PAST EVENTS
MMLS
PAST EVENTS
"Learn from the past
Prepare for the future"
"The Pembrokeshire Coastal Murders"
Steve Wilkins
Retired Detective Chief Superintendent
10th May 2023
John William Cooper (born 3 September 1944) is a Welsh serial killer. On 26 May 2011, he was given a whole life order for the 1985 double murder of siblings Richard and Helen Thomas, and the 1989 double murder of Peter and Gwenda Dixon. The murders were known in the media as the "Pembrokeshire Murders" or the "Coastal Murders" and our speaker, retired detective chief superintendent, Steve Wilkins, played a crucial role in bringing him to justice.
After a spat of local burglaries Cooper was sentenced to 14 years in 1998 for robbery and burglary. He was released from prison in January 2009.
Cooper had a history of criminal activities, including thirty robberies and violent assaults, and was suspected of being involved involved in a series of double homicides in a otherwise quiet coastal area.
Because of subsequent developments in DNA and forensic science, the police carried out a cold case review named Operation Ottawa. In April 2009 were able to identify Cooper's shotgun as being the murder weapon including DNA evidence was provided by forensic scientist Professor Angela Gallop. The police collected further evidence against him and moved quickly so that Cooper was arrested again in May of that year. He was convicted, on May 26, 2011, for the two double murders and sentenced to four life sentences without the possibility of parole. Cooper was also sentenced for the rape of a 16-year-old girl and a sexual assault on a 15-year-old girl, both carried out while a group of five teenagers were held at gunpoint in March 1996, in a wooded area behind the Mount Estate in Cooper's hometown of Milford Haven, Pembrokeshire.
For the brutality of his crimes, Cooper was handed a whole life order, meaning that he will never leave prison alive. The presiding judge, HHJ John Griffith Williams, said "the murders were of such evil wickedness that the mandatory sentence of life will mean just that." Cooper is serving his time in an undisclosed prison.
Graeme Poston
President MMLS
"North West Air Ambulance"
Gemma Mullen
Anaesthetic / Prehospital Emergency Medicine Consultant
Annual Joint Meeting with the Liverpool Medical Institution
26th January 2023
At a joint meeting of the two societies (the LMI and the MMLS) on the 26th Jan a good sized audience heard a talk on the North West Air Ambulance Service from Dr Gemma Mullen, Consultant Anaesthetist and Emergency Medicine Consultant. Dr Mullen works as the senior medical member of the group that uses helicopters to reach seriously ill people in the fastest time and transport them to the appropriate hospital.The speaker presented evidence showing how delay in treatment, whether the injury be skull or heart related, can make a difference to survival rates and outcomes.
Dr Mullen described the practical difficulties in treating patients in the open air; often on hillsides and on uneven ground. Depending on the severity of the condition, as the clinician Dr Mullen has to decide on the spot what treatment to give. This may include major procedures including opening the chest in exceptional circumstances.
The speaker could not explain why such an important medical service was not financed as part of the NHS. A mystery shared by the audience. The Service is dependant on charity and needs £9 million for 2023. The audience were encouraged to support the charity with donations.
A vote of thanks was proposed by Nigel Gilmour KC. for what was a fascinating and well presented talk.
Nigel Gilmour KC
"Montgomery – Seven years on"
Mr Matthew Stockwell
Exchange Chambers, Liverpool
30th March 2022
Mr Stockwell began his presentation with an overview of his background and how he came to develop his personal injury and clinical negligence practice. He then went on to ascertain the composition of his audience which was fifty per cent lawyers and fifty per cent medics.
He continued with a discussion of his practice and experience pre and post the Montgomery ruling of the Supreme Court in March 2015. Mrs Montgomery was a highly educated person working for a pharmaceutical company and came from a medical background. She is an insulin dependent type 1 diabetic of short stature and this was her first pregnancy. Diabetic mothers are prone to carrying larger babies than non-diabetics. The first breach of duty was a miscalculation of the baby’s size and that of Mrs Montgomery’s pelvis and so the risk of shoulder dystocia (the baby’s shoulders getting stuck in the pelvis during a conventional vaginal delivery were not explained to her. The second breach of duty was the failure to discuss the risks of vaginal delivery and offer a Caesarian section. She was induced at 38 weeks gestation and the baby suffered shoulder dystocia, complicated by abruption of the placenta leading to the baby being starved of oxygen. When the baby was delivered the oxygen starvation had resulted in severe cerebral palsy.
Mrs Montgomery sued Lanarkshire Health Board for her baby’s brain injury and after two hearings in Scotland, the second finding in favour of the Health Board, the claim was taken to the Supreme Court in London who found in Mrs Montgomery’s favour by a majority verdict. The Supreme Court ruling was that patients have a right to know all of the available treatment options for their condition (including not to treat) and be able to assess the risks and benefits of each treatment based on their material importance to each patient, also based on the range of clinical skills available to each patient.
Mr Stockwell discussed the differing roles of advising patients and gaining informed consent in addition to the role of safety netting. He then discussed four claims based on the Montgomery ruling that he had represented which was followed by a lively and lengthy discussion with the audience.
For ease of reference, Mr Stockwell kindly provided a list of all the reported authorities which have cited the case of Montgomery in the last 7 years in the attached PDF file below.
