JUDGMENT
1 MASON P: The respondent worker was employed by the appellant as a potato grader. On 7 May 1987 she was injured when she came into contact with the potato-brushing machine. She suffered severe laceration to the right ear and face and a blow to the head.
2 She was taken to the Repatriation General Hospital at Concord. The immediate history taken by the resident medical officer was:
Lacerated upper portion pinna of right ear at work on a potato machine - piece almost severed. No loss of consciousness.
The injury was sutured and the worker was discharged on the day of admission. Two days later she returned to Concord Hospital complaining of a very painful ear, headaches, flu-like symptoms and fever. The diagnosis was "early infected ear and flu". Daily dressings were prescribed .
3 On 17 June 1987 the appellant terminated her services. Workers Compensation payments were made for a few months and thereafter she went onto sickness benefits. She never returned to work.
4 On 25 June 1987 she presented to a general practitioner, Dr Vo complaining of headache, dizziness, painful right ear lobe, ringing in the ear and vomiting. During 1987 she returned on eight further occasions. Her right ear was not improving and had poor cosmetic appearance. The doctor treated her with various medications and subsequently referred her to an ear, nose and throat specialist who told her that she had "just an outer problem". In 1988 she presented eighteen times with the same complaints to the general practitioner. She was referred to a neurologist and an otorhinologist.
5 On 17 October 1988 she was interviewed by a consultant psychiatrist, Dr Wong, in the presence of her elder brother. The brother gave the history that:
Some ten days ago there was a marked change in her in that she suddenly behaved very irrationally. She threw away a lot of food at home and woke everybody up very early in the morning. She told her brother there was no need for him to go to work as she had bought a factory. She also mentioned that her mother had bought a house in Hurstville, which was entirely untrue. She repeatedly removed books from a bookcase, put them on the floor and then replaced them on the book case. She took several showers a day, at times in the middle of the night and on one occasion came out of the shower with her hair dripping wet. She went without food for 2-3 days during which she drank only water. She did not express any unequivocal paranoid ideas, although she mentioned on one occasion that she would no longer have to die now that she "was back". Her brother recalled that she had one similar but more severe episode 10 years ago, when she was in a refugee camp in Malaysia. On that occasion she cried and laughed for no apparent reasons and complained of being harmed, although she did not elaborate on that. That episode came shortly after she arrived in the refugee camp and subsided gradually with medication after 1-1½ months. She has had no recurrence until the present episode.
6 In his report, Dr Wong recorded that the worker was reasonably cooperative when she saw him, although her answers were rather laconic. She told him:
in a rather matter-of-fact manner the accident she had in her factory. She said that since the time of the accident she had been having gripping pain on the right side of her head associated with discomforts on the right side of the neck, the right shoulder and the right upper extremity. However, she appears rather reluctant to go into her personal history although later during the interview she appeared rather more forthcoming. However, she displayed no incongruities in her emotions or any other unequivocally psychotic features.
Dr Wong was unable to come to a firm diagnosis on the basis of the interview, although his initial impression was that the worker had had a "hysterical reaction" .
7 Dr Wong saw the worker again on 25 October and 8 November 1988. He subsequently reported that:
… her condition had settled down quite considerably. She slept well and she manifested no further unusual behaviour. Both she and her brother gave the further history that all along she had led a very sheltered existence. She has very few friends and rarely went out and when she did, it was only with her family which is very closely knit. She has few hobbies and was used to occupy herself with listening to music, watching television and reading the newspapers. She is now 27 but her mother would not allow her to go out except to visit her sister who is some 10 minutes away. When she went to work her sister took her to and from work as her mother was concerned that she would otherwise be let astray. Apparently her parents have been over protective towards not only Miss Tu but her siblings as well and they got to know their spouses through introductions by their parents. Miss Tu told me that she was not unhappy with her present lifestyle and not too worried, even though she was unable to resume work.
8 In his report stemming from these visits, Dr Wong referred to his earlier, initial impression about an hysterical reaction. He stated that the further history he obtained and the "prompt disappearance of her symptoms" supported that diagnosis. He felt that the reaction had come about as a result of stress acting upon the worker's rather vulnerable personality.
9 Unfortunately the worker's psychiatric condition deteriorated. By 1991 at the latest she was diagnosed as suffering a form of schizophrenia whose present symptoms are extremely debilitating.
