The medical evidence
32A number of medical reports were tendered into evidence and oral evidence was given by two psychiatric specialists.
33The earliest report in point of time is that of Dr Joseph Waks, a general practitioner who specialises in occupational medicine. The applicant was referred to him by Ms Ohanian and was examined on 30 October 2002. Dr Waks' report of 4 December 2002 was furnished after some delay in obtaining medical release statements and after Dr Waks had spoken to Dr Newlyn, who was then treating the applicant. Dr Waks, after referring briefly to the applicant's history as given, diagnosed the applicant as suffering from a "depressive illness/phobic reaction" and felt that his long-term prognosis was "guarded" depending upon whether or not the applicant's workplace issues could be resolved. He commented, however, "even then there may have been irreparable damage in the relationship between his team leader/manager and himself." Dr Waks thought that the likelihood of the applicant being able to return to normal duties depended upon resolution of the workplace issue.
34It will be remembered that the applicant had been referred to Dr Thomas Newlyn, psychiatrist, at an early stage. In a report dated 14 January 2004, Dr Newlyn diagnosed a "work-related depressive illness" that began in June 2003 and for which Dr Newlyn had been treating him since 24 October 2003. He said: "I had treated a previous episode of work-related depression from 21 August 2002 through January 2003." In that report, Dr Newlyn thought that the depressive illness had improved significantly when the applicant was placed under different supervision and in a different workplace in 2002. He said:
My psychiatric opinion remains that Mr Cameron's depressive illness would greatly improve if he were transferred to another position on the same entitlements under the supervision of another person.
35On 3 December 2005, Dr Newlyn provided a report to Mr Pirie of Konekt. This repeated the diagnosis that he had consistently given (albeit that sometimes Dr Newlyn referred to the adjustment disorder before the major depressive disorder and sometimes he reversed the order). In answer to a request, Dr Newlyn said that he expected the applicant to be able to return to suitable duties within one week and to return to his pre-injury duties within two weeks.
36Dr Newlyn was asked to complete a medical certificate, in standard form, by State Super which he did on 27 March 2006, this being the date of his last consultation with the applicant. The certificate asked Dr Newlyn to furnish his opinion on the applicant's incapacity for work by indicating his agreement with a number of alternative propositions. In indicating which of those propositions he agreed to, Dr Newlyn certified that, in his opinion, the applicant:
Will never be able to be employed in his/her normal occupation due to this incapacity.
Is still able to be employed in some form of paid occupation - examples are (but no examples were provided by him).
Is still able to administer his/her own financial affairs.
37In signing the certificate, Dr Newlyn agreed to the following:
I certify that the member named here is suffering from a medical condition which, in my opinion, is likely to result in their being unable ever to be employed in a capacity for which they are reasonably qualified by education, training or experience. I also certify that, in my opinion, the person has suffered from that condition for a period of three and three-quarter years.
38For completeness, I note that the "incapacity" referred to in the certificate was one of "depression".
39Dr Newlyn provided a detailed psychiatric report on 24 July 2006, some four months after the earlier certificate. He had not examined the applicant in the interim.
40That report set out in some detail the history received by Dr Newlyn from the applicant, which it is not necessary to repeat for present purposes. Dr Newlyn had last been consulted by the applicant on 31 May 2006. Prior to that he had examined the applicant on a monthly basis.
41In his report, Dr Newlyn diagnosed the applicant as suffering from "adjustment disorder with mixed anxiety and depressed mood, chronic and major depressive disorder, single episode, moderate."
42In responding to questions put to him by State Super, to whom the report was addressed, Dr Newlyn proffered the opinion:
Mr Cameron was released to return to work by me in December 2005. However, his employer was unwilling to reemploy him so he chose medical redundancy.
He said that the applicant was "fit to resume work similar to the work he was performing at NSW Maritime", was "capable of working 30 or more hours per week" and was "capable of working part-time".
43When responding to a question about whether the applicant was permanently unable to do any particular kinds of work, Dr Newlyn said that the applicant had
reported on 31 May 2006 that the stress of redundancy had exacerbated his depression and that he believed that he was unable to work at this time but should be able to resume work in the future.
He thought that the applicant had "a good prognosis". It should be observed that this report expresses an opinion that is inconsistent with that contained in the earlier certification of 30 March 2006 and these conflicting opinions were the subject of detailed cross-examination.