Graeme Poston
President MMLS
"Heroes"
DR C Evans FRCP, HHJ N Gilmour QC
Annual Joint Meeting with the Liverpool Medical Institution
19th February 2022
The first presentation was by Dr Evans who listed a number of distinguished Liverpool physicians, starting with Dr William Duncan, born in Liverpool, trained in Edinburgh before returning to Liverpool as the first Director of Public Health in the UK. He went on to list other distinguished Liverpool physicians, including the 2 who won the Nobel Prize for Medicine, Sir Ronald Ross in 1902 for discovering the mode of spread of malaria and Sir Charles Sherrington in 1932 for his work on the motor function of muscle. Other equally distinguished physicians included Lord Cohen of Birkenhead, Sir Cyril Clark, Professor Rod Gregory, Professor Cecil Grey and Dr Ronnie Finn.
However, he focussed on his real hero Dr Noel Chavasse VC and bar. Captain Noel Godfrey Chavasse, VC & Bar, MC (9 November 1884 – 4 August 1917) was born in Liverpool and qualified in medicine at Oxford. He was also an Olympic athlete, and served as an Army medical officer during the First World War. He is one of only three people to be awarded a Victoria Cross twice. The Battle of Guillemont saw acts of heroism by Chavasse, the only man to be awarded the Victoria Cross twice during the First World War. In 1916, he was hit by shell splinters while rescuing men in no-man's land. It is said he got as close as 25 yards to the German line, where he found three men and continued throughout the night under a constant rain of sniper bullets and bombing. He performed similar heroics in the early stages of the offensive at Passchendaele in August 1917 to gain a second VC and become the most highly decorated British officer of the First World War. Although operated upon, he was to die of his wounds two days later in 1917.
HHJ Gilmour then followed with a presentation on his Liverpool hero, F E (Fred) Smith, first Earl of Birkenhead. Frederick Edwin Smith, 1st Earl of Birkenhead, GCSI, PC, DL, KC (12 July 1872 – 30 September 1930), known as F. E. Smith, was a British Conservative politician and barrister who attained high office in the early 20th century, in particular as Lord High Chancellor of Great Britain. He was a skilled orator, noted for his staunch opposition to Irish nationalism, his wit, pugnacious views, and hard living and drinking. He is perhaps best remembered today as Winston Churchill's greatest personal and political friend until Smith's death aged 58 from pneumonia caused by cirrhosis of the liver.
Smith was born at 38 Pilgrim Street, Birkenhead in Cheshire, the eldest son and second of five surviving children of Frederick Smith (1845–1888) and Elizabeth (1842–1928), daughter of Edwin Taylor a rate collector, of Birkenhead. He won a scholarship to Wadham College, Oxford, in 1891. Smith made his name as an Oxford "swell", distinguishing himself by his dark good looks, his energy, his unashamed ambition and his scathing wit. Having eaten his dinners at Gray's Inn and passed his bar finals with distinction in the summer of 1899, Smith was called to the Bar and finally left Oxford, and quickly built up a brilliant and lucrative practice on the Northern Circuit, initially basing himself in Liverpool. Smith rapidly acquired a reputation as a formidable advocate, first in Liverpool and then, after his election to Parliament in 1906, in London. In May 1915, he was appointed Solicitor General by H. H. Asquith and knighted. In 1919, he was created Baron Birkenhead, of Birkenhead in the County of Chester following his appointment as Lord Chancellor by Lloyd George. From 1924 to 1928 Birkenhead served as Secretary of State for India. After retiring from politics, he became Rector of the University of Aberdeen, a director of Tate & Lyle, a director of Imperial Chemical Industries, and High Steward of the University of Oxford.
Graeme Poston
President MMLS
"Knifesavers"
Mr Nikhil Misra
Consultant Emergency and Trauma Surgeon
Liverpool University Hospitals NHS Foundation Trust
24th November 2021
Mr Misra commenced by describing the problem of the knife crime epidemic that has arisen across the UK over the last decade, commencing in London and Birmingham but now endemic across the whole country.
The problem has grown exponentially and the peak age of offenders remains 15 and the most frequent time for these assaults to occur is just after 4pm when the schools close. The problem with most serious knife assaults are cardiovascular injuries to the heart and great vessels (both arterial and venous) and a lack of knowledge by first time attenders at the scene in how to manage such injuries. This problem is compounded by the rate of major bleeding and the time it takes for the victim to ‘bleed out’ leading to cardiac arrest and death.
Mr Misra explained what we can learn from the US epidemic of gun crime and the management of mainly low-velocity gun shot injury, in particular the use of tourniquets and pressure dressings to compress injured and bleeding vessels.
He then explained the ‘Knifesavers’ project that he had initiated in Merseyside and was now being expanded across the country. Compact Knifesaver packs contain pressure dressings and tourniquets and people who are possibly likely to encounter knife crimes (teachers, cab drivers, policemen etc.) are trained on full size dummies how to use the contents of the Knifesaver packs to control bleeding and staunch the life-threatening haemorrhage. So far, nearly 1000 packs have been distributed across Merseyside.
The meeting concluded with an active discussion with the audience who greatly appreciated Mr Misra’s achievements to date.
Graeme Poston
President MMLS
"The Investigation of the Brighton Bombing"
A Retired Special Branch Officer
29th September 2021
A retired Detective Sergeant in the Special Branch gave a presentation on the investigation and prosecution of the Brighton bomber, Patrick Magee.
At the time in question, October 1984, the Officer was on the special protection squad assigned to protect the Prime Minister, Margaret Thatcher. The 23 Kg Semtex bomb had been planted by Magee some 3 weeks earlier in an en suite bathroom at the Grand Hotel, Brighton, set to go off precisely at 03.00 on the morning of the 12th of October 1984 in the middle of that year’s Conservative Party conference. It was intended to kill and maim as many people as possible, including Mrs. Thatcher and her cabinet.
