Expert Witness Journal Issue 66 April 2026 - Flipbook - Page 14
2019 and it was more likely that if a recommendation
had been made for further investigation, he would
have followed it up. Also, Mr Ahmed was familiar
with a process whereby a request was made, and it
was for the patient to take it further – he had gone
through this process with his blood tests. There was
no evidence in the records that Mr Ahmed had had
an x-ray of any sort before, this was a new form of
investigation, which made it less likely that if told
about it, he would have dismissed it.
Both those cases had evidence that the Claimants
understood the signi昀椀cance to follow the advice of
GP.
Furthermore, Dr Daish accepted it is likely that
she would have told Mr Ahmed that the reason for
the x-ray was to rule out more serious pathology,
in particular cancer. The Judge noted this is an
investigation that most people, not simply those
worried about their health, would take forward.
Comment
The Judge held that the Defendant could not show
that Mr Ahmed understood the signi昀椀cance of his
failure to attend, and without that understanding,
it would not be unreasonable for a person in
Mr Ahmed’s position not to attend the relevant
appointments.
This case is a useful reminder of how a Court will
consider and evaluate medical records, and how
silence on an issue can be a critical factor in a case,
especially when considering evidence about usual
practice.
The Judge also scrutinised the medical records
and noted:
•
•
•
This case also shows again how di昀케cult it is to
establish contributory negligence in clinical
negligence claims.
There was no record in the appointment note of
any discussion about the chest x-ray or in the Dr
Daish’s plan. This was a contrast to the records
of other doctors, who recorded their further
investigations in their notes. The Judge held it
likely that if Dr Daish had been dealing with the
chest x-ray in Mr Ahmed’s presence, she would
have made reference to it in the record of the
discussion or her plan.
Whilst Dr Daish’s evidence was that part of the
reason she allowed 2 weeks before the review
appointment to permit the x-ray to be obtained
and reviewed, this was not included in her note.
This was not a normal consultation where all
matters were dealt with in the presence of Mr
Ahmed. Dr Daish had further thoughts after Mr
Ahmed had gone and prescribed prednisolone
– that made it more likely the x-ray was also an
afterthought.
Mr Konstantinos Papagiannopoulos
Cardiothoracic Surgeon - MBChB, MMEd(Thorax), MD(CTh)
Mr Papagiannopoulos undertakes medico-legal work. He has attended lectures
and received the Cardiff University Bond Solon expert witness certificate.
His areas of interest are:
• Minimally invasive treatment of lung cancer including chest wall (rib case).
• Management of airway disease benign and malignant (wind pipe) with
local resection, PDT and stents.
• Treatment of emphysema; surgical and endoscopic using special valves.
Would Mr Ahmed have attended for a chest x-ray if
he had been informed
• Treatment of chest wall deformities; pectus repairs without the use of
metal bars both minimally invasive and open (Nuss or Ravitch).
The Judge had no di昀케culty in 昀椀nding Mr Ahmed
would have attended for a chest x-ray if he had been
requested.
• VATS (key hole) surgery for malignant and benign diseases of chest with
an established program in Leeds since 2005.
• Complex operations for lung cancer involving spine offering team
approach with a senior Neurosurgeon.
• Minimally invasive treatment for Thoracic Outlet syndrome (key hole
surgery).
Contributory negligence
• Minimally invasive treatment (key hole) of atrial fibrillation.
The Judge noted the observations of Yip J in Dalton
v Southend University Hospital NHS Foundation
Trust [2019] EWHC 832 at [33] that contributory
negligence in clinical negligence cases is rare.
• Management of mesothelioma.
• Offers second opinion for complex and failed procedures with National
and International referrals
Details of expert witness practice:
• Claimant to defendant to joint expert ratio: 75/20/5
• Medical negligence cases
• Does not undertake medico-legal work under the age of 18
• Workload: approximately 120-150 cases per annum
• Experience in Coroner’s/Crown Court
The Judge distinguished the cases of Pigeon v
Doncaster Royal In昀椀rmary and Montagu Hospital
NHS Trust [2002] Lloyd’s Rep Med 130 and Sims
v MacLennan [2015] EWHC 2739 (QB). Pigeon
concerned a Claimant who accepted that she
understood the risk she was taking in not having
smear tests. Sims concerned a Claimant who failed
to follow advice to have his blood pressure checked.
EXPERT WITNESS JOURNAL
Contact: Mrs Martha Kotti (Private secretary)
Tel: 0113 2698859 - Email: mkotti@yahoo.com
Address:
Thorax Medical & Legal services Ltd, 1 Stoneleigh Close, Leeds, LS17 8FH
12
APRIL 2026
