Anonymised Personal Injury Report

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The Web Presence of Donald A. Campbell, Consultant Neurosurgeon serving the Courts in UK, and Ireland, Europe, America, and the Far East since 1984

Mr D. A. Campbell BSc. MB. ChB. FRCS. FRCS(Ed).

Unit 3, Park Hall Farm, Adderley Road, Cheadle, Staffordshire, ST10 2NJ.

Tel/Fax: 01538 757435

Email:  Bellerophon144@me.com

MEDICAL REPORT

The report is addressed to the Court by whom the matter is to be heard

RE:  Mr   Joe Bloggs

DATE OF BIRTH:                       4th May 1989

OCCUPATION:                           Unemployed Bricklayer

ADDRESS:                                  12, Acacia Avenue,

                                                        Anytown, AA1 1AA

DATE OF EXAMINATION:          10th June 2111

AT:                                                17 St John Street

                                                      Manchester

                                                      M3 4DW

SUBJECT OF REPORT:             Road Traffic Accident on 25th Never 2999

INSTRUCTING PARTY:              Suem & Grabitt, Solicitors

REFERENCE NO:                      ABC.DEF.12345

OUR REFERENCE NO:             DAC.DNS.2083XXX

DOCUMENTS SEEN:                 Photocopied General Practice Records

                                                    Photocopied Hospital Records

                                                    Radiology on CD





Appendix I

Mr D A Campbell FRCS (London)  FRCS (Edinburgh)


Appendix I

 

 

Mr D A Campbell FRCS (London)  FRCS (Edinburgh)

 

 

Graduate of Edinburgh University Medical School.

 

Full-time NHS Consultant Neurosurgeon for 12 years until 1996 and thereafter remains in active medicolegal practice in Harley Street.

 

Special interest in Cervical and Spinal Surgery, missile injuries to the head and spine, and stereotactic surgery.

 

Involved in postgraduate lecturing to doctors and lawyers involved in medico-legal issues

 

Extensive experience in medico-legal work, having given written or oral evidence in excess of 5000 cases.

 

Trained and experienced with regard to CPR procedures, and has wide experience in compliance with orders of the Court regarding medical evidence in personal injury cases.

 

 Experienced in producing medico-legal reports relating to personal injury claims, being instructed by claimant and defendant representatives, as well as receiving joint instructions.

 

Member of Society of Expert Witnesses

 

Listed in:

 

Expert Witness Directory

UK Register of expert Witnesses

Expert Witness Website

 

G.M.C. Registration                No. 1333231(S)

 

Professional Indemnity Insurance Hiscox Insurance

 

Waiting list approximately eight weeks.  Available for medicolegal consultation at private consulting rooms and hospital in London, Birmingham, Brighton, Derby, Gloucester, Manchester, Newcastle-under-Lyme, Norwich, and Sheffield.




In addition to examining Mr Bloggs I have had access to photocopies of a considerable volume of hospital records and General Practice records.  I have not as yet formally reviewed his radiology and will do so as an addendum to this report.


Prior to the events to which this report refers, Mr Bloggs tells me he had been healthy with no significant injuries to head, neck or back.  Prior to injury he had had no significant medical conditions and had not undergone any operations.


On the date of examination Mr Bloggs tells me he is taking Penicillin [he has had a splenectomy as a result of this accident and therefore needs to take Penicillin for the rest of his life], Codydramol as required on most days, varying amounts between two tablets a day to six tablets a day depending on the severity of his symptoms and how much physical activity is undertaken.  He is not known to be allergic to any medications.


  1. HISTORY OF PRESENT CONDITION

 

1.1 On 25th of Never 2999 Mr Bloggs was the front seat passenger in a vehicle fitted with head rests, seatbelts and airbags.  He has no recollection of the events himself, but tells me that he understood that he had had the seatbelt over his shoulder and was in the process of fastening it at the time the accident occurred.  He appears to have a pre-traumatic amnesia of about two hours and a posttraumatic amnesia of several days, although clearly this is a little difficult to assess given the severity of his other injuries and the amount of painkillers he was receiving for them, but nevertheless given the severity of his injuries I am quite satisfied that his posttraumatic amnesia period will be well in excess of one hour. 