The bomb did kill 5 people with a further 34 people seriously injured. The building was very seriously damaged, but Mrs. Thatcher escaped unhurt and was taken immediately to Lewes police station where she spent the rest of the night. She then returned to Brighton to give her conference speech before returning to London.
This bomb was extremely sophisticated when compared to earlier IRA time bombs (which had a maximum time of 1 hours between activation and detonation. Magee had taken parts of a beta-max VCR machine to create this new timer which was set to detonate 3 weeks after he activated it and left the hotel.
Magee then immediately left the country and moved around Europe during the weeks thereafter the bomb exploded. He subsequently returned to join an IRA cell in Glasgow planning a series of seaside resort bombings and political assassinations the following year. However, their communications were intercepted by GCHQ and the location of the cell identified, the cell was then arrested and broken up, to be subsequently given long prison sentences at the Old Bailey, although Magee was subsequently released in 1998 as part of the Good Friday agreement.
The Speaker received a lengthy ovation from those present, following which there was an incisive question and answer session.
Graeme Poston
President MMLS
"Withdrawal of treatment from children – who decides?"
Lorraine Cavanagh QC, St Johns Buildings
14th April 2021
After a prolonged break since our last event due to lockdown restrictions the Society was pleased to host its first online lecture with an excellent turnout from our members.
The presentation began with an explanation of who were the relevant participants in the process of withdrawing life sustaining treatment from children and a discussion about when was a child old enough to be able to make their own decisions about declining life-saving/life changing treatment. Under the Mental Capacity Act (2005) the Court considered 16-18 year olds as still children and those aged 16 and 17 remain under the jurisdiction of the High Court. Gillick competency pertained to those under 16. However, Gillick competency and the Mental Capacity Act (2005) are not analogous. Therefore a child aged 17 years and 364 days cannot refuse treatment and their planned treatment(s) can be overridden by the Court, whereas an adult (18 and over) can refuse to accept treatment. The underlying principle is to get children as safely as possible to the age of 18 if at all possible, therefore a 17 year old anorexic has no right to refuse nutritional (and other) treatment and support.
Recent changes to the law regarding the prescribing of puberty blocking treatment to children in their early teenage years have extended the principles of prescribing life-sustaining treatments to life-changing treatments (but presently remain subject to ongoing appeals). However, the Court’s inherent jurisdiction is not intended to order doctors to undertake treatment and no-one can dictate the treatment to be given to a child. The intended desirable result is that the choice of treatment is in some measure a joint decision of the parents, treating doctors and the Court. This responsibility does not confer upon parents an unfettered right to make welfare decisions in respect of their children (RLCH NHS FT -v- Evans, 2018).
When problems arise because of disagreements between parents and treating doctors about withholding or withdrawing life sustaining treatment(s) for children there is frequently an underlying communication difficulty. Unresolved disputes regarding treatment between the treating doctors and the parents need to be decided by the Judge, with or without the assistance of mediation and these Courts function 24 hours a day, 7 days a week, 52 weeks of the year as such often life and death decisions have to be made with only a few hours’ notice. The underlying principle that guides the Court is that the best interest of the child must prevail (as it was in the tragic case of Charlie Gard) and the Court has to be mindful of the occasional problem of the clandestine obstinacy of medical opinion.
The Court considers that absence of pain is not necessarily absence of harm as was evidenced in the tragic Knight case where the parents wanted to take an extremely unwell child home but were refused by the Court. Loss of conscious awareness does not mean that active interventions can be wholly disregarded. Therefore, in conclusion the underlying issue for the court is the balance between the burden of the underlying disease versus the benefit(s) of any treatment, and ultimately the burden this balance places on the child.
The Society is very grateful to the speaker for allowing the Society’s members access to her very comprehensive slide set laying out the legal judgements on which these decisions have been made.
Graeme Poston
President MMLS
"The Paterson Inquiry and the Cumberlege Report – First Do No Harm"
Dr Alexandra Harkins
Responsible Officer,
Independent Doctors Federation
17th June 2021
Dr Harkins kindly gave our second online lecture with a fascinating insight into some of the challenges of regulating medical practice. In particular, the difficulties the regulators have in walking the fine line between protecting the patients and respecting the autonomy of the profession.
Our President, Graeme Poston has kindly prepared an executive summary of all the details of the talk here.
Everyone expressed their thanks for an excellent talk that was well attended. Going forwards we will continue to host events online wherever possible although we look forward to being able to resume our meetings in person as soon as it is safe to do so.
"Learning from Mass Casualty Events;
What Can We Do Better?"
Merseyside Medico Legal Society annual joint meeting with the Liverpool Medical Institution
Elkan Abrahamson, Director, Jackson Lees, Liverpool
Jason Wong, Consultant and Senior Lecturer in Plastics, Reconstructive and Trauma Surgery, University of Manchester
23rd January 2020
Mr Elkan Abrahamson, Director of Jackson Lees Solicitors, Liverpool has considerable experience in the legal aspects of mass casualty events. He began by touching on the Birmingham Pub Bomb Inquest and the Manchester Arena Inquiry. An inquest is inquisitorial and not adversarial and the legal test to hold an inquest is a death that is violent, unnatural, the cause is unknown, or died in detention. He then expanded on the Hillsborough inquests. The first in 1989 under Dr Carl Popper was at a time when there was no legal aid for families, no process of discovery and no disclosure of evidence. The inquest was broken down into brief 1-2 hour mini inquests for each of the then 95 deaths at that time, followed by an overall generic inquest of the event. The subsequent Taylor inquiry was critical of the quality of police evidence and concerned about obstructiveness among the higher levels in the police. So far Hillsborough has cost in excess of £100 million in legal costs and remains the subject of ongoing criminal investigation.
