Medical opinion
61The majority of the medical opinion favours the plaintiff. I do not think it all requires description here. I do think it necessary to state some matters of primary focus. The defendant had the plaintiff examined by Dr Anthony Lowy, an occupational physician, in April this year. No report has been served from this doctor. I infer that the contents of the report would not have assisted the defendant's case. The defendant also had the plaintiff examined by a Dr Smith, an orthopaedic surgeon.
62Dr Searle, an orthopaedic surgeon, provided the plaintiff's solicitors with two reports. The first is dated 4 September 2010 (Exhibit B, page 447). The second is dated 30 August 2013 (Exhibit C, page 452). Dr Searle also gave oral evidence.
63In his first report Dr Searle records that he was told by the plaintiff that he had no history "of any symptoms or injury relevant" to his lower back. Accordingly, the doctor thought the protrusion of the L5/S1 disc was due to the injury in November 2009. When Dr Searle reviewed the plaintiff in August of this year he was also provided with the documents from Orange Base Hospital in 2004 and from Blayney Hospital in 2007 (Exhibit B, pages 294-300). Armed with the further information Dr Searle stated in his second report:
"I note that I previously suggested his injury occurred at work on 5/11/09, but the documents indicate there were at least two previous back injuries at work. The ongoing symptoms from the aggravation of his L5/S1 disc problem on 5/11/09 are persistent and permanent and cause a severe degree of disability."
64Dr Searle therefore amended his opinion to change the L5/S1 disc injury from a product of the 2009 incident to an aggravation of an earlier condition caused by the two prior back incidents.
65When Dr Searle gave evidence he seemed to alter his, now amended, position by stating that the two earlier incidents were probably no more than muscle strains. The only extra information that he had in the witness box was the assumed history that the earlier incidents were shortlived and the plaintiff soon returned to work.
66When I pointed out the inconsistency between his oral evidence and his second report, Dr Searle said that it was very difficult to reach any firm conclusion and that the possibilities included there being both a fresh injury and an aggravation in 2009. It was central, I think, to the doctor's opinion in the witness box that he was asked to assume that the effects of the two earlier injuries were very limited. I do not think this accurately reflects the whole of the evidence. When the plaintiff attended the Orange Base Hospital it was already some six days following the injury. Although scans were not ordered he was provided with painkillers, directed not to lift and to consider consulting a physiotherapist. In addition, the triage nurse noted that his "back has been progressively getting worse ... some pain down legs and around into sides".
67When the plaintiff went to the Blayney Hospital in 2007 he gave a history of spinal injury including a disc prolapse. In addition, the plaintiff said that he had some episodes of back spasm, although infrequent and only after sitting for some hours on a forklift.
68Dr Searle was asked to comment on the report of Dr Smith in which Dr Smith says the results of the MRI scans are what one would normally expect to see in a person of the plaintiff's age. Dr Searle makes no mention of any of the observations in the MRI scans besides the problem at L5/S1. I asked him whether this meant that the other observations in the scans were of no significance. He said he concentrated on L5/S1 because that was his best estimate of the origin of the plaintiff's problems. On one view the doctor's disregarding of the other signs tends to corroborate Dr Smith's opinion that the various signs in the plaintiff's back are 'normal' for a person of his age. On the opposite view Dr Searle's emphasis of L5/S1 singles that area from the other signs suggesting that it stands out as an area of traumatic injury.
69I will return to Dr Smith's report below but state now that I generally reject it. I think Dr Searle's second report is more likely to be correct than his oral evidence when one factors in the fuller history given by the plaintiff and contained in the earlier notes. In my view, the preponderance of the evidence suggests that the incident on 12 November 2009 involved an aggravation of an already existing condition and that that aggravation has persisted to the present time and is the cause of the plaintiff's continuing disability.
70Dr Searle's opinion was that the plaintiff was effectively unemployable. He was not challenged on this opinion, nor was he shown the DVD which the defendant submits indicates the plaintiff has a greater capacity than he admits.