44Before dealing with Dr Newlyn's oral evidence, I refer to a further report issued by him dated 9 October 2007 to Dr Coorey, the applicant's treating general practitioner. In that report, Dr Newlyn repeated the diagnosis that he had given in the report of 25 July 2006, which I have earlier set out. He then referred briefly to the applicant's medication and said:
Today I again said that the circumstances of his resignation from Waterways was such that I couldn't change the opinion that I gave State Super. I told him that I could no longer help him unless he sought a second psychiatric opinion with a psychiatrist of your choosing. It is possible that the second opinion psychiatrist would agree to take care of Mr Cameron, but I would be willing to accept him back with an opinion concerning care options.
45Dr Newlyn was called to give evidence by the respondent. In examination in chief, he was referred to the conflicting opinions in the certificate and report respectively, to which I have earlier referred. His explanation centred around the fact that he was given a limited opportunity to express an opinion in the certificate because he was obliged to assign assent or otherwise to particular matters. He said that his more detailed report represented his real opinion.
46In cross-examination, Dr Newlyn was taken to his records and, firstly, to the report to Mr Pirie of 3 December 2005, to which I have earlier referred. Dr Newlyn's detailed records subsequently became evidence in the proceedings. In those records, he had assigned, on each occasion that he saw the applicant, a "global assessment function". Dr Newlyn explained in evidence that this was intended to reflect the functionality of the patient. He said:
... God might get a 100, everybody else doesn't quite make it. Most of us function between 90 and 95; people at 80 are doing very well but are occasionally stressed by their work. At 70 you have got some stress; at 65 you are stressed but able to work.
In cross-examination, Dr Newlyn said that at 65 the global assessment function indicated that a person was visibly showing signs of stress but still able to work, but that below that level "it gets more dire." He said that at a level of 50 a person would be having difficulty with stressful work and that at level 45 he probably would not be able to work.
47The records of Dr Newlyn indicated that as at November 2005 he had assigned a global assessment function of 45. When he reported to Mr Pirie on 3 December 2005, he changed that to 65, without having seen the applicant in the interim. He was asked why such a change occurred and he said:
That was my - on reviewing my records I decided that I had made an error in assigning an assessment of 45 and it should have been 65.
Furthermore, Dr Newlyn conceded that in furnishing his report of 3 December 2005 expressing an opinion of fitness to return to full employment within two weeks, he had not seen the applicant since 3 November 2005 and had not discussed with the applicant in any way that he was of the opinion that the applicant would be able to return to the workforce at the end of 2005. This was despite the fact that on 3 November 2005 the applicant had told Dr Newlyn that he was continuing to have difficulties about his work situation and had not worked for a year, was continuing on medication prescribed by Dr Newlyn, that his condition was chronic and that he continued to suffer from major depression. When asked whether he had given consideration to the fact that the same person who the applicant had said had bullied him as his supervisor might again be present, Dr Newlyn said that he had given no consideration to this matter and could not deal with the issue. When asked to elaborate on his opinion, Dr Newlyn said:
... I really believe that in answering a question about whether a person can return to their pre-injury duties I'm not - my role there is saying: can the person return to work? It's the employer's responsibility to make sure that the workplace is safe.
He was then asked whether he should introduce some "disclaimer" about whether the applicant should work under the same supervisor as previously. He replied that in his experience of disclaimers "they're counterproductive." By this he meant that qualifications on return to work produced "extraordinary difficulties in returning people to employment."
48The upshot of Dr Newlyn's evidence was that he thought it would be more productive for the applicant to return to work under the care of Konekt, a rehabilitation provider, than not being at work. He would leave it to the rehabilitation provider and to the employer to ensure that the work that was provided was suitable for the applicant. At that stage, he was also unaware that the employer was considering medical retirement for the applicant.
49Dr Newlyn conceded that in expressing an opinion about the applicant's ability to return to work with NSW Maritime, he was not familiar with the jobs that were available with that organisation and that he was "not a workplace placement specialist".
50In re-examination, Dr Newlyn was asked about his opinion as to the applicant's fitness for work in May 2006. He said: "My opinion in May 2006 was that Mr Cameron could work, albeit maybe not at Waterways, but he could work."