Suggestions to improve such processes include no fault compensation (although the Home Office isn’t keen), position statements to narrow the issues, costs positions (inquests historically had no public funding), better control over the extent of police funding. Grenfell and Manchester Arena are inquiries and not inquests. Inquiries are necessary when there are security services involved and concern justice, accountability, responsibility, prevention but not financial damages. They aim to prevent cover up when military and judicial organisations are trained to protect each other. Following Hillsborough the Public Authorities Accountability Bill is still before Parliament which hopefully will improve such future investigations.
Mr Wong began by explaining his background, training and research interests in plastics and reconstructive surgery. He is part of the Manchester Major Trauma Team. On the night of 22nd May 2017 he wasn’t on call but was at home in Manchester city Centre when he heard the bomb explode at the Arena. He immediately went to Manchester Royal Infirmary to assist. A major incident was declared at 22.32 and all live casualties had been cleared from the arena by 02.40 and the major incident declared over by 05.00. The majority of the surviving casualties had limb injuries and so there was considerable need for plastic surgical input, extensive use of artificial tendons, nerve repairs and vascular reconstructions, leaving many victims with lifelong life changing injuries and psychological problems. Even one year later many victims were still in wheelchairs or on crutches.
This led to the creation of the Manchester Institute of Health and Performance based on the science base and sports traditions in Manchester, devising programmes of ongoing reconstruction and rehabilitation. About 50% of the 120 seriously injured survivors (who had come from across the country) returned to Manchester to consider this programme and 25 signed up to the protocol. The measured metrics of rehabilitation demonstrated significant performance
"The 'Honour Killing' of Shafelia Ahmed"
Retired Detective Inspector Geraint Jones
28th November 2019
DI Jones began his presentation by outlining the necessary criteria for effective detective work: resilience; motivation; team player; dedication to the community; painstakingly laborious; vocationally rewarding; believe nobody and check everything.
Shafelia Ahmed first ran away from her home in Warrington in February 2003 and was reported missing again from home on the 18th September 2003 (when she had already been murdered by her parents on September 11th). Her parents put the house up for sale on the 15th September 2003 and alleged that she had run away with her boyfriend Mushy, but he denied any knowledge of her whereabouts. Shafelia had not been seen since the 11th September and her bank account showed no activity, but there was concern from her friends of domestic violence and possible forced marriage abroad.
Her disappearance arose against a background of domestic abuse since the age of 13 and an attempt by her parents to leave her with relatives in Pakistan for an arranged marriage, from which she escaped. In July 2003 Shafelia self-harmed when she swallowed a caustic liquid resulting in severe oesophageal burns requiring subsequent oesophageal dilatation and a month’s stay in hospital.
The investigation remained a missing person inquiry for the first 3 months until suspicion fell on her parents who were arrested in December 2003, but there was insufficient evidence and they were released on bail.
Shafelia’s body was found in Cumbria in February 2004 and although the body had so decomposed that the cause of death wasn’t clear, the circumstances pointed to unlawful killing. Her inquest in 2007 concluded that Shafelia had been murdered and an attempt by the family to appeal the Coroner’s verdict was rejected at the Royal Courts of justice in 2011.
However, this now led to Shafelia’s younger sister, Alesha now approaching the police when she explained the circumstances of her parents murdering her sister. Her parents were arrested and in 2012, 9 years after Shafelia’s disappearance, based on Alesha’s evidence her parents were convicted of her murder after a 12 week trial, although the cause of death (probably strangulation) was never established. Both received sentences of 25 years.
Following the presentation there was a broad discussion concerning the ramifications of such honour killings within society.
"Genomic Medicine"
Dr. Carwyn Hooper,
Senior Lecturer in Ethics and Law,
St Georges Hospital Medical School, University of London
5th September 2019
Dr Hooper began his presentation by explaining his background training in medicine and philosophy. This led him to establish the Genomic Medicine course at St Georges Hospital Medical School aimed at explaining the social implications of genomic medicine. These implications included testing for genetic disorders, the implications of whole genome sequencing (including next generation sequencing), the effect of this on the individual patient and their family. While these developments will become part of standard patient care, improving diagnostics, prognosis and precision medicine, they have significant medico legal implications.
These medico legal issues include: informed consent; confidentiality; intellectual property rights; secondary/incidental findings; direct genomic testing; and problems in the interpretation of these findings by over-stretched (and probably poorly informed) practitioners in primary care.
Dr Hooper continued by highlighting the ABC case currently ongoing at St Georges. This case involved a man with undiagnosed chronic psychological symptoms who killed his wife and was convicted of manslaughter. However he was subsequently found to be suffering from the underlying congenital disorder Huntingdon’s Chorea, which leads to premature death due to cerebral deterioration. When asked if his family could be informed, he denied permission. The multidisciplinary team managing his case therefore decided not to inform the family but his daughter was pregnant at the time. Following the birth of his grandchild there was a subsequent accidental breach of confidentiality and his daughter was then diagnosed as inheriting the Huntingdon’s gene. The daughter was of the opinion that had she been informed of this diagnosis while she was pregnant then she would have considered terminating the pregnancy and on this basis sued the hospital. The claim now rests with the Court of Appeal. This claim raises the question as to whether such cases should be managed as individual patients or affected families?
