Post-accident consultations
1. The plaintiff was admitted to Westmead Hospital on 5 October 2011. Unusually for this type of case, the full clinical records for that admission are not in evidence. The extract of those records that has been tendered in evidence shows the contemporaneous medical survey of the plaintiff's injuries identified a loss of consciousness with amnesia for the events, frontal abrasions to the head, an occipital laceration, an injury to the lower cervical spine, a fractured right scaphoid, a fractured left hamate, abrasions to forearms, an abrasion to the left hip, and abrasions to the knees: Exhibit "L", p 432;
2. On 11 October 2011, Dr Sanki recorded that the plaintiff had attended on Dr Fernandopulle, a general practitioner, after the accident and as a result, the plaintiff had been referred to him. He noted the plaintiff's complaints as scalp lacerations, as well as pain and stiffness in his hands, wrists, knees, back, neck and shoulders. That attendance was to obtain a medical certificate for an insurance claim, possibly on an income replacement policy: Exhibit "L", pp 453 - 459;
3. On 28 October 2011, the plaintiff saw Dr Dave about the injuries he sustained in the subject accident. The plaintiff complained about his left hand. There were no complaints recorded concerning other parts of his body at that time: Exhibit "L", p 442;
4. In February 2012, as noted by Dr Sanki, the plaintiff complained of pain in the back of his right hip, and in the 4th and 5th metacarpal bones, difficulty flexing his fingers in both hands, and a feeling of tingling in the fingers of both hands. Nerve conduction studies revealed delayed action in the right median nerve. The back pain was neurologically investigated by MRI and hip pathology was excluded. The hip pain was thought to be pain referred from the plaintiff's back. MRI studies were suggested. There is no report from the assessing neurosurgeon, Dr Van Gelder. The MRI appears to have been carried out years later, in 2014: Exhibit "D", p 6;
5. On 20 February 2012, at the request of his solicitor, the plaintiff was assessed by Dr John Bentivoglio, a consultant orthopaedic surgeon, who expressed some whole person impairment ratings for the plaintiff's orthopaedic problems relating to his neck, back, knee and shoulder complaints: Exhibit "D", p 23;
6. On 23 April 2012, Dr Sanki noted the plaintiff complained of pain in both knee joints. He was advised to have an MRI but this was not done immediately due to his lack of funds: Exhibit "D", p 7;
7. On 3 August 2012, the plaintiff underwent MRI scanning of his lumbar spine and both knees. Dr Kevin Tay reported the plaintiff had degenerative changes in his lumbar spine at L2/3, a broad-based disc protrusion at L5/S1 with stenosis of the L5 neural exit foramina. The right knee had meniscal tears. A CT of the right femur was recommended to better assess a medullary lesion: Exhibit "D", pp 1 - 2;
8. On 10 September 2012, according to the report of Dr Sanki dated 26 April 2015, an MRI confirmed the presence of bilateral carpal tunnel syndrome in the plaintiff's wrists: Exhibit "D", p 6;
9. On 10 September 2012, or thereabouts, the plaintiff had shoulder ultrasounds which confirmed the presence of left sub-acromial bursitis which was treated with a cortisone injection into that shoulder. At that time, an ultrasound of the plaintiff's right elbow showed the presence of right ulna nerve neuritis. The ultrasound on the right shoulder around that time showed supraspinatus tendonitis: Exhibit "D", p 6;
10. On 26 October 2012, the plaintiff underwent a medico-legal assessment by Dr Dennis Cordato, a consultant neurologist, who reviewed his complaints and expressed a percentage whole person impairment assessment of 15 per cent: Exhibit "D", pp 67 - 70;
11. On 27 November 2012, at the request of his solicitors, the plaintiff underwent an orthopaedic assessment by Dr John Bentivoglio. He considered the prognosis for the plaintiff's neck problems was guarded, the permanent damage at L5/S1 was assessed as likely to cause ongoing symptoms, possibly indefinitely, and the prognosis for both knees was for ongoing problems that would be difficult to treat, he has ongoing right shoulder problems, there is a risk that the right hip symptoms could lead to degenerative osteoarthritis and the prognosis for the plaintiff's hand problems remains guarded. He stated that the plaintiff is not capable of returning to work: Exhibit "D", pp 17 - 22;
12. On 30 March 2013, the plaintiff attended Dr Ali Sarfraz who diagnosed tenderness in his hands and arms, with restricted knee and neck movements. He was referred for physiotherapy. In a separate medical certificate of the same date Dr Sarfraz also noted the plaintiff had received injuries to his neck, back, right hip, both knees, his left little toe, his face and both arms: Exhibit "L", p 443;