1.2 I understand that there were five people in the car and that they were driving through   ......on a bumpy road.  The driver was apparently trying to 


make the car take off on some bumps and lost control.  The vehicle rolled off the road and ended up in undergrowth.


1.3 Mr Bloggs was taken from the scene of the accident to the XXX Hospital with multiple injuries including a ruptured diaphragm, intra abdominal bleeding, ruptured spleen, a fractured collar bone, what is described as a brachial plexus injury [damage to the nerve at the root of the neck], fracture of the lumbar spine and fracture of his right hand.  At the time of the accident he was employed as a driver, but he stopped that job after the accident and is now working as a computer technician, having started that job in December 2009.  Since starting his new job he tells me he has had no time off work in the form of sick leave.  He did try his previous job, but had to give it up because lifting aggravated his lower back as did prolonged driving.


1.4 In addition to his various injuries he has suffered severe pressure sores on the back of his head and his sacrum.


  1. COMPLAINTS ON THE DATE OF EXAMINATION


At 10th June 2010 Mr Bloggs complains of the following:


2.1 He has chronic back pain, even when taking it fairly easy and he finds it difficult to stand for prolonged periods of time, but likewise finds it difficult to sit for prolonged periods of time.


2.2 He has pain in his left shoulder and collar bone and finds it difficult to sleep on his left side, something which he did before.  He also describes how even using his left arm for minor tasks, such as holding a bowl of cereal, gives a strong ache in his left side.


2.3 His short-term memory is very poor and he gives an example that he had a driving license and when his friends ask him to pick them up from 



somewhere he has to ask for direction, whereas it would have been something he would have done without even thinking about it previously.


2.4 He has a short attention span and his parents and girlfriends have said he has become snappy and irritable.


2.5 His left arm feels weak, but he is going to the gym three or four times a week trying to build up the strength in the arm.


2.6 He has unsightly pressure sores on the back of his head, which he finds very embarrassing.  He describes them as looking like a target [he also has pressure sores over his sacrum, but is less troubled by them because he can cover them up with clothing].


2.7 He feels that he is no longer walking normally and he seems to be favouring one leg with a slight limp and finds walking on uneven ground difficult.


2.8 He has noticed a ringing in both ears, particularly when things are quiet at night, although he is not aware of any formal deafness; this was not present prior to the accident.


  1. EXAMINATION ON 10TH JUNE 2010 


3.1 Examination reveals Mr Bloggs to be alert and orientated in time, place and person and fully aware of the purpose of this report.  There are no inappropriate signs to examination and he gives a straightforward history.  He is right-handed.


3.2 Examination of the cardiovascular, respiratory and abdominal systems reveals him to be of slim build.  His blood pressure is 110/75 with a pulse of 74 per minute, regular in time and force and there are no relevant features in these systems.


3.3 Abdominal system.  He has an extensive midline laparotomy scar with a right iliac fossa drain scar.  Given the fact that he has had to have a splenectomy, a formal opinion from a general surgeon should be obtained, but I would confirm that where patients have undergone splenectomy they are at risk of infections, in particular meningitis and it is for this reason that patients are put on long-term Penicillin.  Similarly I would stress that he has had an orthopaedic injury to his left shoulder and this needs to be addressed by an orthopaedic surgeon.


3.4 Central nervous system.  Cranial nerves:  He denies any change in his sense of smell.  Pupils are equal and react to light and accommodation; fundi appear normal.  Eye movements are full with no nystagmus or diplopia.  Facial sensation is slightly reduced on the left compared to the right with some patchy changes, but they do not correspond to anything suggestive of damage to the trigeminal nerve.  He has two unsightly pressure sore areas on the back of his head; one 3cm in diameter in the midline and one 2cm x 1cm slightly to the left of the midline.  There is no hair growing here and they are quite obvious.