Dr Hooper concluded his presentation with a review of the impact of genomics on personal responsibility for health care policies. Such an approach is included in health care provision in a number of countries including Germany and Japan. They encourage healthier lifestyles in exchange for cheaper healthcare provision, while financially penalising patients for the cost of unnecessary procedures that go wrong. Such policies raise the question of personal lifestyle choices versus genomic medicine, which the patient can’t influence.
The presentation concluded with a lively and informed discussion over a wide range of issues raised by Dr Hooper in his presentation.
"Past, Present and Future of Fertility Treatment"
Mr Andrew Drakely,
Clinical Director at the Hewitt Fertility Centre
29th May 2019
Mr Drakely has a long-established fertility practice at the Hewitt Fertility Centre in Liverpool and his presentation to the Society covered the history of fertility treatment through to present day practice, concluding with a vision of the future. He began be explaining the physiology and anatomy of conception, and that when investigating infertile couples one third are due to male problems, one third to female problems and the other third remain unknown. However if appropriately investigated and managed then 80% conceive within 12 months and overall 90% will have conceived within 24 months.
Currently treatment strategies fall into three groups: ovulation induction; artificial insemination; and in vitro fertilisation. Sperm counts have been falling over the last 30 years with associated losses of quality and motility of sperms. This is due to both environmental issues and lifestyle issues, including obesity. Female infertility can be due to poor hormone regulation resulting in anovulatory states, infection (including chlamydia), hydrosalpynx/pyosalpynx, variants of uterine anatomy, endometriosis, and uterine fibroids and polyps. Furthermore, by the age of 34 most women have already used 95% of the ova they were borne with, not to be replaced.
In vitro fertilisation is performed trans vaginally under ultrasound scan guidance. Ten to 20 eggs are collected and then mixed with sperm and placed in an incubator where over the next 5-6 days there is usually a 60% fertilisation rate. Since Louise Brown, the world’s first ‘test tube’ baby was born in Oldham in 1978, more than 8 million babies have been born worldwide following successful IVF. However, currently in NHS England there is widespread disparity in funding levels between CCGs.
The final part of Mr Drakely’s presentation focused on the future where advances are anticipated to be as marginal gains rather than great leaps forward. One focus will be on genetics, trying to exclude recessive genes leading to hereditary conditions. The information needs of couples receiving such data. Improving male health and lifestyles to reduce BMI and blood pressure. Improve spermatogenesis and reduce oxidative stress. Lastly the possibility of creating sperm from stem cells. In women research will focus on the relationship between the mother’s immunity and her fertility. Work in the embryology laboratory will focus on AI to improve the metabolomics of cultured eggs and determine better quality embryos, assisted by minimally invasive embryo biopsies, egg reconstruction surgery and the treatment of mitochondrial diseases. He concluded with a discussion of the new place of polygenic analyses of future embryos and the implications of such analyses for informed consent of the treated couple.
"Complications in Aesthetic Medicine"
Dr. Lee Walker,
Clinical Director of BCity Clinics, Liverpool
28th March 2019
Mr Walker has a long-established aesthetic medical practice in Liverpool and his presentation to the Society covered his concerns about some of the current unregulated practice of aesthetic medicine in the UK. Aesthetic fillers, unlike prescription only medicines and many medical devised are essentially unregulated and can be administered by anyone (e.g. hairdressers and beauticians), who unlike clinicians see the recipients as clients, not patients.
Botox causes flaccid muscle paralysis and now has in excess of over 800 clinical and non-clinical uses, including ectropion and dry eye, and strabismus with diplopia. While no fatal anaphylactic reactions have been reported, does cause complications and side effects. Such effects include lack of client satisfaction due to unrealistic expectations.
Fillers cause facial vascular injuries, particularly in the glabella region of the centre of the face where the arterial network links the internal and external carotid systems between the brain and the face. There have been reports of lip fillers escaping to occlude the ophthalmic artery so causing blindness and the problem relates to untrained practitioners having little or no knowledge of the anatomy of these arteries and their many variants, or appreciation of the appropriate depth to which the fillers should be injected.
The diagnosis of such a vascular injury is suspected by poor facial capillary refill which should normally be 1-2 seconds but in facial necrosis is prolonged to over 6 seconds. The treatment of such facial vascular injuries involves very urgent subcutaneous injection of hyaluronidase, which is an off-label prescription only medicine so can only be administered by a licensed clinician and carries a risk of anaphylactic reaction and is contraindicated in pregnancy and some cancers. Other possible treatments include glyceryl tri-nitrate, Viagra, steroids, liposome and heparin.
Mr Walker’s presentation concluded with a lively question and answer session with members of the Society and their guests, mainly about the medico-legal aspects of the current practice of aesthetic medicine in the UK.
"Doctors on the Front Line:
the case of Dr Bawa-Garba"
Mr Shannon Eastwood, Atlantic Chambers,
Dr Richard Hughes, Consultant in Emergency Medicine
24th January 2019
"Unsocial Media? The Pros and Cons of Social Media for Medics"
Fin McNicol, Director of Communications,
Aintree University Hospital NHS Foundation Trust
26th September 2018
After a career in journalism and PR, Fin McNichol's special interests are in crisis communication and media management.
