QUESTIONS AND ANSWERS

Mr Calisto is a Consultant Paediatric Neurosurgeon. His area of expertise is in paediatric conditions of brain and spinal cord (central nervous system or CNS), potentially amenable to surgical treatment. Despite some forms of hydrocephalus, tumours, infections, skull fractures and intracranial (intracerebral, subarachnoid, subdural, extradural) bleeds, just to cite some, often do not require an operation, they mostly need specialist surveillance, management input and/or advice by a paediatric neurosurgeon, who is familiar with the regional anatomy, injury pathogenesis (causation), associated abnormalities (scalp swelling for example), time to recovery and prognosis. Mr Calisto will be able to comment on the above and will recommend further experts, as soon as possible, should this be needed.

Mr Calisto is a qualified neurosurgeon with 13 years of experience in the field of paediatric neurosurgery, almost 6 of which spent as a full time NHS consultant in Oxford. Thanks to the long tradition of internationally reputed medicolegal experts, in Oxford Mr Calisto benefited from the best possible environment to develop his interest in the pathomechanisms of infantile head trauma and alleged non accidental injuries. He completed the required legal training at Bond Solon. His electronic library contains hundreds of scientific and legal papers on the topic of acquired infantile head injuries, also representing how the scientific views have evolved in the last fifty years. Mr Calisto’s medicolegal reports regularly include reference to a relevant selection of these studies, which are made available to the instructing solicitor, and to royal societies guidelines, rules and directives when appropriate. In 2020 only, while working full time for the NHS, Mr Calisto has provided more than 20 reports, mainly in family and criminal, but also civil proceedings. He is an honorary senior clinical lecturer at Oxford University. The skills he uses with young patients and families in his daily NHS practice make his communication more direct and easily understandable even when discussing complex matters and even in non-medical contexts. Mr Calisto’s expertise is known to his colleagues, lawyers and judges across the nation (see section on feedback). He is fully registered with the GMC, up to date with his revalidation safeguarding and mandatory training, he is fellow of the Royal College of Surgeons of England and member of paediatric neurosurgery societies nationally and internationally. His medicolegal practice is fully insured. A copy of Mr Calisto’s CV, qualifications and insurance certificate is available on request.

Mr Calisto will prepare his report with a skilled view of a paediatric neurosurgeon who views, interprets and bases clinical/surgical decisions upon numerous scans of children. However, for the Court, he is not a trained radiologist or qualified by examination in imaging. In view of the latter, he would recommend that the Court considers a paediatric radiologist or neuroradiologist to review these aspects.

Mr Calisto is a neurosurgeon, by training. Although his expertise is in paediatric neurosurgery as he has practiced in this field for the last 13 years of his career, completing two fellowships in two large UK paediatric hospitals, he will not be able to comment on paediatric matters, including: medical (as opposed to surgical) causes of subdural bleeds, skeletal fractures other than skull, skin bruises, marks, etc. There are of course areas of overlapping between the different expertises, which is where discussions between experts of different disciplines usually take place.

It is unusual that there are conflicts of interest in such cases, however owing to the dearth of paediatric neurosurgeons in the country who are willing to take on this work, we usually check at the outset that Mr Calisto is not involved in any parallel investigations or has looked after the child himself at any point. It is always helpful to provide the child’s initials, Court reference number and date of birth to definitively exclude any conflict of interest.

Mr Calisto is currently taking on instructions, either jointly or from one of the parties. He accepts both claimant and defendants' instructions. Due to the typical high demand in this field, and the need to balance the medicolegal practice with a full time NHS job caseload, while Mr Calisto aims to file his report well in advance of the agreed date, the usual turnaround time to produce a report in a standard (ca. 1500 pages bundle) case is of 10 – 14 weeks. A more precise estimate will be provided on request, depending on the specific time at which it is made.

Mr Calisto will slot a case in his reporting schedule once a signed letter of instruction is received, with agreement of fees, and at least the core information about the case is made available. This part of the bundle includes, for example, birth notes, emergency services and A&E records, discharge summaries, GP/health visitor records, “red book’, child protection team report, first-hand accounts of the events, photographs of the subject and places if applicable, and scans. It is not uncommon to receive further information weeks after the instruction (other experts’ reports, late statements, specialist assessments, etc.). If it was too late (typically three weeks from the agreed filing date) to include this in the report, Mr Calisto will provide an addendum as soon as possibly feasible, compatibly with the overall reporting schedule and NHS clinical pressures. It is however required that a letter of instruction with confirmation that fees will be met in full is made available.

There is often a delay between the initial approach and the case being heard to instruct experts, therefore it is imperative that an up to the minute timescale is ascertained. Until an instruction is definitely confirmed, and the relevant material made available, Mr Calisto cannot reserve space in his tight schedule for cases that may not proceed. The reporting schedule is in fact determined by  the order in which full bundles arrive, on a first-come, first-served basis: we will therefore require the bundle to secure a date.

Mr Calisto, like most of the public administrations, prefers electronic rather paper documents, although he can accept both. The email address reports@oxpensolutions.co.uk is a secure mailbox backed by Protonmail, a Swiss based, GDPR compliant (https://protonmail.com/blog/gdpr-email-compliance/) email provider which uses end-to-end, zero access encryption (https://protonmail.com/security-details). 

