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[2000] VSCA 221
Court of Appeal (Vic)
2000-11-23
WINNEKE, P., PHILLIPS and CHARLES, JJ.A.
Original judgment source is linked above.
Accident compensation - Transport accident - Paraplegia of male victim, affecting fertility - Inability of victim to impregnate wife normally - Need for IVF attempt - Procedure to include extraction of sperm, extraction of eggs and replanting in wife's body after fertilisation - Whether cost of "medical service" payable by the Commission as compensation "in respect of" the victim - Whether "medical service" was "received" otherwise than by the accident victim - Whether cost must be payable "to" the victim - Transport Accident Act 1986 ss.35(3), 60(1)(a).
"A series of electro-ejaculations was organised with Dr Terry Lim and these were performed on 20 and 21 July 1998. The samples obtained contained a high concentration of sperm but the majority were dead and the sperm motility was less than 1% in the first sample and only 4% in the best part of the second sample. These samples have been stored frozen. In my opinion the quality of these samples is insufficient to give the couple a reasonable chance of obtaining a pregnancy by artificial insemination and that they will need intracytoplasmic sperm injection (ICSI) as part of an in vitro fertilisation (IVF) attempt. This pattern of abnormality of semen is common in men with chronic spinal cord injuries. Sperm production is normal but the sperm degenerate in the genital tract because of the loss of normal nerve function. With ICSI we have been able to obtain high fertilisation and pregnancy rates in couples with chronic spinal cord injury in the man. Other similar patients with spinal cord injuries are successful in at least 50% of cases. Modern management of male infertility associated with spinal cord injuries often allows the couple to have children and a normal family life. This has obvious benefits to the injured man to improve his quality of life and to continue his rehabilitation and diminish the social disadvantages of this horrible injury."
In an earlier report, dated 21 April 1998, there is a somewhat fuller description of what was involved in intracytoplasmic sperm injection and its relevance to the appellant's condition. Dr. Baker wrote then:-
"Initial attempts to obtain sperm from [the appellant] before 1991 were not successful, although sperm were seen in a urine sample and thus there is some hope that sperm could be obtained for treatment but this would involve in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) because of the very low sperm numbers that we are likely to be able to collect. The introduction of ICSI in 1993 has revolutionised the treatment of male infertility. Couples in whom there were too few sperm for natural pregnancy or standard IVF can now be treated with a reasonable expectation of having children. However, this treatment involves the woman having drugs to stimulate the development of a number of eggs, a minor surgical procedure to collect the eggs, extensive laboratory work to inject the sperm into the eggs and culture the injected eggs during the early phases of fertilisation and embryo development. The fertilised eggs are then transferred into the uterus or frozen. These procedures carried out on the woman are done for male fertility. In [the appellant's] case, the infertility arises directly from his spinal cord injury caused by a transport accident."
"(3) The Commission is not liable to pay compensation to a person in accordance with this Act unless the person is entitled to compensation."
Section 60 is found in division 3 of the Act, which is headed "Benefits". It commences:-
"60. Medical and like benefits (1) In addition to any other compensation paid under this Act, the Commission is liable to pay as compensation in respect of a person who is injured or dies as a result of a transport accident - ...".
What follow are five lettered paragraphs, each of them describing various costs that might be incurred in consequence of death or injury in a transport accident. In particular paragraph (a) reads thus:-
"(a) the reasonable costs of road accident rescue services, medical services, hospital services, nursing services, rehabilitation services and ambulance services received in Australia because of the accident; ...".
"'hospital service' includes- (a) maintenance, attendance and treatment in any hospital; and (b) the provision by any hospital of- (i) medical attendance and treatment; and (ii) nursing attendance; and (iii) medicines, medical, surgical and other curative materials, appliances or apparatus; and (iv) any other usual or necessary services provided by a hospital with respect to the treatment of the injury of a person; ... 'medical service', except in Part 10, includes-
(a) attendance, examination or treatment of any kind by a medical practitioner, registered dentist, registered optometrist, registered physiotherapist, registered chiropractor and osteopath or registered podiatrist; and
(b) attendance, examination or treatment of any kind by a registered psychologist on referral from a medical practitioner; and
(c) the provision, and as may be necessary from time to time (including at the time of an injury) the repair, adjustment or replacement of skiagrams, crutches, artificial members, eyes or teeth, spectacle glasses or hearing aids; and
(d) the provision by a registered pharmacist on the request of a medical practitioner or registered dentist of medicines or curative apparatus, appliances or materials; and
(e) the provision by a medical practitioner, [etc.] of any certificate or report required by the person or the person's dependants for any purpose relating to the operation of this Act; ...
(a) means the provision to or for a person for the purpose of rehabilitation of any aid, treatment, assistance, appliance, apparatus or any other service; and
(b) without derogating from the generality of paragraph (a), includes the provision to or for a person for the purpose of rehabilitation of attendant care, household help, modifications to a home or a motor vehicle, counselling or transportation costs-
if the provision under paragraph (a) or (b) is of an authorised service in accordance with section 23; .."
There is a definition in s.3 of "reasonable", another word appearing in s.60(1)(a), but I pass that by; the question whether the costs actually incurred were "reasonable" for the treatment involved was not a question raised for determination on this appeal.
"Accordingly, both the Applicant and the TAC submit that Section 60(1) provides for their different contentions about whether or not IVF treatment provided to a couple in circumstances whereby the husband is infertile in consequence of injuries received in a transport accident, is a service contemplated as being compensated under the Act. There is no dispute that the Applicant is infertile because of the injuries received by him in the transport accident. The issue for determination by me is whether or not the treatment required to avoid the consequences of such infertility is compensable under the Act."
The transport accident occasioned the appellant's infertility and the treatment (whether "received" by the husband or the wife) is a treatment which in toto is administered only because of the appellant's condition and solely for the purpose of the appellant's impregnating his wife. The treatment involves the wife not because of any defect in her reproductory system; it involves her only because of the defect lying now within the appellant who cannot himself impregnate his wife unless they both undergo this treatment. I am not yet persuaded that s.60(1)(a) is to be read as subject to any further limitation than those to be found expressly within paragraph(a) itself and the introductory words of the subsection; but supposing that the words "received in Australia" were properly to be read as the Commission urged, I think that in this case, notwithstanding the necessary and willing participation of the appellant's wife, the medical treatment in question, in all its component parts, is properly described as "received by" the appellant and the reasonable cost of the services involved is therefore the liability of the Commission.
It is enough that the services fall within the definition of "medical services" and that as such the reasonable cost of those services is properly the liability of the Commission under s.60(1)(a).
[1] F.C.T. v. Scully [2000] HCA 6; (2000) 74 A.L.J.R. 504 at 513, 520
[2] unreported, Supreme Court of Victoria, 19 April 1995
Denton
Transport Accident Commission [2000] VSCA 221