His talk was about how hospitals have had to adapt to the use ,and misuse, of social media. He acknowledged that social media gave hospitals opportunities for good eg spreading tales of success but it came with risks. His hospital uses Twitter and Facebook mainly. It has a combined following of above 13000. In his view all hospitals need to be serious about social media because patients use it. At Fazakerley its use is encouraged.
A difficulty is preserving confidentiality. To advance this aim there are guidelines emanating from BMA,MDU and GMC. The audience were shown the guidance drafted for use at Fazakerley. The main lesson was," if you would not say it to someone's face then don't say it online"
Some Drs had been tempted to frankness on line and in a recent period of 18 months some 28 investigations had led to suspension or warning from the GMC.
Part of the job was to advise medical staff subjected to abuse or criticism on line from patients. The normal advice would be to ignore it otherwise the abuse can go viral.
This was an interesting address, attractively presented, on a topic that increasingly has a role to play in hospital administration, for good or ill.
HH Nigel Gilmour QC
"Unsocial Media? The Pros and Cons of Social Media for Medics"
Fin McNicol, Director of Communications,
Aintree University Hospital NHS Foundation Trust
26th September 2018
After a career in journalism and PR, Fin McNichol's special interests are in crisis communication and media management.
His talk was about how hospitals have had to adapt to the use ,and misuse, of social media. He acknowledged that social media gave hospitals opportunities for good eg spreading tales of success but it came with risks. His hospital uses Twitter and Facebook mainly. It has a combined following of above 13000. In his view all hospitals need to be serious about social media because patients use it. At Fazakerley its use is encouraged.
A difficulty is preserving confidentiality. To advance this aim there are guidelines emanating from BMA,MDU and GMC. The audience were shown the guidance drafted for use at Fazakerley. The main lesson was," if you would not say it to someone's face then don't say it online"
Some Drs had been tempted to frankness on line and in a recent period of 18 months some 28 investigations had led to suspension or warning from the GMC.
Part of the job was to advise medical staff subjected to abuse or criticism on line from patients. The normal advice would be to ignore it otherwise the abuse can go viral.
This was an interesting address, attractively presented, on a topic that increasingly has a role to play in hospital administration, for good or ill.
HH Nigel Gilmour QC
"The Evolving Role of Doctors in Pre-Hospital Major Incident Management: Medical Advice or Medical Command"
Craig Hooper, Medical Emergency Response Incident Team Manager, North West Ambulance Service
27th June 2018
"Gun Crime on Merseyside"
Andy Cooke QPM,
Chief Constable of the Merseyside Police
14th November 2018
Those attending the talk from the Chief Constable of Merseyside on 14th Nov were expecting a talk on gun crime. They must have been perplexed by the displayed title "War against rebellion is messy- like eating soup with a knife." As the Chief Constable developed his themes (which were concerned with gun crime on Merseyside) the relevance of the title became clear. Gun crime is not a recent phenomenon; in 1946 there were 86 juvenile gangs on Merseyside. The speaker recounted the notable shootings on Merseyside up to the present time. In 1995 the gang war involving Ungi led to the police having guns on the streets for the first time in the UK. The speaker became the first commander of the Matrix force that adopted a hard edged approach to gun crime. They adopted a zero tolerance approach.
A graph was displayed showing firearm discharges on Merseyside from 2009 to 2017. Fatalities were at their height in 2010; use of firearms worst in 2012. It became clear to the police that arrests alone would not solve the problem. Firstly, the police saw the need to work with the communities to break the circle of violence. Secondly the causes of gang formation ,eg neglected children, truancy had to be tackled.
The talk was illustrated with vivid film of actual firearm incidents. The speaker did not paint an optimistic picture of the future of gun crime on Merseyside; cuts in funding leading to fewer officers made his task more difficult.
The audience of more than 50 had many questions of the speaker. The talk was well received
HH Nigel Gilmour QC
"Human Factors and Creating a Culture of Safety"
Dr. Clinton Jones,
Aintree University Hospital NHS Foundation Trust
21st March 2018
"Life and Medicine in Afghanistan"
Dr Wahid Arian
18th January 2018
Over 50 people attended this joint meeting of the MMLS and LMI. Dr Arian was born in Afghanistan at a time of war and became familiar as a child of the sounds of bombs and rockets. As a small child, his family moved to Pakistan to escape the risks of war but later returned to his homeland.
Dr Arian escaped the hostilities and found his way to London where by dint of hard work he acheived what was necessary to gain entry to Cambridge to study medicine. After qualification he specialised in radiology and that led to a Registrar post at Fazakerley Hospital.
Then his insipirational work began, culminating in the formation of ARIAN TELEHEAL of which organisation he is the Director.
The second half of the talk was an explanation of what the speaker has created and the international recognition his work has received.
In simple terms, medics in Afghanistan and more recently in Syria, can receive advice from doctors in the UK using modern technology. Thus an X-ray requiring interpretation is displayed on live link and the hospital in Afghanistan can ask questions of the UK doctors.
This exchange of medical advice could lead to problems. For example, could the UK doctors be sued on the basis that they are in a legal relationship with the foreign patient? Dr Arian outlined the steps taken to minimise such a risk.
The project has the blessing of the Afghan government. A simple idea of bringing better medical treatment to war zones using modern communication aids has come to fruition and is achieving a lot.
The speaker's medical career is on hold whilst he runs what he hopes will soon be a registered charity.
The talk was inspiring and enthusiastically received. It was heartening to hear that the speaker has been awarded an honour by the UN at an event attended by 400 of the world's movers and shakers.