10 In June 1998 the worker filed an application in the Compensation Court claiming weekly compensation from 29 May 1987 onwards. The injuries stipulated in the application (as subsequently amended) were:
(i) injury to the head;
(ii) injury to the right ear;
(iii) lacerations to the face
(iv) precipitation of schizophrenia.
11 The proceedings came on for hearing in the Compensation Court in May 1999 before Commissioner Hunt. By that stage the issues had clarified so that the sole question for determination was whether the accident on 7 May 1987 was a contributing factor to the worker's schizophrenia which, by then, was clear and profound.
12 The appellant employer put the worker to proof (see Red 7).
13 There was no eye witness account of the accident. The worker was unable to give any substantial evidence in the proceedings (see Black 2). Her principal witness was her sister Jennifer Au who described what she observed at the hospital on the day of the accident, and subsequently. She was her tutor in the proceedings.
14 Ms Au gave evidence of the circumstances in which her sister descended into ultimately uncommunicative mental illness. The critical issue addressed in her evidence in chief and cross examination was when and in what circumstances the symptoms later diagnosed as schizophrenia first manifested themselves. Her answers in cross-examination substantially qualified the chronology of immediate signs of mental deterioration given in her evidence in chief (Black 18-19).
15 One workmate and one family friend of the worker gave evidence (Black 20-24), but they were unable to cast any real light on the details of the accident or the critical causation issue.
16 The worker's counsel tendered a number of medical reports. They included reports from Concord Hospital, Dr Wong, Dr Vo and Bankstown/Lidcombe Hospital (where the worker was admitted on a number of occasions after August 1991 when her schizophrenia was already manifest).
17 The worker's counsel also tendered three reports of Dr Frith, a neurology-internal medicine specialist who first treated the worker on 30 May 1988. He took a history that the worker had been unconscious for six hours as a result of the accident. He diagnosed a severe crush injury of the right ear with subsequent disfigurement. He observed the appearance of super-added anxiety state causing nausea and hemicrania. X-rays of the worker's cervical spine and skull taken in 1987 revealed no abnormality. Later reports of Dr Frith recorded the worker's piteous state compared to her earlier condition.
18 There was also a report from Dr Lorentz, a consultant psychologist who saw the worker in April 1988. He too was given a history of loss of consciousness for "up to a few hours or perhaps a day". At that stage the worker was able to answer questions through an interpreter "in an oblique fashion" (Black 76). Dr Lorentz found her post-concussional headaches difficult to classify. He expressed no opinion as to the present issue of causal link, which is hardly surprising given that he did not diagnose schizophrenia.
19 The other reports were from consultant psychiatrists, being those of Dr Grace, who treated the respondent from 1992 onwards, Dr Law, who first saw her in October 1994 and Dr Strum, who saw her for medical-legal purposes in 1999.
20 In his reports, Dr Grace recorded that the worker had never spoken a word to him and that she spent her whole interview muttering inaudibly to herself whilst twiddling her thumbs. Her history was provided by her mother through an interpreter. Dr Grace was told that the worker had lost consciousness in the accident (Black 99). The history was also to the effect that headaches and dizziness had occurred in the months following the accident. Her change of behaviour, including refusal to go outside the home, led to the breakup of the marriage.
21 Dr Grace's reports diagnosed schizophrenia. He cited the history given by the worker's brother to Dr Wong (par 5 above). In his report of 25 January 1994 his conclusion was that
I believe that the accident possibly precipitated or unmasked the current episode of psychosis in a lady who had shown previous evidence of psychosis.
22 A later report (16 July 1996) referred to the evidence from Concord Hospital to the effect that the accident caused no loss of consciousness. Based on this, Dr Grace concluded (Black 104):
In my opinion this extract of report is inconsistent with Ms Tu having sustained a significant head injury of the kind likely to lead to brain damage. As mentioned in my report dated 24 January 1994, Ms Tu has been investigated for brain damage by CT Brain Scan, EEG and SPECT Scan. None of these investigations found definite evidence of brain damage.
…
In relation to whether Ms Tu's condition is a result of her injury on 7 May 1987, it should be emphasised that although it is possible that the accident precipitated her becoming psychotic at that time, it could no way explain her having ongoing illness as there was no brain damage caused by the accident.