Defining the Scope of Expert Duty in Obstetric Prognosis Reports

The Legal and Clinical Scope of Prognosis

In obstetric clinical negligence litigation, the condition and prognosis report is a fundamental component of the expert evidence portfolio. Unlike breach of duty reports, which focus on the retrospective analysis of care against established standards, the prognosis report assesses the future trajectory of the claimant. For instructing solicitors, identifying the specific scope of this report is essential to comply with CPR Part 35.10 and to ensure that the evidence remains proportionate to the issues in dispute.

An obstetric prognosis report should ground the future trajectory of a patient—whether a child or a parent—in documented clinical reality. In cases involving hypoxic-ischaemic encephalopathy or cerebral palsy, the expert witness should integrate neuro-developmental data with the patient’s clinical progress. The legal objective is to provide a structured assessment of the impact of injuries on daily living. Solicitors should ensure the expert has access to updated therapy notes, school reports, and recent paediatric assessments, as the clinical evaluation of long-term impairment provides the primary evidence base for identifying future care and equipment requirements.

Coordinating Multi-Disciplinary Expertise

Obstetric claims often involve complex, evolving clinical needs requiring input from multiple specialties, such as neonatologists, paediatric neurologists, and orthopaedic surgeons. A recurring challenge in litigation is the risk of fragmented evidence. By ensuring experts from different specialties have access to a consistent evidence base, instructing parties can assist the court in reaching a cohesive view of the claimant’s prognosis. Where the court directs or where experts find it appropriate to narrow the issues, CPR 35.12 governs the process of professional discussion and the production of a joint statement.

Ensuring Compliance with CPR Part 35

The expert’s overriding duty to the court, under CPR 35.3, dictates that the prognosis report must remain independent and objective. Experts should be prepared to articulate the range of possible clinical outcomes based on established literature rather than advocating for a single, speculative scenario. Under CPR 35.10, the report must contain the substance of the expert’s instructions and the sources of their information. Solicitors should be precise in their letters of instruction, requesting that the expert clearly distinguishes between current clinical status and anticipated future state, while highlighting any material uncertainties in the clinical evidence.

• Ensure the expert has access to the most recent medical records, including any subsequent surgical interventions or therapeutic assessments.
• Maintain a focus on clinical status and foreseeable care requirements, rather than requesting comments on legal liability within a prognosis report.
• Instruct experts to identify the distinction between evidence-based practice and their own clinical judgement in their prognostic projections.
• Use joint statements under CPR 35.12 to resolve clinical disagreements where there are two or more experts of the same discipline.

Avoiding Common Pitfalls

A significant risk in complex obstetric litigation is the potential for siloing evidence. A report that overlooks the findings of relevant specialists or fails to account for established clinical standards may be of limited utility to the court. Furthermore, experts should avoid speculation that falls outside their specific subspecialty. If a case requires an assessment of life expectancy influenced by non-obstetric comorbidities, the instructing solicitor may consider whether a single joint expert (SJE) under CPR 35.7 would be more appropriate for that specific, discrete issue. Properly defining the scope of the report at the outset, particularly identifying areas of clinical overlap, is the most effective way to protect the integrity of the medical evidence.