3.5 Peripheral nervous system.  Power is 5/5 [i.e. normal] in his right upper limb.  There is no arm drift on the left, but he does have a weakness of grip and dorsiflexion and palmar flexion of the left wrist at about 4/5 and a similar 4/5 weakness of biceps and triceps function [5/5 full power, 2/5 ability to move the effect of gravity removed and 0/5 equals complete paralysis].  He has a left clavicular fracture, which is somewhat obvious, but appears well united.  Tone is normal in the upper and lower limbs with no ankle clonus.  Sensation reveals a global hyperalgesia affecting the left arm and increased sensation or sensitivity over the outer aspect of the left lower limb, but going all the way up to his hip and affecting the sole.  This is not typical of an S1 dermatome and I will return to this later.  In addition there is an approximately 7cm long scar in the right axilla which apparently occurred when a tree branch punctured his shoulder in this accident.  He has right sided sensory inattention.  Co-ordination is intact to finger nose testing bilaterally.  Rombergism is negative.  


Reflexes in the right upper limb are slightly brisk, but left sided biceps and triceps reflexes are completely absent.  Palmomental reflexes are negative.  In the lower limbs he has preserved reflexes in both quadriceps and ankle jerks without reinforcement.  His left plantar is equivocal, whereas the right plantar is definitely flexor. 


3.6 Spinal movement reveals no formal deficit in cervical spine movement.  He makes no complaint of neck pain.  In the lumbar spine he appears to have a slight scoliosis convex to the right with some palpable tenderness at around the thoraco lumbar region and around L4.  There are palpable steps in his lumbar spine at those levels.  Lateral flexion is unrestricted in both directions, but forward flexion is consistent with his straight leg raising of 60 degrees bilaterally, but stretch tests are negative.  The thoraco lumbar region is relatively straight.  He has a sacral pressure sore.


  1. REVIEW OF MEDICAL RECORDS


4.1 There are General Practice records in Lloyd George card format between 12th sometime1990 and 27th Never 2012.  Apart from the entry on that date there is nothing of relevance in these hand written notes.  The entry of 27th Never 2012 notes the accident and that there are persisting significant problems in the left shoulder [some of these pages appear to have been photocopied twice].


4.2 There are computer-generated records between August 1989 and 31st March 2010.  Again, prior to the date of the accident there is really nothing of relevance.  The accident is first referred to formally in the entry of 8th August 2999 noting a road traffic accident on 26th June 2999 and noting that there was a fracture of the first and second cervical vertebrae, as well as an L5 fracture and left clavicular fracture [there is actually an earlier entry in which a dressing for the pressure sores was supplied on 7th August 2999].  He was referred for private physiotherapy on 8th August 2999 and on 13th August  2999 it was noted that in addition to the injuries below there was a 


pneumothorax and a fracture of the right metacarpal and an acromioclavicular joint dislocation.  It is also noted that he had had a splenectomy.  On 8th October 2999 it was noted that he had a pressure sore persisting on the back of his head, which had never healed and he was put on antibiotics for this.  By December 2999 it was noted he was getting chronic back pain and also mid thoracic pain and was given Ibuprofen and Paracetamol.  He seems to have had more physiotherapy on 4th January 2999, which persisted to September 2999.  After that it simply notes that he had been seen in the Orthopaedic Clinic and that he was continuing to have Penicillin V.


