidence already available from experienced medico legal expert witnesses outside the current process,” continued Mr. Stothard.

“To attempt to do so would not only invite derision from users and expert witnesses, but might also be the cause of its own failure if those same experts decide that it is easier to spend their time more productively on other medical work.”