71Dr Smith's report (Exhibit D1, page1) is generally unimpressive. It has the air of advocacy about it, emphasised by strong statements of fact with little or no justification. The plaintiff said that when he saw Dr Smith the appointment lasted five to 10 minutes and there was no physical examination.
72Presumably as a result of the plaintiff's allegations, Dr Smith was called to give oral evidence. Dr Smith said he did examine the plaintiff and the entire consultation would have lasted in the order of 30 minutes. I could not reach a conclusion that there was no examination carried out by the doctor; however I can well understand a perception by the plaintiff that the examination was cursory.
73I was troubled by a number of aspects of Dr Smith's evidence and report. These include the following:
(a)The report is replete with examples of stark conclusions with no foundation. For example:
(i)On page 9 he says, "I would have considered that aggravation would have been short lived. I consider he has long since recovered from that". The doctor gives no basis for stating the aggravation was short lived. Also on page 9 the doctor says, "he is manufacturing physical signs". He carries on, "he is much better than he makes out he is". The justification for this, which could not be valid, is that his spine would have been the same in 2007 and 2008.
(ii)On page 10 the doctor says, "there is no reason why he is not fit for work in my opinion". He does not say why he forms this opinion. He then goes on to quote from a paper about the prevalence of degenerative disease. I excluded this material from the report because it does not appropriately give the reference or reasoning behind it. To simply say, "Powell et al published a paper" is not enough to enable the plaintiff to deal with the conclusions then set out or meet the requirements of an expert report.
(iii)On page 11 Dr Smith says the plaintiff has no requirement for domestic or handyman assistance. He continues "there never has been and there will not be as a result of this accident". Again, there is no proper reasoning for this conclusion.
(b)In relation to the domestic assistance, I asked the doctor why he would not have even given the plaintiff the benefit of a week or two while in pain after the injury of not being able to do any domestic activity. The doctor, to my observation, struggled to give an answer, ultimately coming up with an unsatisfactory "At the end of the examination that's what I thought would be appropriate to say. I mean, I must admit I didn't see it then, but I can't imagine it would cause any significant requirement for domestic assistance." (T 315.28)
(c)Dr Smith agreed that the observations made by Dr Porges (Exhibit B, page 443) were indicative of objective signs. Dr Smith's view does not countenance such a result; however, he would make no concession based on such a result.
(d)Dr Smith said that it was his practice that if he did not think that a document that he had been asked to consider was relevant to his opinion, then he would not mention it. It was for this reason that he had not made any mention of Dr Searle's report of 2010 when providing his own opinion. I fully understand that when a doctor is presented with a number of documents he might not mention all of them in his own report. However I find it unusual that Dr Smith would have made no mention of Dr Searle's opinion, which was diametrically opposed to his own. Dr Searle, like Dr Smith, is an orthopaedic surgeon and one would have expected there to have been some consideration put forward as to why Dr Searle was so obviously wrong.
(e)Dr Smith agreed that on the same day that he wrote his report he also wrote a separate letter to the defendant's solicitors suggesting surveillance of the plaintiff. It was put to him that this was inconsistent with his undertaking to provide a report as an independent expert. He said that the suggestion was the same as a suggestion to, for example, obtain missing medical reports or results of scans in order to allow him to give a full opinion. In my view, such a request is quite different to a suggestion that surveillance be conducted. Putting aside whether or not it is inconsistent with the code of conduct, it is consistent with the overall tenor of the report, namely the assumption of an attitude of advocacy for the benefit of the defendant.
74Because of the unfavourable impression I formed of Dr Smith's evidence and his report, as set out above, and the almost solitary position held by him, I reject his opinions. This position is enforced by my general acceptance of the plaintiff and the mass of medical opinion in his favour. I also note the implicit rejection of Dr Smith's views by the defendant. The figures put forward by the defendant on quantum are entirely inconsistent with the doctor's views. For example the defendant suggested non-economic loss of 28% of a most extreme case, economic loss to date, and a substantial buffer ($150,000) for the future. On Dr Smith's views non-economic loss would be less than 15%, past economic loss of a short duration and there would be no future loss at all.