13. On 16 April 2013, the plaintiff was re-assessed by Dr Bentivoglio who issued a further report that modified his earlier assessment of the plaintiff's percentage of whole person impairment rating in light of more recent investigations: Exhibit "D", pp 26 - 27;
14. On 19 April 2013, the plaintiff was re-assessed by Dr Bentivoglio who noted the plaintiff's prior medical records and noted that he had significant pre-existing damage to his lumbar spine, as well as in his neck from the early 2000's, that is, longstanding pre-existing degenerative disease in his shoulders, and pre-existing chondromalacia in his right knee: Exhibit "D", pp 24 - 25;
15. On 30 July 2013, at the request of the first defendant's solicitor, the plaintiff was examined by Dr Michael Lim, an occupational medicine physician. After reviewing the plaintiff's history, including between 1996 and 7 September 2011, and thereafter, and conducting a physical examination, and reviewing investigation results and the medical reports provided to him, Dr Lim concluded, from the plaintiff's alleged behavioural responses to examination, that he had not injured his neck, shoulders, back or left knee. He also concluded that all the plaintiff's injuries had healed without ongoing disabilities. Dr Lim considered the plaintiff had not given a satisfactory account of his medical history. I considered that comment to be too harsh a judgment in the circumstances and I discount that opinion. Dr Lim had not adequately dealt with the aggravating effect of those injuries on the plaintiff's underlying conditions of health. I therefore found his analysis to be of limited assistance: Exhibit "1", pp 1 - 26;
16. On 13 August 2013, Assessor McGroder issued a MAS Certificate assessing a whole person permanent impairment of 14 per cent for aggravating injuries to the neck, lumbar spine, injuries to the hands, both knees and the left toe fracture: Exhibit "D", pp 184 - 198;
17. On 12 September 2013, Assessor Veerabangsa assessed the plaintiff to have a mild traumatic brain injury due to the subject accident, but no additional percentage whole person impairment followed from that assessment: Exhibit "D", pp 203 - 211;
18. On 10 October 2013, Assessor Wood issued a MAS Certificate certifying the plaintiff's combined percentage of whole person impairment at 14 per cent: Exhibit "D", pp 200 - 202;
19. On 28 October 2013, at the request of his solicitor, the plaintiff was examined by Dr Uthem Dias, an occupational medicine physician. He diagnosed a bilateral carpal tunnel syndrome affecting both wrists. He considered the main contributory factor to that condition to be due to the plaintiff's employment. Dr Dias noted the plaintiff's weight at this time to be 121kg (at p 627), and (at p 630), he identified the plaintiff's left wrist and carpal tunnel syndrome as being due to the nature of the plaintiff's work prior to the subject motorcycle accident. he considered (at pp 631 - 632), that (pre-existing) condition rendered him unfit to return to that type of work because it would further aggravate the carpal tunnel problem by use of the vibrating equipment involved in that work. Instead, he said (at p 631), the plaintiff should pursue a lighter occupation but a barrier to that goal is the effects of the accident on 5 October 2011 which made him unsuitable for any form of employment: Exhibit "1", pp 35 - 55; Exhibit "L", pp 620 - 633;
20. On 5 November 2013, the plaintiff was re-assessed by Dr Bentivoglio who reviewed his back, neck, hand, knee and little left toe problems. He saw no reason to alter his previous opinions. He was still considered to be incapable of returning to the workforce since his injury: Exhibit "D", pp 28 - 32; Exhibit "L", pp 620 - 633;
21. On 4 December 2013, at the request of his solicitors, the plaintiff was psychiatrically assessed by Dr Robert Hampshire, who diagnosed the plaintiff to have a post-traumatic stress disorder of mild to moderate severity with co-morbid dissociative states, panic attacks, and depression, which were considered to be chronic and stable, but having a guarded long-term prognosis: Exhibit "D", pp 34 - 44;
22. In January 2014, according to Dr Sanki's report dated 26 April 2015, a Dr Dave had concluded the plaintiff had symptoms consistent with lateral epicondylitis: Exhibit "D", p 6;
23. On an uncertain date, possibly in 2014, according to Dr Sanki's report dated 26 April 2015, a physiotherapist, Mr Boland, reported that the plaintiff had a chronic pain syndrome and no further details of this are known: Exhibit "D", p 6;