4.3 Attached hospital correspondence prior to the accident contains nothing of relevance.  There is a hand written discharge summary dated 4th August 2008, which contains no useful information other than the fact he was discharged on Paracetamol, Temazepam, Phenoxymethyl, Penicillin, Forticreme, Lactulose, Senna and Docusate Sodium.  There is a computer -generated  nursing note, which is headed ‘Physiotherapy Transfer Report’, but it was noted that he was being discharged home and suggests that there were multiple rib fractures, a tear of the liver, bilateral pneumothorax, unstable L5 fracture treated until 30th July 2008 with bed rest [this would seem to suggest that he was mobilised at four weeks, which seems remarkably early], a C1/2 subluxation, which was said to be treated conservatively and the collar had been removed, a fractured clavicle and what is described as a left L6 neuropraxia resolving and a splenectomy.  I note with some concern that another Transfer of Care letter cannot even spell the word ‘clavicle’ correctly; this is spelt as clavical.  A letter with a stamp on it dated 3rd June 2999 [I presume this should really read 30th June 2999 as it relates to an Accident and Emergency Department admission at 24 minutes past midnight on 26th June 2999] states that the patient was not wearing a seatbelt.  It then contains the phrase ‘? Extracted from vehicle at speed 50 to 60mph’; I am not quite sure what this is meant to mean; if it means ejected from the vehicle, then that would imply it was unlikely that Mr Bloggs was wearing a seat belt, otherwise it would suggest that someone or something had extracted from the vehicle whilst the vehicle was travelling at 50mph, which would seem unlikely.  There 


is a note from the physiotherapists at FFFF Hospital confirming that he had had treatment as well as a note from the NHS physiotherapists stating that they had discharged him from appointments because he had not attended!  There are also some letters from the BBB Therapy Centre in WWWW stating that he had had physiotherapy for his symptoms.  There is a letter from Dr JJJJJ from the clinic of 3rd March 2999 noting that he had, “Almost completely recovered” from “most of his injuries” and going on to say, “Hopefully he will not be left with any deficit at all”; I would simply say that we must make allowances for the inexperience of the doctor writing this letter.  There are discharge summaries from the XXX Hospital dated 5th August 2999 that make no mention whatsoever of any injury to the neck dated.  There is a letter on 15th March 2010 from a clinic on 2nd March 2999 from Mr BBBBBB, Consultant Orthopaedic Surgeon, which makes no mention of any neck fracture and states, “He gets minimal symptoms from his L5 fracture”.  Another Transfer of  Care letter dated 4th August 2008 states that he has partial/superficial loss of pressure sores, site unspecified.  Finally, there is a letter from the clinic of 2nd September 2999 typed on 10th September 2999 from Mr BBBBBB.  The second paragraph contains an extremely concerning comment, “Unfortunately whilst in hospital he developed pressure sores on the back of his occiput and remains with one unhealed area and two bald areas.  Michael himself is not apparently concerned about this, but they are quite obvious cosmetically, and it is very regrettable that this always seems to happen here”.  I would contrast this comment with the literally hundreds of pages of “nursing notes” produced on the computer in which it is recorded regularly that his pressure areas have been treated routinely by the nursing staff.  I have to say with regret that it is quite obvious that the nursing staff spent more time filling in the comment on the computer screen than actually nursing this man; there is no excuse for anyone of his age developing pressure sores on the back of their heads in modern practice.  The only explanation for this is that there was insufficient nursing time spent with the patient doing nursing, which then allowed the patient to lie still with the circulation to vulnerable areas of the skin to be interrupted causing the pressure sores.  I find it even more concerning that Mr BBBBBB does not 


seem to be aware that his patient had sacral pressure sores, something that used to be regarded as a matter of risk in elderly geriatric patients where there were insufficient nurses on the ward to look after their skin.  It would seem that the pressure area care in the CCCCCCC Hospital for a seriously ill young man of nineteen years of age is so poor that it is regarded as a matter of routine that he should develop pressure sores and it seems to be accepted that these are inevitable; they simply are not.


