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What I do as a Pharmacist Expert Witness

Medico Legal

Advising a solicitor about a drink driving case led Graham Mould to become a pharmacist expert witness

Pharmacist Graham Mould regularly appears in court to give expert testimonials on cases involving drink driving, drug overdose and medical negligence.

What is your professional background?

I graduated with an honours degree in pharmacy from the University of London in 1964 and became a member of the then Royal Pharmaceutical Society of Great Britain. I obtained a master’s degree from the University of London in 1972 and a PhD from the same university in 1977, working on aspects of the metabolism of psychoactive drugs while at the London Hospital Medical School. Afterwards, I joined the NHS where I worked in a pathology laboratory at the Royal Surrey County Hospital (RSCH) in Guildford, developing a therapeutic drug monitoring service to be used by hospital clinicians. After 15 years of managing the service, I left and worked for a further seven years in the RSCH, supervising clinical trials with new and currently available drugs on patients and volunteers.

How did you become a pharmacist expert witness?

When I was working in the pathology laboratory at RSCH, the head of the department, who was already involved in cases as an expert witness, asked me whether I would advise a solicitor who wanted some advice about a client accused of driving under the influence of alcohol. I accepted the offer and, as a result, I started preparing similar reports for other clients. Soon I was asked to comment on other cases requiring my pharmaceutical expertise, which I found interesting because it involved a wide range of drugs and other compounds. In 2009, I obtained a diploma in the expert witness course organised by Cardiff University, which gave me a good grounding in the skills required to be an expert witness and provided an impetus to continue this work.

What do you have to do as part of this role?

First I am asked whether the case is within my expertise and if I am willing to be involved. Once I am instructed to go ahead, I prepare a report, which has to meet certain standards, setting out the details of the case. This usually involves reading through police reports, witness statements, medical records, hospital notes and any toxicological evidence, such as blood drug concentrations. For example, if the case involves a client accused of shop lifting and the perpetrator is under the influence of a benzodiazepine then I have to assess whether the drug (or other drugs that may have been taken) influenced the actions of the client involved. I then give an unbiased opinion on the results of my assessments and come to a conclusion. Essentially I am advising the court on my opinion, which should not be influenced by whether I am being instructed by the prosecution or defence.

What is the most difficult thing about being an expert witness?

Should the case come to court and I am required to represent the defence or prosecution, I am expected to defend my opinions when I am cross-examined by the opposing barrister. My first time in court was a nightmare because I was not used to the jargon and I misunderstood some of the questions posed. It was this experience that prompted me to go on a course instructing me about being an expert witness. Nevertheless, some of the legal terms are still difficult to get to grips with and being cross-examined is still nerve racking.

I have recently been involved with medical negligence claims where there may have been a dispensing error, a belated side effect of a drug or interaction between drugs, which requires the analysis of medical notes. In some instances, this can involve four or five files of notes. In others, it may be a CD to download and read. Some of the information is irrelevant but the notes have to be read in their entirety in case they contain useful information for the report.

What do you think makes someone a good expert witness?

Being good at problem solving is important. My experience of performing research where critical analysis of a problem is required stands me in good stead for making other decisions, such as assessing whether particular drugs are responsible for particular actions. Because of my previous work, I have a range of expertise in different aspects of pharmacy, including dispensing, toxicology, pharmacology and pharmacokinetics. This means I can give comments on formulations and dispensing issues, as well as toxic effects of particular drugs.

What is the most interesting case you have worked on?

One particular case involved the death of a young female medical student who had taken a compound called 2-4 dinitrophenol (DNP). It is used commercially as a dye and insecticide and is highly toxic. It was originally used in the 1930s as an ingredient in weight control medicines before it was banned by the US Food and Drug Administration as a diet supplement because of serious adverse events when taken orally. It has an extremely narrow therapeutic index. Over recent years it has been available over the internet in the UK as a slimming agent. The student had started to take it to lose weight and, tragically, she appeared to have taken too much and died as a result. I was called to give evidence at the inquest and the coroner had some stern words to say regarding the availabilty of this compound.

I also get involved with a number of cases where the client has been convicted with driving under the influence of alcohol. Some of the excuses clients use to explain why their blood alcohol level is above the legal limit for driving a vehicle are amazing – for example, “my pudding contained a lot of alcohol and I didn’t realise”. However, I must not be influenced by my own impressions — I have to consider only the facts.

What do you enjoy about being an expert witness?

It enables me to stay up to date on many different aspects of drug therapy in different age groups. For example, I advise on situations involving infants, such as the absorption of methadone into breast milk; older patients, such as the side effects of oral opioid therapy; and those who take some of the ‘legal highs’ or novel psychoactive substances. Even the most innocuous compound can produce unwanted side effects that can be detrimental to particular individuals.

I rarely meet the person for whom I am writing the report but I do come into contact with many different barristers and travel to many different courts in the UK.

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