24. On 9 January 2014, Assessor Reutens issued a MAS Certificate that stated some of the plaintiff's psychiatric problems were due to the subject accident, namely, an adjustment disorder with mixed anxiety and depressed mood (a reformulation of the former concept of PTSD and mild to moderate depression). She certified the plaintiff's co-morbid dissociative state was not due to the subject accident: Exhibit "D", pp 213 - 226;
25. On 13 January 2014, the plaintiff consulted Dr Dave to review the effects of the accident. Dr Dave wrote to Dr Sanki to advise of the need for electrophysiological investigations. He suggested the plaintiff had lateral epicondylitis of the right elbow: Exhibit "L", p 441;
26. On 13 January 2014, the plaintiff saw Dr Dave about his right hand and wrist problems and bilateral epicondylitis as well as an unspecified knee problem: Exhibit "L", p 443;
27. On 3 March 2014, at the request of his solicitor, the plaintiff was assessed by Dr Peter Giblin, a consultant orthopaedic surgeon. He carefully recorded the plaintiff's pre-existing injuries (between 1993 and 2008), his current complaints of neck, shoulder, back, hand, knee and foot problems. He also reviewed a series of imaging scans in the period 2010 to 2013. Dr Giblin noted a number of areas of permanent unfitness for work. He considered the plaintiff was fit for sedentary work but with his physical restrictions, he may be susceptible to aggravation and long term deterioration. He supported conservative treatment and vocational rehabilitation: Exhibit "D", pp 53 - 60;
28. On 3 March 2014, Dr Giblin expressed the opinion the plaintiff had an 18 per cent whole person impairment: Exhibit "D", pp 61 - 62;
29. On 23 April 2014, Dr Dave, orthopaedic surgeon, recommended that the plaintiff have an excision of his united scaphoid in the left wrist. The history was a fall on his outstretched hand 5 months earlier, in November 2013. Dr Dave saw CT scans that were reported as showing a possible fracture of the left hamate bone and the fourth metacarpal: Exhibit "L", pp 436 - 440;
30. On 25 June 2014, the plaintiff consulted Dr Van Gelder, a consultant neurologist, at the referral of Dr Sanki. Dr Van Gelder recorded a history of injuries to his neck, low back, knee, right hip and left foot. Dr Van Gelder reviewed the plaintiff's neck, shoulder, upper limb and low back symptoms with radiated symptoms. Dr Van Gelder referred the plaintiff to Dr Dowla for neurophysiological tests: Exhibit "L", pp 461 - 462;
31. On 30 July 2014, according to Dr Sanki's report dated 26 April 2015, the plaintiff was examined by a neurologist, Dr Dolan (sic for Dowla), who considered he was suffering from bilateral ulnar nerve motor slowing across the elbow joints with residual median nerve slowing bilaterally more severe on the right side due to incomplete neurolysis. A further decompression of the right carpal tunnel was recommended: Exhibit "D", p 7;
32. On 30 July 2014, Dr Dowla carried out neurophysiological testing of the plaintiff's upper limbs and suggested decompression of the right carpal tunnel: Exhibit "L", pp 465 - 466;
33. On 5 August 2014, according to Dr Sanki's report dated 26 April 2015, the plaintiff had a lumbar MRI that showed a left postero-lateral disc protrusion at L5-S1 encroaching on the left S1 nerve root, but without displacement: Exhibit "D", p 6;
34. Between 2014 and 2018, the plaintiff's general practitioner recorded the plaintiff's active medical problem to be major depression in and the inactive problems to historical osteoarthritis in his feet, gout, bilateral tennis elbow, cervical and lumbar radiculopathy: Exhibit "L", p 467;
35. On 23 February 2015, at the request of his solicitor the plaintiff was assessed by Mr Stephen Buddle, a consultant rehabilitation advisor. Mr Buddle recorded a pre-accident work injury (at p 611), on 1 September 2010, involving a fall leading to a left wrist injury involving a fractured scaphoid, and a pre-existing carpal tunnel problem that may have been aggravated by that fall. Mr Buddle identified the earnings of a mechanical engineering technician at Crystal Car Wash to be $120,000 or $2308 per week gross (at p 612), and he then identified some other job classifications that suggested (at p 618), loss of about $1400 per week gross after allowing for lighter duty mitigatory earnings of $908 per week gross: Exhibit "L", pp 610 - 619;
36. On 25 September 2015, Dr Dowla reported that the plaintiff has bilateral median nerve slowing at the wrist: Exhibit "L", p 464;
37. On 10 November 2014, Dr Dave saw the plaintiff for his upper limb problems and suggested an MRI investigation of the cervical spine: Exhibit "L", p 443;
