Dr Squier had been a consultant paediatric neuropathologist at the Oxford University John Radcliffe Hospital since 1984. She developed a medico-legal practice providing reports as an expert neuropathologist and gave evidence in cases in the civil, family and criminal courts. A significant part of her practice concerned cases of babies who had died as a result of suspected non-accidental head injury (NAHI – also known as shaken baby syndrome) and was of part of the minority who believed that a particular triad of conditions was not necessarily indicative of NAHI.
Dr Squier was referred to the General Medical Council (GMC) on 1 April 2010 and the substantive hearing took place between 5 October 2015 and 21 March 2016.
The charges did not concern Dr Squier’s stance on NAHI, but rather that in giving her opinion she had strayed outside the boundaries of her expertise, and misrepresented the academic opinions of others in coming to her conclusions.
The Medical Practitioners Tribunal (MPT) determined that Dr Squier’s fitness to practice was impaired and concluded that she had provided deliberately misleading and dishonest evidence in five cases. As a result her name was erased from the medical register. Dr Squier appealed the decision under section 40(1)(a) of the Medical Act 1983.
On appeal, Mr Justice Mitting was tasked with reviewing the factual findings of the MPT. As is customary in respect of appeals, Mr Justice Mitting was to allow the appeal if the decision of the MPT was wrong or unjust because of a serious procedural or other irregularity. He reviewed each allegation in turn and a number of the allegations were overturned, in particular those relating to dishonesty. In overturning the allegations, Mr Justice Mitting noted that the “determination of the MPT is in many significant respects flawed” and that they had made a number of “unsustainable findings”. In making that decision, Mr Justice Mitting determined to impose a Conditions of Practice Order designed to prevent Dr Squier giving expert evidence in civil, family or criminal courts in the UK, but allowing her to otherwise continue in her practice.
Dr Squier did not escape criticism with Mr Justice Mitting concluding that, on occasion, she had indeed given evidence outwith her expertise and had miscited the research papers on which she relied.
Impact of the decision
Mr Justice Mitting made it clear in his concluding remarks that it would have been desirable for the MPT in this complex case to have been chaired by a lawyer with judicial experience and who had an “understanding of the context in which expert evidence is given in court”. Mr Justice Mitting’s determination also re-articulated the duties of an expert in providing expert evidence. At paragraph 34 of his judgement he summarises key guidance on the duties of experts when citing the work of others, namely the duties to:
- explain that a hypothesis is controversial
- place before the court all material which contradicts the hypothesis
- make all material available to other experts in the case
- make sure that the report and evidence is accurate and not misleading
- take reasonable steps to verify information provided
- not deliberately leave out relevant information
- set out all material facts, literature and material on which the expert has relied in forming their opinion within the report.
Mr Justice Mitting also made it clear that an expert must not cite the work of another as supporting their view when it does not and further that the expert has an overriding duty not to mislead.
This case highlights the needs for fitness to practise panels to be properly equipped to consider complex cases and to be constituted so it can do so.
Most crucially, the case serves as a reminder for those practitioners carrying out court work (and in particular those giving oral evidence at a final hearing) to remain within the confines of their expertise. Practitioners must not be afraid to refuse to be pushed by advocates into providing an answer which would require them to speculate on areas which are outwith their specialism and knowledge.