51Dr Hugh Morgan, a specialist psychiatrist, commenced treating the applicant in November 2007 having been referred by Dr Coorey. In a report to Dr Coorey of 30 November 2007, Dr Morgan diagnosed a major depressive disorder, moderately severe, chronic. He prescribed medication, and referred him to a psychologist to undertake a course of cognitive behaviour therapy. Dr Morgan has continued to treat the applicant since.
52Dr Morgan was asked to provide a medical report to the applicant's current solicitors. That report is dated 10 August 2009. Dr Morgan said that the applicant remained "substantially disabled by his condition and ... very vulnerable to exacerbations in his condition due to relatively minor stressors ..."
53Dr Morgan said that he believed that the applicant was totally and permanently disabled at the time that he ceased to be employed by NSW Maritime in May 2006 in that he was then permanently unable to be employed in any remunerative occupation in which it would be reasonable to expect him to be able to engage but for his condition. He said that the applicant had reached "maximal medical improvement" and that his condition:
unfortunately has become chronic and I believe is very unlikely to improve much over the ensuing years. Mr Cameron has been struggling with symptoms of mixed depression and anxiety now for more than seven years ..."
54Dr Morgan gave oral evidence. It was put to him by counsel for the applicant that the applicant's long-term relationship had ended some four to six months before Dr Morgan had first seen him, and that prior to that time he had lived an active social life and had been a union delegate. He was then asked a question concerning the applicant's condition as at May 2006 and gave the following evidence.
Q. Does that assist you in determining how he was in May 2006 is or is not as you have seen him since 2007?
A. My impression when I first saw Mr Cameron in November 2007 was that he was quite significantly depressed and anxious. On balance of probability from looking at previous reports, from his account of events, I suspect that he is correct that he probably began to be depressed before 2002 and in my experience this is not an uncommon scenario that people may begin to develop a depressive illness and take time before they seek help. In my opinion I think that he really didn't recover over that time, despite treatment that he started with Dr Newlyn and I think that with his partner separating that this would have further exacerbated his problems.
55Questions were put to Dr Morgan by the respondent's counsel in cross-examination which emphasised the fact that the applicant had endeavoured to return to work on a number of occasions and that this might indicate some ability to work. Dr Morgan responded that it was not uncommon that patients endeavour to return to work. He said, "I think that's an entirely reasonable thing to do and sometimes that's successful and sometimes it's not."
56When pressed in cross-examination concerning the applicant's condition in May 2006 against the background of the opinion expressed by Dr Newlyn that the applicant had an ability to work, Dr Morgan said:
my impression is that the nature of Mr Cameron's condition is that it is chronic, that it tends to wax and wane, that's by its nature, that that tends to be affected by external events and that, I guess, I can't really say that specifically.
57Notwithstanding cross-examination, it was Dr Morgan's opinion, expressed as a clinical impression that he had obtained, that the applicant's condition was chronic and stable and that his incapacity in May 2006, as expressed in the report of 10 August 2009, was consistent with everything that Dr Morgan knew about the applicant.
58There appears to be only one report available from Dr Patrick Coorey. It is dated 9 February 2006 and indicates that the applicant was fit for suitable duties from 13 February 2006 to 17 March 2006. There is no hint as to what those suitable duties might be.
59The respondent relied on a report of Dr Michael Robertson, a consultant psychiatrist who had examined the applicant on behalf of the workers' compensation insurer of NSW Maritime Authority on 25 January 2005 and provided a report dated the same day. After setting out the history that he had taken, Dr Robertson diagnosed the applicant as suffering from "dysthymic disorder", complicating a personality with narcissistic traits. He thought that there had been a "work-related aggravation of Mr Cameron's personality ...", and that "the current problem is likely to be long-term."
60In assessing the applicant's then current capacity for employment, Dr Robertson said that he was unlikely to return to employment under the influence of the person whom he had perceived to bully him. Dr Robertson said:
I suspect that retraining and redeployment is the only credible option. I think he would be fit to return to work under a graded return to work program, with a rehabilitation provider, perhaps in a different field ... I do believe that ultimately this worker, if he is to return to full pre-injury hours, will need to be given a specific work description, subject to regular constructive performance reviews, although these are clearly industrial rather than clinical issues.
Dr Robertson proffered a prognosis in these terms: "This condition is likely to persist long-term. I suspect there will be long standing psychological distress."
61The applicant did not require Dr Robertson for cross-examination for reasons that are obvious given his opinion.