38. On 17 February 2015, the plaintiff saw Dr Dave for a final consultation. The MRI scans of the neck and wrists showed degenerative changes but no obvious lesions that could explain all of the plaintiff's symptoms. Da Dave suggested pain management and physiotherapy: Exhibit "L", p 443;
39. On 30 March 2015, Assessor Assem assessed the plaintiff's head, neck, shoulders, hands, back, knee, left foot and right hip injuries to be accident-related: Exhibit "1", pp 94 - 119;
40. On 28 April 2015, Dr Sanki wrote a report on the plaintiff's medical history. Dr Sanki first saw the plaintiff concerning the subject accident on 9 January 2012. He recorded an incorrect history of being hit by a car as was noted. Dr Sanki's report went back to 1999 and dealt with matters of history up to 11 August 2011 as the plaintiff was known to him concerning his pre-motorcycle accident problems with his elbows, neck, right shoulder tendinopathy, bilateral knee joint osteoarthritis and locking, and a fractured scaphoid. On 5 December 2011 the plaintiff was noted to have problems to do with the motorcycle accident and at that time was undergoing rehabilitation treatment for bilateral carpal tunnel problems, osteophytes and disc lesions at C5-6-7, lumbar disc lesions at L4-5, L5-S1 with osteophytes, and knee and scaphoid problems: Exhibit "D", pp 4 - 10;
41. On 28 April 2015, Dr Sanki noted the plaintiff had put on 25kg due to lack of activity. He noted the plaintiff was complaining of severe pain in the cervical and lumbar spine with difficulty in movement. He also noted moderately decreased activity of movements in both shoulders and instances of locking in both knees: Exhibit "D", p 7;
42. On 26 July 2015, Dr Sanki considered that the plaintiff's wrist problems could be apportioned as being 50 per cent accident related, his neck and low back problems being 10 per cent pre-accident. At that time, the plaintiff was awaiting carpal tunnel surgery : Exhibit "D", p 11;
43. On 26 May 2016, at the request of his solicitors, the plaintiff was assessed by Dr Clive Sun, a rehabilitation and pain physician. He was of the opinion that the plaintiff's ongoing restriction were related to an accident in September 2015, with the result that he should have restrictions placed on work involving lifting over 8kg, no forceful pushing or pulling, and avoiding above shoulder work or frequent posture changes. The reference to an accident is plainly a typographical error, as is evidence from the history he recorded earlier in his report: Exhibit "D", pp 63 - 66;
44. On 16 August 2016, A review panel assessment by Assessors Burns, Oates and Bowers issued a certificate concerning the plaintiff's need for treatment limited to neck, shoulder and back massage: Exhibit "D", pp 227 - 237;
45. On 1 December 2016, under the supervision of Dr Hsu, the plaintiff underwent a diagnostic sleep study which showed very severe obstructive sleep apnoea with severe arterial oxygen saturation, (sic). An urgent follow-up appointment was to be made for this problem: Exhibit "D", pp 14 - 15;
46. On 28 April 2017, the plaintiff's endocrinologist stated that the plaintiff's low testosterone levels was secondary to his chronic obesity, pain and depression: Exhibit "D", p 16;
47. On 1 May 2017, the plaintiff was psychiatrically re-assessed by Dr Robert Hampshire for medico-legal purposes. Dr Hampshire noted the plaintiff's former stoicism had left him, he complained of neck pain, headaches, shoulder and back pain, referred pain into the legs, depression and distress. Dr Hampshire reiterated his previous diagnosis, but said the plaintiff now suffered from Major Depressive Disorder which is severe, with marked melancholic features: Exhibit "D", pp 45 - 51;
48. On 9 May 2017, Assessor Fitzgerald issued a certificate identifying the plaintiff's percentage whole person impairment for the combined brain, hand, foot, neck, back and knee problems at 8 per cent: Exhibit "D", pp 238 - 239; pp 251 - 252;
49. On 11 May 2017, the plaintiff was reviewed by Dr Kelvin Hsu who confirmed he had severe obstructive sleep apnoea with severe arterial oxygen desaturation, which if left untreated placed him at increased risk of developing cardiovascular and cerebrovascular disease: Exhibit "D", pp 12 - 13;
50. On 26 July 2017, the plaintiff was re-examined by Dr Lim at the request of the first defendant's solicitor. He stated his view that the only injuries sustained by the plaintiff were: a concussive head injury without neurological sequelae other than amnesia; a scalp laceration; superficial bruises and grazes; a fractured left hamate; a fractured 1st metacarpal of the right hand; a bruised right hip; grazes to both knees; bruised toes and a fractured left little toe. He disagreed with some of the MAS assessors' certificates: Exhibit "1", pp 27 - 34;