4.4 The hand written medical notes begin with what appear to be the Accident and Emergency records of Mr Bloggs’s arrival at 00.24 hours on 26th May 2999 [I fully appreciate that the date of the accident was in fact 25th June 2999, but that is what is written on his records.  The time of the incidence is simply a question mark and he was noted to have a very high pulse rate, though his blood pressure was still maintained at that point and the computer-generated sheet states that the date of the accident is 26th June 2999.  Again I must express concern about the entries on these sheets; it is stated that he was, “Accompanied by a friend, but arrived from: own”, then “The reason for his visit! Is a road accident – various injurys [sic]”.  There is a hand written sheet, which notes that the history was obtained from a bystander and that he was ejected from a car, which then rolled over several times.  There is a history sheet which is difficult to read, but has been signed by Dr SSSSS, which I think says, that the left shoulder should be treated with a collar and cuff and then further management of the lumbar spine fracture is needed; if this is the case and he generally does have a subluxation of C1/C2, it is totally inappropriate to put anything around the neck; the neck needs to be stabilised in proper rigid stabilisation devices.  There is a better, more legible set of notes timed at )1.30 from the Surgical Specialist Registrar noted to have been written retrospectively, which states that he had been found near to an overturned car, brought in by a passerby and that there were no witnesses.  He was noted to be tender over his neck, tender over the left shoulder, to have a cut on the right axilla, swelling of the left hand [although the diagram shows the right hand], guarding in the abdomen, cuts over the lower limbs and said to be non-tender over the thoracic and lumbar spines.  CT scans 


were ordered throughout the spine and were noted at 03.30 hours [although the notes were written in retrospect at 08.30 hours] to have no fracture on the cervical spine, but an L5 body fracture had been found.  A laparotomy was undertaken, chest drains were inserted, a ruptured diaphragm was repaired and lacerations were sutured and it was noted that postoperatively he needed a proper assessment of his cervical and lumbar spines as well as his hand.  An epidural catheter was inserted for pain relief for his rib cage; entirely appropriately.  He seems to have been assessed at 10 o-clock in the morning of 26th June 2008 by Mr BBBBBB, Orthopaedic Consultant and here it is recorded that there was a rotatory subluxation of C1 on C2 to be treated with a hard collar and that the injury was stable, fracture of the ribs, fracture of the clavicle, fracture of the body of L5 with some millimetres of displacement and this was unstable to be treated with six weeks bed rest; that I would agree is entirely appropriate.  The fact that Mr Bloggs was discharged at six and a half weeks after his admission fits with the history that Mr Bloggs gave me, namely that he felt he could not cope psychologically with being in hospital for such a long time and that in fact it was intended that he should be transferred for rehabilitation to Southport Hospital, which was a long way from where he lives and therefore he went straight home.  It would appear that a cut at the back of his head was stitched about mid day on the date of his admission.  By 20th June 2999 it was noted that the fracture was at L4 and by 28th June 2999 it was noted that there was no need for any dressing to the cut on the back of his head and that his clips could be removed at five days after suture.  By 30th June 2999 it was said that there was an L4 and an L5 fracture in the lumbar spine.  By 1st July Mr BBBBB advised that because of the unstable lumbar fracture it was not going to be possible for Mr Bloggs to sit up before six weeks.  Nevertheless his neck fracture was being treated with immobilisation.  By 3rd July 2999 when sedation had worn off and Mr Bloggs was able to co-operate, it was noted that he was having trouble moving his left arm properly and that there was no tone in the left arm.  It was noted on 3rd July 2008 that an MRI scan of the cervical spine and brachial plexus were required at some point.  There is then an undated entry signed by, I think, Dr JJJJJJ stating there was a possible brachial plexus injury to the left arm and an MRI scan 