Mr Calisto has also an NHS.net email address, that is usually preferred option for the National Crime Agency (NCA) and the UK Police Forces. 

Mr Calisto also uses Switch Egress Intelligent Email Security and Secure File Sharing & Collaboration (https://www.egress.com), Caselines Evidence Management System (https://caselines.com), and Microsoft Office 365 encryption Services.

Hard copies or digital memory supports such as CDs, USB pens, etc. can be sent via tracked and signed mail to Mr Calisto’s office, whose address will be communicated in response to the approach.

Mr Calisto is a data controller, registered with the Information Commissioner’s Office (ICO), and with the duty of controlling that the processing of personal data complies with the current UK data protection regime, as set out in the Data Protection Act (DPA) 2018, along with the UK General Data Protection Regulation (GDPR). The relevant material is stored on secure, encrypted drives, HIPAA (Health Insurance Portability and Accountability Act) business associate agreements compliant (https://www.sync.com/pdf/sync-hipaa-baa.pdf). Oxpen Solutions Ltd. reserves the right to destroy any relevant material used by Mr Calisto twelve months after provision of a report, unless by prior agreement.

Mr Calisto will need to directly examine all CT and MR scans performed in a case, both of head/brain and spine, if appropriate. He will not need skeletal X-rays or photographs of the eyes’ fundi. The scans should be made available in DICOM format, either as part of a compressed file or prepared by the treating hospital on a proprietary, encrypted CD. In this case, functioning passwords are expected to work on either Windows or Mac environment. A frequent source of delay is corrupted discs, broken discs, wrong images on discs or missing or incorrect passwords. 

If, once instructed, there is a delay in receiving any documents/scans, this risks is higher of the filing date not being met and possibly an application for an extension may need to be made.

NHS backed, internal transmission of diagnostic imaging.

In exceptional circumstances the scans stored on the local hospital radiology servers (picture archiving and communication system – PACS) can be transferred to Oxford University Hospitals PACS for the attention of Mr Calisto (Image Exchange Portal - https://www.iepservice.co.uk/IEP/External/Login).

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​Under no circumstances gif, jpeg, jpg, pdf, bmp, tiff, png, eps, raw formats will be accepted, as they do not contain any patient identification data and do not allow the type of data elaboration required during the review of the scan.

Mr Calisto accesses his emails multiple times per day and aims to reply within 24 hours for urgent matters or anyway within 2 to 5 days for less urgent queries. Commenting on another expert’s report or answering a further set of questions usually takes between 7 and 10 days, although Mr Calisto aims to prioritise these matters every time that it is possible.
Mr Calisto can be reached on his mobile, preferably after 5:00 PM, every day, if needed, preferably with prior notice. This applies to urgent communications but also to pre-trial meetings, for example.

Mr Calisto’s list of availabilities for the following 12 months will be shared on specific request. Where dates of availability are issued, these may be subject to change until confirmation is received for a booking by the instructing solicitor/CPS. In general, Wednesdays AM and/or PM slots, and Thursday and Friday afternoons are available to be booked. Different slots can be requested, due to particular circumstances, as long as more than 8 weeks notice is given and that Mr Calisto’s clinical commitments can be rescheduled with no inconvenience for his patients and colleagues. In general, long notice works better than short notice in terms of chances to find the requested slot available. 

Where there are gaps between requesting availability and booking court dates/experts’ meeting dates, please ensure you request the most up to date version of Mr Calisto’s availability schedule. 

Mr Calisto receives court warnings and requests for experts’ meetings on a daily basis and as such he cannot block out multiple dates of availability to each case. 

Mr Calisto is available for experts’ meeting also after 5:00 PM, when most convenient for the Team of experts.

Mr Calisto’s preferred way to give evidence is from Oxford, via remote video link. MS Teams, Zoom, Skype business or CVP are all equally suitable platforms. Please provide details of a remote video link preferred by the Court.

Mr Calisto is happy to provide a report as a family or criminal case and as such has no representations to make.

Mr Calisto has lowered his hourly fees, to meet the financial constraints of the current times. His costs are inferior to some other expert colleagues in his specialty and he will do everything in his power to reasonably keep to a minimum the amount of time spent on a case, without compromising on the quality of his services. However, the LAA rate is widely considered to be a non-acceptable fee for this type of work, by the handful of paediatric neurosurgeons practising as court experts in family or criminal proceedings. A shortfall is commonly ordered by the Court and expected to be covered by one of the parties as specified in the letter of instructions.

One or, more commonly, more invoices will be raised at the end of the work, each addressed to the parties involved, using the available email addresses, as specified in the Letter of Instruction. The system used is Quickbooks online ©, which the invoice will be downloadable from. Any issue can be raised with admin@oxpensolutions.co.uk.

The best way is to request them at admin@oxpensolutions.co.uk; we aim to reply within 24 hours from receiving the email. 

The best way to contact Mr Calisto or his Admin Team is via the email addressadmin@oxpensolutions.co.uk; we aim to reply within the same day or the following day at the latest.

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