Expert Witness Journal Issue 67 June/July 2026 - Flipbook - Page 105
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These questions lie at the core of every consent case
assessed in clinical practice.
Individualised assessment of risk: The
clinician is required to take reasonable steps
to understand the patient’s values, concerns,
and circumstances, and to tailor disclosure
accordingly. Materiality is therefore contextspeci昀椀c rather than purely clinical.
Dr S. Boulis, GP Expert Witness
As a GP expert witness, I prepare
independent reports in clinical
negligence cases, with a focus on
informed consent, standards of care
and decision-making in primary care.
Obligation to discuss reasonable alternatives:
The duty extends beyond disclosure of risks of
a proposed intervention to include reasonable
alternative treatments (including no treatment).
Failure to evidence such discussion remains
a frequent and legally signi昀椀cant feature in
breach analysis.
My overriding duty is to the Court. All reports are
prepared in accordance with CPR Part 35, Practice
Direction 35, and the Guidance for the Instruction
of Experts in Civil Claims (2014).
Causation: Still the Battleground
Although breach of duty in consent cases may
be established through inadequate disclosure,
causation frequently remains the most contested
issue.
I welcome instructions from clinical negligence
solicitors and counsel in England, Scotland and
Northern Ireland.
If you would like to discuss a potential instruction or
expert witness query, please feel free to get in touch:
spboulis@doctors.org.uk
The central question is not simply whether the
patient was inadequately informed, but whether that
failure materially altered the outcome: Would the
patient, if properly informed, have made a di昀昀erent
decision that would have avoided the harm su昀昀ered?
This requires a balanced, forensic analysis of the
patient’s prior medical history and records, their
expressed concerns at the time, and their risk pro昀椀le
from a GP expert witness.
General Practice is unique. In primary care, the
longitudinal nature of the GP–patient relationship
is particularly signi昀椀cant. A GP expert is often
uniquely placed to comment on what the clinician
knew, or ought reasonably to have inferred, about
patient preferences over time.
Dr Rahila Khan
Consultant Obstetrician
& Gynaecologist
The Therapeutic Exception
MBBS, MD, FRCOG
Often raised, rarely justi昀椀ed. The threshold—serious
harm to the patient’s health from disclosure—is high
and narrowly applied.
Rahila Khan joined Pyper Medical Services in 2021, she has
completed 110 expert reports. Currently, she is preparing 3
reports per month on clinical negligence in Obstetrics for
both claimants and defendants.
Conclusion
Montgomery is not just a legal milestone. It aligns
the law with modern expectations of shared
decision-making and reinforces the centrality of
patient autonomy.
For those providing expert opinion, it requires a
disciplined and structured analysis:
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Was the risk material in the circumstances of
this patient?
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Was that risk adequately disclosed?
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If disclosed, would it have altered the patient’s
decision?
l
Consultant Obstetrician and Gynaecologist at University
Hospitals Sussex since 2010.
l
Lead in Maternal Medicine and Diabetic pregnancy
l
Broad experience in all aspects of Obstetrics, including
high-risk pregnancies and intrapartum management.
l
Extensive experience of O&G in 3 continents and different
perspectives on treatment.
l
Fellowship Programme in Maternal Fetal Medicine at University of
Connecticut, USA, which included obstetric ultrasound scanning.
Contact Details:
Medico-legal secretary; Alayne Fawkes
Mobile: 07506 173663
Email: pms@pypermedical.co.uk
Website: www.pypermedical.co.uk
Hareswith Cottage, West Chiltington Road, Storrington, West Sussex, RH20 4BP
EXPERT WITNESS JOURNAL
103
JUNE 2026