would be needed.  Yet on 8th July 2999 there is an entry stating that there was no neurological deficit of the left upper limb.  On 11th July 2999 the Senior House Officer notes that there were pages missing from the notes for two whole days and this SHO [Dr BBBB] quite correctly said that pressure area care was important.  On 23rd July 2999 the dietician noted that Mr Bloggs was being fed by his family and only wanted to order ice cream from the menu in the hospital; the slightly disapproving tenor of this note would suggest to me that in fact Mr Bloggs quite reasonably did not like the hospital food.  However it does not appear that this possibility occurred to the dietician who simply noted that the family were persisting to feed him.  On 3rd August 2999 for the first time a mention is made of a pressure sore at the back of the head, which was said to be healing.  Although Mr Braithwaite mentioned the need for an MRI scan to be undertaken of the neck and brachial plexus, this does not appear to have been undertaken at this point and Mr Braithwaite made an entry that he was less involved orthopaedically and was simply handing over Mr Bloggs’s care to the general surgeons.  A CT scan was undertaken on 26th June 2999 and I can see no mention of any further scans in fact being undertaken.


  1. CONCLUSIONS


5.1 Mr Bloggs had no previous medical history which would have rendered him more prone to injury than a normal person.  The quality of note keeping in this case is frankly atrocious, but it would appear that there is a consistent history throughout the notes suggesting that Mr Bloggs was in fact ejected from the passenger compartment of the vehicle and had been found outside the vehicle by a passerby.  This would suggest that Mr Bloggs was either not wearing seatbelts or they were incorrectly fastened.


Mr Bloggs has had multiple injuries involving his chest, diaphragm and abdomen and clearly the specialist opinion of a general surgeon would be required, but I would say that from my reading of the notes and my own training as a general surgeon prior to taking up neurosurgery, no criticism can 


be attached to the general surgical management, which was entirely appropriate and appears perfectly reasonable.  


Similarly I do not believe that any criticism attaches to the orthopaedic management of his spine, which was entirely reasonable.  I am concerned about the lack of scanning and investigations, but I do not believe that Mr Bloggs has come to any harm as a result of having his investigations, either not undertaken at all or undertaken at a very much later date than was clearly initially intended.


I am however concerned about the quality of nursing; it is simply totally unacceptable in a developed Western Country for a young fit man to develop pressure sores on the back of his head and in his sacrum; this is simply atrocious nursing and completely avoidable.  This is a matter that has to be addressed by a nursing specialist, but I would have to say that any consultant who finds that patients are developing pressure sores as a matter of routine on wards under his control, should be discussing the matter at the highest possible level with nursing management and ensuring that this is not allowed to be something, “which always happens here”.


The opinion of a plastic surgeon will have to be obtained in relation to these pressure sores.  Now that Mr Bloggs is mobile and indeed back at work, I would have thought that the sacrum pressure sores is not something which would be a practical problem.  Pressure sores are a reflection of severely impaired mobility added to by bad or inadequate diet.  The fact that his family had to bring in food to him, I think speaks volumes.  It may well be possible to correct the unsightly pressure sores on the back of his head by plastic surgery with the use of tissue expanders and rotational flaps, but that is a matter which will have to be addressed by a plastic surgeon.


Turning now to the head injury; given the severity of the injury I think we have to assume that Mr Bloggs has suffered a significant closed head injury.  He has developed tinnitus, has an altered personality, and has poor short-term 


memory and impaired concentration.  Because of this I think we need to get a formal clinical psychologist’s report to document the degree of memory and concentration impairment.  He is at statistically increased risk of epilepsy as he has lost his continuous memory for more than an hour [reference Annergers and Jennett].  Again I express my concern that no one seems to have informed Mr Bloggs that he should have informed the DVLA of this injury.  Mr Bloggs, through no fault of his own, was not aware that he should have done so.  I have advised him to do so now and would say that on the basis of past experience it is unlikely that his driving license will be withdrawn now, but had he informed the DVLA of his severe head injury, his license would have been withdrawn immediately and he would not have been allowed to reapply for at least six months.  The length of time for which the driving license would be withdrawn is a matter for the DVLA Medical Branch, but in general terms after injury such as this, from a purely head injury point of view, they would avoid driving for six months and then discuss the position with the relevant General Practitioner before giving a decision.  There is no treatment to alter the degree of memory loss or concentration, but it is important that it is formally recorded.  Similarly I do not think there is any point in doing an EEG to look for epilepsy, as Mr Bloggs gives no history suggestive of epileptic attacks, but he is at statistically increased risk of epilepsy for approximately double that of the uninjured population.  If of course he were to develop any blackouts or epilepsy, then he would have to be investigated and possibly treated.


