Medico-legal Report
Prepared by
Mr Thomas Chapman BSc, MBChB, MRCS, FRCS (Plast)
For
IQED Ltd, Cardiff
(On behalf of DAS Law)
Miss Erin Kennedy
IQED ref: 152123
(DAS Law ref: SHU/030602/0026789/Kennedy
Interview 7
th
March 2017
Report Completed 12
th
March 2017
Mr Thomas Chapman | Consultant Plastic Surgeon | BSc, MB ChB, MRCS, FCRS (Plast)
Secretary: Jamie O’Connor Email: mrthomaschapman@outlook.com Tel:01172795983
www.mrthomaschapman.com
Table of Contents
1. General Information
2. Details of accident history
3. Current Physical Disability
4. Psychological Effect of Injury
5. Effect on schooling and future work
6. Other effects of injury
7. Prognosis
8. Treatment Options
9. Declaration
1 General Information
1.1 The Witness
I am Thomas William Lawson Chapman. I qualified in medicine in 1998 (GMC number 4505286) and
entered the field of plastic and reconstructive surgery in 2003. I completed specialist training in 2010
and have been a substantive consultant in plastic surgery since 2012. Part of my responsibilities
include the treatment/care of patients with facial injuries. I have provided reports as a medical
witness since 2013 and have completed the ‘legal aspects of surgical practice’ course run by the
Royal College of Surgeons (England).
1.2 The Claimant
Miss Erin Amy Kennedy is 9. (D.O.B 18/11/2007) She lives with her mother at 7 Morgan Way,
Peasedown, St John, Bath. (BA2 8TT). She attends primary school. The claimant attended with her
mother (Karen Louise Kennedy) and ID was provided by photographic driving licence and banking
card.
1.3 Instructions
I have been asked to provide a report by IQED Ltd, on behalf of the instructing solicitors, DAS Law
Ltd, in relation to injuries sustained by the above claimant in relation to an accident that took place
on 06/05/2010. I have been specifically asked for a report to include any relevant pre-accident
history, psychological and physical injuries sustained, treatment received and present condition.
Future capacity for work and prognosis was also requested. I was asked to interview and examine
the claimant as well as comment, as appropriate, on the patients notes available (below)
1.4 Available records
The following records have been made available to me;-
1. Accident and emergency records RUH Bath dated 6/5/2010
2. GP Records (Hillcrest Surgery)
3. Copies of instructing letters
1.5 Interview
The interview took place at Spire Glen Hospital, Bristol on 7
th
March 2017.
2. Details of Accident History
2.1 The following has been summarised from the medical notes and by interview with the claimant.
2.2 On 6
th
May 2010 the client was playing outside and sustained a laceration to the chin from
falling. The history given from the clients’ mother was that the client was playing with her brother
out at the front of the house. She heard a scream and although did not witness the event was told
by Erin and her brother that Erin had tripped over a drain cover that was not flush with the ground
and her chin had been cut on a pedal of her brothers’ pushbike as she fell. The accident and
emergency department notes state at first ‘?MOI (method of injury) knocked over by child on bike’,
and subsequently ‘fell on? handle bars of brothers bike’.
2.3 The client was seen in RUH accident and emergency at 16.30 hrs. Oral analgesia was given, the
wounds assessed and referred to maxillofacial surgery. The client was seen by maxillofacial surgery
at 17.10 hrs. The wounds were washed and dressed, oral antibiotics given and arrangements made
to come in the following day for repair of the laceration under general anaesthetic.
2.4 On 7
th
May 2010 the client attended for repair of the laceration under general anaesthetic. 7
non-absorbable sutures (5-0 Nylon) were used to close the wounds. There is a comment ‘chin badly
bruised’. Instructions were given to remove the sutures at the general practice after 5 days
2.5 On 17
th
May the client attended the general practice for removal of sutures. The comment is
‘well healed with scab in the middle. Has 7 sutures in place, mum says middle section not sutured. 4
sutures removed but patient becoming restless’. Comment ‘apply polyfax tds 3 days then review to
remove remaining 3 sutures’
2.6 On 20
th
May the patient attended the general practice again. The comment is ‘remaining sutures
removed very difficult as patient struggling, crying but eventually removed’.
2.7 The patient attended the GP once more on 30
th
June 2010. The comment is ‘scar causing some
puckering of the chin. Advised we should watch and wait at this stage, scar may relax and skin may
adapt over time, she is certainly very young for another anaesthetic unless absolutely necessary
anyway so NO need to be seen yet. They are going through litigation so may be seeking another
opinion re the scar anyway’
3. Current Physical Disability
3.1 On the central chin, there is a scar which is visible at conversational distance.
3.2 The scar tissue takes the shape of a line running from 7o’clock to 1 o’clock on the substance of
the chin. It is approximately 3.5cm long.