For those wishing to contribute to the organisation, go to: http://www.arianteleheal.com/
Or email: arian.teleheal@gmail.com
"Sugar and Spice and all Things Nice - Drugs in Prison, the Problems and its Treatment"
Dr Luxman Parimelalagan
8th November 2017
The speaker at this talk on 8th November had, following qualification, gone into prison medicine specialising in addiction. He works in Manchester and Liverpool prisons. The addictions he treats are for drugs and alcohol.
The prison population was 86,327 week ending 27/10/17. A recent feature was the presence of the elderly in prison, serving
sentences for historical sex crimes, the volume of these prosecutions having increased.
HMP Liverpool is a local Category B prison, taking remand prisoners direct from courts.
An idea of the work pressure at Liverpool was in the following figures:- from 1st July to 27 October 2017, 2,978 new patients were registered; 1,088 patients were assessed by the Substance Misuse Team; 548 were treated for opiate addiction and 247 for alcohol addiction.
The speaker described the assessment and treatment of the alcoholics but at greater length spoke of the assessment and treatment of those with opiate addiction. The involved drugs were as expected e.g. Heroin, prescribed opiates, illicit medications and NPS (New Psychotic Substances). The latter are artificial man-made drugs that cannot be detected by urine test or drug dogs. New ones are being made, almost daily by "chemists". In 2014 alone, 350 new NPS drugs were created. These drugs are becoming increasingly potent and cause death, acute health episodes and prison disorder including assaults on prison officers. They are a major problem for prisons.
The speaker described the pressures put on the official prescribers in prisons by prisoners who may not be entitled to a drug but wish to get their hands on some for personal gain. Because many of the drugs prescribed by the medical staff are diverted to those not intended to have them (estimated at 70%). The irony is that the prison service is a "supplier". The recent smoking ban has increased the trade in illicit drug use.
The slides gave a vivid picture of the means used to get drugs into prisons. The low-tech means include Kinder Eggs, dead pigeons and tennis balls thrown over the wall. The high tech routes included drones. Very occasionally prison officers had been caught supplying prisoners!
The speaker ended his talk by posing the question: "is the war on drugs in prisons one that can be won?" His view was negative.
In the role of a prison doctor dealing with addiction, the speaker did not pretend that he cures but that he makes the patient more comfortable.
The talk was enthusiastically received albeit the message was sober and depressing. It was very clear that prison medical staff are highly motivated albeit working in conditions many doctors would seek to avoid.
And reference to "Spice" in the title? It is the prison term for any illicit drug use.
HH Nigel Gilmour QC
"Regulation or Litigation:
Driving up Clinical Standards"
Dr Andrew Loughrey
26th April 2017
Dr Andrew Loughney's talk was attended by about 40 members. The speaker is the director of Liverpool Women's Hospital and had previously been a consultant in Obstetrics and Gynaecology in the North East.
His talk was about clinical risk, the management of risk and the strategy to drive up clinical standards. Dr Loughney gave figures for maternal deaths and baby deaths showing a considerable improvement over the last 10 years in both figures. The direct death rate from 2003 to 2013 was halved and the indirect death rate reduced from 7.7 to 6.1 per 100,000 births. How had this come about? Whilst the improvement was undeniable the causes of it were not clear. Thus had the intervention of the Care Quality Commission or professional regulation been proved to make a difference? There was no solid evidence in either case. Part of professional regulation is revalidation; there is no evidence this actually works in the sense of reducing avoidable mistakes.
The speaker's interest in promoting good clinical practice had led him to do surveys of his medical colleagues as to whether they thought things such as professional regulation and litigation improved practice. The results suggested they did. In particular the "stick" of litigation was increasing safety thinking. There was evidence that the litigation threat was leading to higher spending on patients (e.g. more tests) but fewer malpractice claims. Younger doctors have accepted litigation risk and bought into it.
There were numerous questions from the audience with some doubts being expressed as to the view that the threat of litigation has increased the quality of clinical care. If this was so why were claims against doctors increasing?
The audience gave enthusiastic support to the vote of thanks from Dr C. Evans. It was a fluent and thought provoking talk.
HH Nigel Gilmour QC
"Confession is Good for the Soul. Is it Good for Medical Professionals?"
Stephen Grime QC
1st March 2017
The speaker was the distinguished silk from Manchester, Stephen Grime QC.
The theme of the talk was the recent development of a duty in law requiring doctors and other associated medical people (including hospital staff) to notify patients when things went wrong - the duty of candour.
The starting point was the Francis report which proposed there be a duty to confess. This proposal was considered by all Royal Colleges in 2014; the joint recommendation was that doctors be honest and open with patients.
Then the Government intervened and produced regulations that in somewhat opaque language impose a duty of candour on hospital administrators as well as medical staff. The regulations are too new to ascertain any change in medical practice.
The address was clear as well as being instructive and it stimulated a number of questions as well as discussion. The audience of 35 people gave the speaker enthusiastic thanks.
HH Nigel Gilmour QC
Joint meeting of the LMI and MMLS
"Cheshire and Merseyside Major Trauma Service - An Incredible Journey?"
Dr. Nina Maryanji
26th January 2017
The speaker spoke to a good sized audience about what happens when someone suffers a "major trauma". That term was defined. The trauma was most commonly suffered by falls; then RTA; then blows; and then stabbings. The trauma units in Cheshire and Merseyside sees 1800 - 2000 patients a year.