Turning now to the question of spinal injury.  We have reference to a stable neck injury with a subluxation of C1 on C2, which was treated by stabilisation in a Miami collar.  Again we need to see the results of the X-rays to know what is going on here.  By definition this injury cannot have been stable; if it were stable there would have been no need to put Mr Bloggs in a collar.  The comment has been made that this is a brachial plexus injury affecting only the root of C6; I do not wish to appear pedantic, but an injury affecting the root of C6 is not a brachial plexus injury; if it is indeed a single root damage.  From examining Mr Bloggs today however, it is quite clear that the area of sensory 


disturbance is much more extensive than simply C6 and his persisting weakness would suggest myotomes of at least C5 to C7; that would indeed suggest a brachial plexus injury, but the slightly unusual distribution of his hypersensitivity would also suggest that this may in fact represent contusion in the spinal cord in the neck.  This can only be cleared up by doing an MRI scan of the cervical spine and I can find no mention anywhere in his notes that anyone has ever done this. 


As far as his lumbar spine is concerned he has some persisting low back pain, but his fracture will be well healed at this stage and the description in the notes would suggest there was relatively little bony displacement.  Again however, I need to see the scan to see whether this is in fact the case.  His disordered sensation in his left lower limb also would suggest that this may not be a reflection of a problem in the lumbar spine, but may in fact be a reflection of cervical cord damage.  There is mention in the notes of a concern about tenderness in the mid thoracic region, but no one seems to have investigated this either.


I think at this stage we have to do an MRI scan of the cervical, thoracic and lumbar spines simply to see what the state of play is with both the spinal bone alignment and the spinal cord and exiting nerve root.  Until we do so, we do not know what the explanation for his symptoms is and we are not going to be able to give a prognosis or advice as to treatment.


In general terms, there is a potential for recovery for up to two calendar years from the date of an injury.  We are now one year and eleven months after injury, so it is unlikely that any of his present symptoms are going to improve.  It is impossible to say however, whether or not there is any potentially surgically treatable condition in his cervical, thoracic or lumbar spines until we see the results of the investigations.


I now turn to the question of employability.  To some extent this will depend on the results of the clinical psychologist assessment of his memory and 


concentration and intellectual functioning, but I was impressed by the fact that Mr Bloggs has got back to work as soon as he practically could after this very severe injury and has in fact changed his work quite reasonably, to one in which he has to do less driving and less lifting.  I am also impressed by the fact that he has not taken any time off sick other then for medical appointments in taking up his new job, which he tells me he is able to cope with without any major problems.  If however he were to lose this employment, he must be clearly regarded as being at a disadvantage in the open labour market, but the degree of that disadvantage will depend to some extent on the result of the clinical psychologist’s investigation.  This is a complicated case and I would be happy to discuss it further with you.




I understand my duty to the Court and have complied with this and will continue to comply with it and I am aware of the requirements of Part 35 and Practice Direction 35, this protocol and the Practice Direction on pre-action conduct.



I confirm that I have made clear which facts and matters referred to in this report are within my own knowledge and which are not.  Those that are within my own knowledge I confirm to be true.  The opinions I have expressed represent my true and complete professional opinions on the matters to which they refer.









MR D A CAMPBELL, BSc MB ChB FRCS FRCS[Ed]

Consultant Neurosurgeon

© Donald A Campbell 2017