3.3 The scar tissue is 1-2mm across and pale/white in nature.
3.4 There is some indentation (1-2mm) which is visible immediately underlying the scar.
3.5 The scarred area lacks sensation to fine touch. Feeling is normal outside the scar.
3.6 There is no apparent functional disability or impact on activities of daily living.
3.7 There are no symptoms reported from the scar tissue.
4. Psychological Effect of Injury
4.1 Erin says never had counselling and she doesn’t report having any nightmares or flash-backs.
4.2 The clients mother commented that Erin had disturbed sleep for 6 or 7 days following the
incident.
4.3 The client appeared well adjusted and was able to talk freely about the incident and show me
her scar without apparent distress or embarrassment
4.4 The client, when asked, said that the appearance of the scar does not bother her currently.
4.5 The client could not report any teasing in relation to the scar from her peers/ at school.
4.6 The client could not recall episodes of being questioned about the scar from strangers.
5. Effect on School, Activities and Future Effect on Work
5.1 At present, there has been no effect on schooling.
5.2 There might be a limitation on future work depending on the needs of a future employer (for
example, modelling of facial products in aesthetic industry, film industry etc.)
5.3 Future schooling could be affected if the appearance of the scar were to bother the client and
she seek treatment. I am unable to comment on the likelihood of this, as this is outside my area of
expertise.
5.4 There are no activities, either pre or post morbid that the patient is restricted by the injury. The
clients mother commented that initially following the injury, the client has been reluctant to go
outside for a couple of weeks.
6. Other consequences of injury
6.1 I am not aware of any other long-term impact of the injury on the patients’ health.
6.2 I am not aware of other consequences of this injury other than those already stated.
6.3 I am not aware of any other past medical history of relevance to this case.
7. Prognosis
7.1 The scar will have now matured to an extent that it is unlikely to change any further without
surgical or non-surgical intervention. i.e. the scaring will be permanent.
7.2 The scar will grow in proportion to her.
7.3 The lack of sensation in the scarred area will unlikely improve further, even in the event of
surgical treatment. i.e. the numbness will be permanent.
7.4 There is no risk of deterioration in appearance from the current state, only a risk that the
appearance may concern the client more in the future than it presently does.
8.0 Treatment Options
8.1 There are a few possible treatment options to improve the scar however no option comes with
an absolute guarantee of success. Some element of scarring will remain/be permanent.
8.2 There are non-surgical options of camouflage make-up. I cannot comment further as this is not
my area of expertise, with respect to how successful this is likely to be. Such an option would be
somewhat time-consuming and life-long.
8.3 Another non-surgical option would be to try and improve the indentation of the scar with a filler.
This could be combined with option 8.2 above. A range of fillers are available from temporary to
permanent. A permanent filler would require allergy testing and the effects while longstanding are
difficult to reverse. A temporary filler needs repeating every 3-4 months as the effects. A sensible
approach might be to try a temporary filler first, with a view to a permanent filler injection if the
effects were favourable. The degree of improvement might only be subtle.
8.4 A surgical option would be to try and reduce the indentation of the scar by re-excising it and re-
approximating the deep tissues. There would be risks of bleeding, infection and wound healing
problems. The degree of improvement could, again, be subtle. Initially, the scar could be more
noticeable. There would be post-operative bruising swelling and pain. The client would likely need a
few days off school and would need to refrain from contact sports for 4 weeks.
8.5 The option above could be combined with z-plasty of the scar. This would break up the scar line
to make it less noticeable. It would also aid in reducing the indentation.
8.6 It is my opinion that the sensible choice would be to try the last option (8.5), if in the future the
scar bothers the patient enough to seek improvement. Although the most ‘radical’ option it, in my
opinion, has the best chance of success of improving the scar. At present, I suspect this would be
necessary under general anaesthetic but in future might be possible under local anaesthetic.
9. Declaration
I confirm that I have made clear with 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.
I understand that mu overriding duty is to assist the Court on matters within my expertise and that
this duty overrides any obligation to those who have instructed me or their clients.
I confirm that I have complied with that duty and will continue to do so and that I am aware of the
requirements set out in Paragraph 35 of the Civil Procedure Rules and the accompanying Practice
Direction ,the protocol for Instruction of Experts to give evidence in Civil Claims and the relevant Pre-
action Practice Direction/Protocol.
I confirm that I have no conflict of interest of any kind, other than any which I have already set out in
this report. I do not consider any interest which I have disclosed affects my suitability to give expert
evidence on any issue on which I have given evidence and I will advise the party by whom I am
instructed if there is any change in circumstances which affects this statement.
