How is the Hunter v Hanley standard applied in a psychiatric context?

The question is whether no psychiatrist of ordinary skill, exercising reasonable care, would have acted as the treating clinician did. It is not enough that another responsible psychiatrist would have acted differently; the report identifies whether the practice in question falls outside the range that a responsible body of psychiatric opinion would support.

Can you report on both breach and causation in the same instruction?

Yes, and in most instructions that is more efficient, provided the two questions are addressed separately and one is not allowed to influence the other. Where an agent wants them addressed sequentially, that can be arranged instead.

Do you accept instructions in secondary victim claims without seeing the primary victim?

Yes. The assessment and opinion concern the secondary claimant's own psychiatric state and its causal relationship to what they witnessed; the primary victim's condition is relevant background rather than the subject of examination.

How do you deal with hindsight bias in suicide and self-harm cases?

The assessment of the risk assessment and response is made against the information available to the treating clinicians at the time, not against what is now known about the outcome. The report states explicitly what was and was not known at each material point.

Will you act for both NHS boards and pursuer agents?

Yes, on separate instructions with a conflict check carried out in every case. The opinion given does not vary according to which party has instructed the report.

Psychiatric clinical negligence expert witness in Scotland

Clinical negligence instructions in psychiatry ask two distinct questions that must not be run together: whether the care provided fell below the standard of a responsible body of psychiatric opinion, applying the Hunter v Hanley test as it operates in Scotland, and whether any breach caused or materially contributed to the harm complained of. A report that blurs breach and causation is of limited use to an agent preparing a case, so I address them as separate sections with separate reasoning.

I act for pursuer and defender agents, NHS boards, medical defence organisations and, on a precognition basis, the Crown, in claims arising from psychiatric inpatient and community care, risk assessment failures, missed diagnoses, medication management, and secondary victim claims arising from psychiatric harm suffered on witnessing the consequences of another's negligence.

Scope of opinion

What I can advise on

Whether the standard of psychiatric assessment, risk assessment or care fell below that of a responsible body of psychiatric opinion, applying the Hunter v Hanley standard.
Whether any failure identified was one no ordinarily competent psychiatrist exercising reasonable care would have made, as distinct from a difference of clinical judgement between reasonable schools of thought.
Causation: whether the alleged breach caused or materially contributed to the outcome, including in suicide and serious self-harm cases the difficult question of what a competent risk assessment and response would probably have changed.
The adequacy of risk assessment documentation and its use in clinical decision-making, judged against the standards and guidance in force at the time, not with the benefit of hindsight.
In secondary victim claims, the psychiatric consequences for a family member or bystander of witnessing or its immediate aftermath, and whether those consequences amount to a recognised psychiatric disorder.
Whether earlier or different treatment, medication or level of observation would probably have altered the outcome, expressed with appropriate caution given the counterfactual nature of the question.
Quantum-relevant matters where instructed: diagnosis, prognosis and treatment need flowing from an established breach, prepared separately from the liability opinion.
Whether the case raises questions properly outside general adult psychiatry — forensic risk assessment methodology, for example — in which case I say so and identify the appropriate additional expert.

Breach is assessed against the knowledge, guidance and resources reasonably available to a psychiatrist at the material time. I do not apply current guidance retrospectively to care given years earlier, and I say expressly where practice has since changed.

Typical instructions

Suicide following discharge from inpatient care: A family instructs a report following a death by suicide shortly after discharge, asking whether the discharge risk assessment met a responsible standard and whether a different discharge plan would probably have prevented the death.
Missed diagnosis in primary or secondary care: A pursuer alleges that a depressive or psychotic illness was missed or misattributed to physical causes over an extended period, delaying treatment. The instruction addresses whether the standard of assessment fell below a responsible body of opinion and what earlier diagnosis would probably have changed.
Secondary victim claim following a traumatic event: A parent or partner who witnessed the immediate aftermath of a negligently caused injury or death to a relative claims a psychiatric injury in their own right. The report addresses diagnosis and causation for the secondary claimant, distinct from any primary claim.
Medication management and adverse outcome: A claim concerning the prescribing, monitoring or withdrawal of psychiatric medication, where the instruction asks whether the prescribing practice met a responsible standard and whether the adverse outcome is causally connected to it.

The report

What the report includes

The report sets out the instructions received, the full clinical records considered in chronological order, a summary of the relevant guidance and standards in force at the material time, and separately reasoned sections on breach of duty and on causation, each answering the specific questions in the letter of instruction.

Where the treating clinicians' contemporaneous records and the pursuer's or family's account differ, that difference is identified and the opinion states which is relied on and why. Where the case turns on a genuine difference between reasonable schools of psychiatric opinion rather than a departure from any responsible standard, the report says so clearly rather than manufacturing a criticism.

The report closes with a statement of truth and a declaration that the duty to the court overrides any duty to the instructing party, in accordance with the Royal College of Psychiatrists' guidance on expert evidence and the relevant court rules.

Timescales

Timescales and format

Clinical negligence instructions are records-heavy, and no assessment of the examinee is required for a pure breach and causation opinion in a death case; where the pursuer is living, an assessment is arranged in the usual way. Where an assessment is required, appointments usually take between 90 minutes and two hours.

Report turnaround runs from receipt of the complete clinical records, including all relevant entries and not a selected extract: [CLIENT TO CONFIRM: X weeks]. Volume of records in these cases is often substantial, and an indicative timescale is confirmed once the full record set is received.

Supplementary reports on further disclosure, joint reports and joint statements with the opposing expert, consultation with counsel, and attendance at proof are all available. Fees and cancellation terms are set out under fees and timescales.

Questions

Frequently asked questions

How is the Hunter v Hanley standard applied in a psychiatric context?: The question is whether no psychiatrist of ordinary skill, exercising reasonable care, would have acted as the treating clinician did. It is not enough that another responsible psychiatrist would have acted differently; the report identifies whether the practice in question falls outside the range that a responsible body of psychiatric opinion would support.
Can you report on both breach and causation in the same instruction?: Yes, and in most instructions that is more efficient, provided the two questions are addressed separately and one is not allowed to influence the other. Where an agent wants them addressed sequentially, that can be arranged instead.
Do you accept instructions in secondary victim claims without seeing the primary victim?: Yes. The assessment and opinion concern the secondary claimant's own psychiatric state and its causal relationship to what they witnessed; the primary victim's condition is relevant background rather than the subject of examination.
How do you deal with hindsight bias in suicide and self-harm cases?: The assessment of the risk assessment and response is made against the information available to the treating clinicians at the time, not against what is now known about the outcome. The report states explicitly what was and was not known at each material point.
Will you act for both NHS boards and pursuer agents?: Yes, on separate instructions with a conflict check carried out in every case. The opinion given does not vary according to which party has instructed the report.

Instructing

Instructing Dr Qureshi

Instructions are accepted from pursuer and defender agents, insurers, regulatory bodies and occupational health providers. A conflict check is carried out before any instruction is accepted.

Send a letter of instruction Check availability and conflicts

Or call 07739 587092.