The average age of a patient is 56.9 years and 66% were male reflecting the regularity of alcohol as a feature of the accident. Some 2/3rds of patients arrive at the unit after 5pm and before 9am. Some 2/3rds were affected by drugs or alcohol.
Our speaker described the aims of the trauma units and the procedures pre- and post-arrival in hospital. One aim was ambulance response in 8 minutes and 60 minutes to receive definitive hospital care. Those treating major trauma patients were all familiar with the notion of the "golden hour"; this being the optimum period within which lives are saved. The ambulance service has the task of controlling haemorrhage and packing wounds. Upon arrival at Aintree Trauma Unit, between 15 and 18 staff will meet the injured. The medical staff will cover a number of specialities until an assessment of the patient is done to see what speciality will be involved.
X-rays can be done very quickly due to the proximity of the imaging unit to the reception area.
Not surprisingly many issues have to be dealt with such as dealing with next of kin and police and maybe checking the Organ Donor Service.
The average length of stay is 9 days; the patients that die bring that average down.
The talk was hugely informative and attractively presented. The audience was attentive. The well deserved vote of thanks was presented by the President of the LMI, Dr Machin."
HH Nigel Gilmour QC
"Doctors in the Dock - The Criminal Law, The GMC and The Medical Profession"
Keiran B Coonan QC
16th November 2016
"On 16th November a large gathering comprising a number of concerned doctors as well as lawyers had the good fortune to hear Kieran Coonan QC speak on the above topic. Our speaker is one of the country's most experienced defenders of doctors, both in criminal cases and before the GMC.
The essence of his talk was whether the present law relating to medical negligence manslaughter was unfair to the medical profession. Recent cases of doctors being convicted of manslaughter had led to letters to the national press suggesting that doctors should not be prosecuted for "mistakes" leading to a patient's death.
Our speaker explained the elements needed to be proved by the prosecution before a case was left to a jury to decide guilt. In essence the prosecution had a very difficult task and extraordinarily bad treatment leading to death had to be proved.
The speaker referred to a number of cases both leading to conviction and not. It was clearly the speaker's view that the law was not unfair to the medical profession and only the grossest cases of incompetence would satisfy the criteria for conviction. It would be wrong to establish an immunity from prosecution for one profession whilst retaining the offence of negligent manslaughter for others. He felt the unease of some doctors was misplaced, possibly resulting from ignorance of what the law was.
The audience responded enthusiastically to what was a tour de force."
HH Nigel Gilmour QC
Annual Dinner
15th October 2016
"On Saturday 15 October 2016, at the Artists Club in Liverpool, 35 people sat down to an evening of good food and great speechfying.
The meal, comprising a smoked fish starter, beef fillet medallions and pear and almond tart was of high quality and well received.
The speaker was introduced by the President, Judge Nigel Gilmour QC who revealed he had known the speaker for over 40 years and that any stories about the President were likely to be unreliable. Judge John Roberts DL was the speaker and he seemed to know personally most of those present.
This allowed him to tell stories, inevitably amusing, about those he knew. Happily the laws of defamation were suspended for the occasion and much mirth and a little embarrassment ensued.
The speech was a tour de force and brought to an end a very successful and amusing evening."
HH Nigel Gilmour QC
"The trials and tribulations of a High Court Judge"
Sir David Maddison
21st September 2016
"The Society was royally entertained on the evening of 21st September by a talk from the recently retired judge, Sir David Maddison. The speaker had brought with him a friend called Cyril.
Cyril was a dummy draped in the robes of a judge of the QBD. The ermine was impressive despite the wear it had suffered during the speakers term of office. The audience was invited to "grope" Cyril; this revealed that the model was a female which explained Cyrils hunch-back. We were told of the procedure for the appointment of High Court judges. No longer a tap on the shoulder from a friend but rather a wholly independent process that was designed to appoint the best qualified candidate.
We learnt how the judge and his/her clerk become paired. An interview of half an hour and if either does not think the relationship will work they can say no. The speaker told us he had had 2 clerks in his time on the High Court both of whom were entirely satisfactory.
We learnt of the process of being allotted a room in the huge Royal Courts of Justice in the Strand and how you got to choose the court centre out of London where you spent appreciable lengths of time. Sir David spoke of Judges Lodgings and which was his favourite( the one serving Durham). No tales of what happened in those lodgings (unfortunately).
The description of what the judges court dress comprised became complicated; there were robes to match the seasons of the year, thus a summer and winter robe. Air conditioning in most courts has now made the distinction unnecessary . The highly entertained audience had a number of questions to ask. Answered they were in an amusing way. Dr Chris Evans delivered the vote of thanks that was met with acclaim".
HH Nigel Gilmour QC
Annual Garden Party
3rd July 2016
"Our Social Secretary, Jenny Menzies once again very kindly hosted the garden party at her lovely home. There was food and drink aplenty and we were entertained by a swing band.
This year's charity for the event was the Clare Daley Foundation. Clare was a young woman who tragically died from malignant melanoma. Her brother gave a very heartfelt and moving tribute to his sister and spoke of his determination to help others in her memory through the Foundation by raising awareness of melanoma and by supporting other charities and organisations in the fight against this cancer. The society donated £1,000 to the charity".
CONTACT
MMLS
OUR ADDRESS
Jennifer Menzies,
MMLS Social Secretary
The Coach House,
Drewell Road,
Liverpool
L18 8AT
Email: jmmenz17@gmail.com
For any general inquiries, please fill in the following contact form:
