Injuries caused by slip and fall
22The evidence as to the injuries suffered by the plaintiff in her fall was inconsistent and confusing. The appellant gave evidence as to how she fell and the consequences as she perceived them. However, there was some psychiatric evidence that she suffered from an underlying borderline personality disorder which may have affected her perceptions and response to pain. Further, she saw a number of medical practitioners, some at least of whom were satisfied that she was exaggerating her symptoms. The picture was further complicated by the fact that she suffered other physical injuries between the date of the accident and the trial.
23Some of the issues might have been resolved by reference to the medical evidence. Unfortunately, there was a high degree of variability and inconsistency between the opinions of medical practitioners called for the plaintiff and those called for the defendant: neither side sought to cross-examine any expert called by the other. There was, indeed, no oral evidence from any medical practitioner. As the Court has commented on previous occasions, this situation gives rise to great difficulty for a trial judge required to assess conflicting medical evidence and determine factual issues as to injury and causation: for recent examples, see Morvatjou v Moradkhani [2013] NSWCA 157 at [110]-[113] (Tobias AJA) and P&M Quality Smallgoods Pty Ltd v Leap Seng [2013] NSWCA 167 at [104] (Hoeben JA, Tobias AJA agreeing). Despite these complaints, trials are not run for the ease of the court and if the parties decline to incur the expenses involved in calling experts, they cannot be required to do so, nor should they be. It is a matter for the court to apply appropriate principles in resolving the inconsistencies in the evidence proffered by the parties.
24Bearing these considerations in mind, it is necessary to consider the findings made by the trial judge. First, she set out the evidence given by the plaintiff as to the injury to her ankle and her back in the accident. She noted that whatever injury she sustained to her ankle, the effects were short lived and that her ongoing problems related to her lower back: at [38]-[40]. The trial judge rejected claims that a degree of bladder incontinence and seizures from medication were causally related to the accident, because there was "no medical support for either complaint": at [41]. This finding was not challenged on appeal.
25The plaintiff gave evidence that she had, since the accident, been assaulted by her boyfriend on a number of occasions and had been "in a couple of car accidents", having to be cut from the car and taken to hospital in the course of one accident. She said that she sustained injuries to her back and stomach in the accident, although the detail of those injuries was not established: at [42]-[44]. The trial judge made the following findings at [59]:
"I have concluded that the plaintiff did sustain an injury to both her ankle and back in the fall, but that both resolved within a few months of the incident. I accept that she experiences some pain or discomfort but I do not accept that she has an ongoing and severe disability occasioned by the fall in Coles. She has pain in her back, spine and leg but given the evidence about being bashed and being involved in at least one serious car accident since the fall, I cannot be satisfied that it was caused by the fall."
26The trial judge also expressed concern about "many troubling aspects" of the plaintiff's evidence. The reservations were twofold. First, the trial judge noted that there was disconformity between her appearance in the witness box, together with information she supplied to a Centrelink job capacity assessor and to a physiotherapist, on the one hand, and complaints of extreme disability made to medical practitioners and an occupational therapist, on the other. The second reservation related to a concession that she used cannabis occasionally, as contrasted with a record made at Gosford Hospital on 13 December 2009 that both she and her partner smoked "very heavily": at [60] and [61].
27It is necessary to give careful consideration to this evidence and the findings and, in particular, any explanation the witness may have given in the course of her evidence for such inconsistencies. It may be that the inconsistencies are such that it is not possible for the trial judge to resolve them in a manner favourable to the plaintiff. On the other hand, the fact that the plaintiff exaggerated her symptoms on one occasion to a particular medical practitioner does not necessarily mean that her evidence in court is not credible.
28With respect to the consumption of cannabis, the appellant was asked by her counsel if she occasionally smoked marihuana for pain relief since the accident: Tcpt, 23/02/12, p 17(5). She agreed that she had done but was no longer doing so. She also agreed that when she was younger she had tried "a lot of different drugs including marihuana". She denied that she was "a regular drug user at the time this accident occurred", stating that she was actually not taking anything: p 17(18). In cross-examination she was asked if she was using cannabis heavily before the fall at Coles and denied that she had smoked while she was pregnant with her daughter Crystal, or thereafter: Tcpt, p 34(5). It was also put to her that she had told a child protection social worker at Gosford Hospital, about nine days after the fall that both she and her boyfriend smoked cannabis "very heavily". Her answer and the ensuing questions were as follows (Tcpt, p 35):
"A. I said I would have had marihuana in my system, but I didn't say that I smoke it, because I had a lot of people smoking it around me.
Q. It was the case wasn't it that you were smoking marihuana heavily leading up to the fall as way of dealing with your life situation, isn't that right?
A. I didn't smoke it, I had people around me smoking it.
Q. You said that to that social worker didn't you?
A. I don't remember saying them words to her at all."
29It appears that, at least implicitly, the trial judge rejected her oral evidence, which she described as "at odds with" the notes from Gosford Hospital, and disbelieved her explanation. (The judge attributed the date of the interview at Gosford Hospital to 13 December 2009, but, as put to the plaintiff in cross-examination, it in fact took place on 18 December.) The interview took place whilst the plaintiff was a patient in the hospital, at a time when her boyfriend came to visit and an argument erupted, leading to the intervention of the social worker and later security staff. What turned on the discrepancy as to the statements about cannabis use was not clear.
30The other matter, which appears to have directly affected the assessment of the plaintiff's evidence, was the proposition that her presentation to medical practitioners and to the occupational therapist as "extremely disabled and unable to perform even basic daily tasks ... was entirely at odds with her presentation in the witness box ...": at [60]. That matter was raised at an earlier point in the reasons where, after setting our her evidence of her injuries and current symptoms, the trial judge stated:
"45 I had the opportunity of closely observing the plaintiff when she gave evidence. She walked unaided and without any sign of disability from the body of the court to the witness box and back. She sat in the witness box for almost three hours without a break. She did not shift position or complain of any discomfort in that period. It is possible that she was being stoical but that explanation does not sit conformably with the way in which she presented to the various medical practitioners.
46 In the witness box, she presented with a particularly flat affect, but denied taking any medication or drug prior to giving evidence. It is possible, as her counsel suggested, that she is severely depressed.
47 I can only assess the plaintiff based on how I observed her to be, and in accordance with the evidence."
31There are three difficulties with this passage. First, the estimate of time was significantly inaccurate. The transcript recorded that she was affirmed and commenced her evidence at 11.31am: Tcpt, p 7. Assuming that the lunch adjournment was taken at 1pm, she was therefore in the witness box for a period of 1.5 hours. It is clear that the lunch break did not end at the usual 2pm, as her counsel apologised for the delay at the recommencement: Tcpt, p 39(20). Her subsequent evidence extended for approximately one-third of the transcript of the morning's evidence: accordingly, she was probably in the witness box for half an hour after lunch. The proposition that she "sat in the witness box for almost three hours without a break" was mistaken.
32Secondly, there are great dangers in a trial judge seeking to assess the severity of a medical condition or disability by watching the person's presentation in court: in Chaina v Alvaro Homes Pty Ltd [2008] NSWCA 353 I noted that a trial judge is entitled to take account of observations of a witness, or party, in the courtroom, including whilst not in the witness box: at [31], referring to Government Insurance Office of New South Wales v Bailey (1992) 27 NSWLR 304 at 313 and 323. I suggested that such an exercise should be approached with caution, whether the plaintiff was in the witness box or not, reasons for caution including "the possibility that a condition may fluctuate; that a person unfamiliar with the courtroom environment may react differently in the courtroom and outside it, and that the judge does not have medical expertise": at [31]. (This was not an extreme case of a trial judge reaching a view based on his or her own reading of an MRI or scan, but the underlying concern is similar: cf Strinic v Sing [2009] NSWCA 15; 74 NSWLR 419 at [58]-[64].)
33Thirdly, and related to the second point, the trial judge should not have drawn inferences from the presentation of the plaintiff in the witness box as to the seriousness of her medical conditions without identifying the possibility of such an inference being drawn and inviting counsel to raise it with the witness or, if they did not wish to do so, raising it herself. Failure to take that step, at least where the available inference was not obvious to others in the Court, involved an element of procedural unfairness. (Even if a judge considers a possible inference is obvious, it will usually be desirable at least to alert counsel to the possibility.)
34The trial judge concluded that "there is a degree of exaggeration by the plaintiff of her symptoms, particularly when she was presenting to various medical practitioners": at [62]. (Some of the practitioners took a similar view.) However, read in the context of her reasons as a whole, it appears that her own assessment of the plaintiff in the witness box influenced her assessment of the plaintiff's current state of disability. It is not possible to dismiss the procedural unfairness as having no possible influence on the outcome of the trial: cf Stead v State Government Insurance Commission [1986] HCA 54; 161 CLR 141 at 147. To the extent that the outcome in the present case depended upon the proper assessment of the plaintiff's evidence, there would need to be a retrial.
35Whether that result follows requires some further assessment of the way in which the trial judge disposed of this aspect of the case. The relevant passage, at [59], is set out at [25] above. Two significant findings derive from that passage. First, although the trial judge apparently thought that the plaintiff exaggerated her symptoms, she held that the plaintiff continued to suffer pain in her "back, spine and leg". On that view, it might be arguable that the "many troubling aspects" of the plaintiff's evidence were not ultimately relied upon to dismiss her complaints of suffering. (If that were correct, it would also follow that little turned for present purposes on the inconsistencies within the medical evidence.)
36Secondly, and more plausibly, the passage suggests that the assessment of the plaintiff's claim of injury suffered in the fall turned not on her description of her disabilities, but on the issue of causation. That issue required findings as to other possible causes of the disabilities she continued to suffer. At [42] the trial judge said:
"She also said that since the accident, she has been assaulted by her boyfriend on a number of occasions, and required treatment from her general practitioner. She said that she was 'bashed pretty badly' on one occasion and that he kicked her."
37It was true that the plaintiff continued to suffer assaults from her boyfriend after the accident, but the one to which the trial judge referred occurred almost a year before the accident. In chief, the plaintiff gave evidence that she had attended Gosford Hospital after being assaulted: it was put to her that the date was March 2008, although she was not sure of the date: Tcpt, p 18(10)-(20). No further detail as to that event was adduced. The evidence continued in relation to a later event:
"Q. I think you saw Dr Haberfield on 29 January 2009?
A. Dr Habberman.
Q. Did you tell him you had been in a car accident?
A. Yes.
Q. And was that a correct statement to that doctor or not?
A. No I --
Q. What had in fact happened to injure you at that time?
A. I actually got bashed pretty badly by Clinton.
Q. And was that something you didn't want to tell the doctor?
A. Yes."
38The plaintiff was cross-examined in respect of this incident and asked, at Tcpt, p 30(20):
"Q. Why did you make up that story that day?
A. Well I was scared it would have happened, I would have got beaten worse, because I thought the doctor would have had to say something to someone and he would have got into trouble for it, and I didn't actually want him to get into trouble because he was the father of my daughter."
39The plaintiff was cross-examined about the nature of the injuries and said that she was "limping a little bit, it was because I had pretty bad bruising", which she identified as being "up on my side" and said that she had been kicked twice by her boyfriend. She denied suffering back problems immediately before the slip at Coles.
40The words quoted by the trial judge at [42] make it clear that this was the incident to which she was referring. It was not an incident that had occurred since the accident, but prior to it. There was no reference in the evidence to her having received medical treatment for domestic violence after the accident.
41The trial judge then noted at [43]:
"43 She said that she had been in a couple of car accidents since the fall in Coles. In the first accident she said she was hurt but said nothing so as not to 'get the driver into trouble'.
44 In the second accident, however, she had to be cut from the car and taken to hospital because 'I couldn't feel my legs'. She said that she hurt her back and stomach in the accident. No evidence was led as to the injuries she had sustained in the accidents and the likely effect of those injuries on her back pain."
42The plaintiff gave evidence in chief as to those accidents, which it was suggested to her occurred in April 2011 and August 2011: Tcpt, p 19(25). Counsel was apparently questioning on the basis of references "in medical material". With respect to the first accident, she gave the following evidence as to her injuries, at Tcpt, p 19(42):
"Q. What did you injure in that incident?