51. On 9 April 2018, the plaintiff saw Dr Nadia Tejani, an endocrinologist, for his obesity and reduced testosterone levels. Depression was identified as the problem needing treatment: Exhibit "L", p 488;
52. On 31 July 2018, the plaintiff's general practitioner placed him on a mental health programme for his depression, insomnia and anxiety following his motor vehicle accident: Exhibit "L", pp 476 - 484;
53. On 31 July 2018, the plaintiff was the subject of a general practitioner mental health plan for his depression, anxiety and insomnia following the motorcycle accident: Exhibit "L", pp 504 - 508;
54. On 11 February 2019, Assessor Ashwell issued a MAS certificate identifying a current whole person impairment rating of 10 per cent, but reduced by 2 per cent to allow for pre-existing conditions, yielding a final impairment of 8 per cent: Exhibit "D", pp 240 - 250;
55. On 25 February 2019, Dr NT Renganathan, a cardiologist, wrote to Dr Fernandopulle noting the plaintiff's history of dyslipidaemia, hypertension, chronic back pain for cervical spondylosis with radiculopathy, obesity and obstructive sleep apnoea for assessment of cardiovascular risks and lower limb swelling. Further investigations were planned: Exhibit "L", pp 486 - 487;
56. On 19 August 2019, Mr Christopher Kaleh, a psychologist, wrote to Dr Fernandopulle recommending CBT for his extreme psychological distress, altered mood and anxiety with knock-on effects on his concentration, attention and memory: Exhibit "L", p 485;
57. On 10 March 2020, Assessor Perla assessed the plaintiff's injuries as related to the subject accident to comprise soft tissue injuries to the cervical and lumbar spines, both knees and right hip. He also assessed the plaintiff's foot fracture and hand injuries, and the soft tissue injuries to those latter two areas, to have resolved: Exhibit "L", pp 654 - 679;
58. On 6 October 2020, at the request of his solicitor, the plaintiff was assessed by Dr Clive Sun, a consultant rehabilitation specialist. Dr Sun's reports were dated 9 June 2016, 21 June 2019 and a conclave report with Dr Lim on 26 June 2019. In this latest report by Dr Lim, based on a further examination of the plaintiff, it was noted (at p 606), the plaintiff had gained more weight, and was now 135kg, having gained 35kg, and had developed hypertension and sleep apnoea. Dr Sun believed (at p 607), that the plaintiff's injuries from the accident were concussion, soft tissue injuries to the cervical and lumbar spines and to both shoulders, as well as to his right hip and both knees: Exhibit "L", pp 476 - 484;
59. On 8 October 2020, at the request of his solicitor, the plaintiff underwent a vocational assessment by Mr Ross Girdler. Mr Girdler expressed the view (at p 636), that the effect of the physical and psychological injuries suffered by the plaintiff in his 5 October 2011 motorcycle accident prevented him from returning to his pre-accident employment. The assumptions within that opinion require critical evaluation in light of the opinion expressed by Dr Dias: Exhibit "L", pp 634 - 643;
60. On 3 November 2020, at the request of his solicitor, the plaintiff was assessed by Dr Julian Parmegiani, a consultant psychiatrist. Dr Parmegiani diagnosed the plaintiff with an adjustment disorder with mixed anxiety and depressed mood caused by the subject accident: Exhibit "L", pp 596 - 604;
61. On 11 November 2020, at the request of the second defendant, the plaintiff was examined by Dr Graham Vickery, a consultant psychiatrist: Exhibit "11". Dr Vickery expressed his findings in what seems to be adjectivally qualified terms. He stated there "was no apparent clinically significant anxiety, melancholic depression, paranoid delusional ideation or formal thought disorder. There was no apparent incapacitating cognitive impairment", and "no apparent psychiatric impairment noted in the clinical examination", nor was there a "diagnosable DSM5 psychiatric disorder due to the motor vehicle accident". Dr Vickery's report did not explore any prior medical history or prior psychological psychiatric history. I therefore considered his report to be superficial as it did not include the plaintiff's relevant medical history. I place little reliance upon that report.
- The materials identified above will be reviewed and analysed for the purpose of identifying my findings as to the plaintiff's injuries, his accident-related disabilities, and in connection with the assessment of his entitlement to damages.