A. My back and I didn't have a - I lost a bit of the feeling in my leg I didn't feel, I couldn't feel it properly.
Q. Was that the same or different sensation to what you'd been feeling since the slip and fall in Coles?
A. It was the same sensation that I was getting.
Q. Do you think your back and/or leg felt permanently worse or temporarily worse after that motor accident?
A. Well I didn't --
...
Q. Did it get worse and stay worse or was it just a short term thing?
A. It got better after a little bit.
Q. You haven't put in any claim or court papers or anything in relation to that incident?
A. No."
43The plaintiff then gave evidence of a further accident in which she had to be cut from the car and taken to hospital "because I couldn't feel my leg at all": Tcpt, p 20(23). Again she described pains in her back similar to that which she had felt since December 2009, "like it was just a sharp cramping pain and like it just felt like it was stabbing and burning my back": Tcpt, p 20(35). She said it got better "a short time after" and that she had made no claim in relation to that incident: Tcpt, p 20(45).
44The plaintiff was asked no questions about injuries suffered in the 2011 car accidents in cross-examination. She was, however, asked about "other incidents of violence" between her and her boyfriend since the fall at Coles. It was put to her that in one of those incidents she had hurt her back, a proposition with which she agreed: Tcpt, p 47(30). It was also put to her that one was a few weeks after the fall, namely in February 2010. She said she did not know the date but agreed there was a time when she went to Wyong Hospital as a result of an incident: Tcpt, p 47(30)-(39). That incident was not relied upon by the defendant as giving rise to further injury; rather it was relied upon as the occasion on which the plaintiff was seen by a physiotherapist who made a record consistent with the plaintiff no longer suffering significant physical disabilities. The cross-examination (Tcpt, p 46) was as follows:
"Q. A note from the physiotherapist of 24 May 2010 it says 'Patient 30 minutes late for appointment', do you remember being late for a physio appointment around that time, that's about six months after the fall at Coles?
A. Is that the one where I had to go into the hydro pool or the other, because I actually had to do a hydro physio.
Q. I can't help you. Do you remember being 30 minutes late for an appointment around that time or not?
A. Possibly could have been late if I was having another argument with Clinton.
Q. The note says something 'Report much improved, only very occasional spasm', do you remember saying something like that, 'Much improved' around that time?
A. I told them once that it was getting better because of Clinton said he wasn't going to be taking me in there to do it any more and I wasn't able to get into the hospital any other way.
Q. The note goes on to say 'Able to run, do sit ups and pick up child', you said those things to the physiotherapist on 24 May 2010 didn't you?
A. Yes only because I knew I wasn't going to be able to get back in there to do any more physio because Clinton had told me he wasn't going to help me to take me in there any more.
Q. So your evidence is that you couldn't do any of those things but you made that up to the physiotherapist is that right?
A. Yes, so then --
Q. Because you knew you weren't going back anyway so you might as well tell a lie about it is that right?
A. Because when I spoke to her about it she said that I needed to keep going and doing more and I said 'Well I won't be able to get in anyway to come in and do them' and she wasn't like listening so I just told her that when I went back the next time that I was able to do heaps of things that I couldn't actually do so she wouldn't sit there and ask me questions.
Q. So you told her could do all those things just so you wouldn't be asked any more questions is that right?
A. Yeah."
45The trial judge relied upon the notes of the physiotherapist as one of the "troubling aspects" of the plaintiff's evidence at [60]. However, if by that remark she intended to indicate that that material supported her conclusion that the plaintiff's injuries from the fall had "resolved within a few months of the incident" (at [59]), it was necessary to make a finding that some subsequent injury was the cause of her current disabilities, from which it was expressly accepted she still suffered. Those can only have been the car accidents, about which the plaintiff gave evidence in chief and as to which the trial judge had no medical evidence of any specific injuries. No doubt there was some inconsistency in the plaintiff's evidence in acknowledging that the pain she suffered following the car accidents was similar to that arising from the fall at Coles, but that it had resolved after a short time, in each case. A possible finding, on the basis of that evidence, was that the plaintiff no longer suffered pain in her back or legs; however, the trial judge made a contrary finding, namely that she continued to suffer such pain.
46These difficulties with the findings made, when related to the chronology and the evidence, demonstrate that the finding as to lack of causation cannot stand.