PERCENTAGE OF A MOST EXTREME CASE
- Prior to the fall, Mr Fry had suffered significant injuries to his left leg in 1978 resulting in six months off work, to his knee in 2009 resulting in three weeks off work, and also had time off work for a lower back injury in 2013 and 2014. He also had a whiplash injury in 2014 and related neck difficulties, and a right hamstring injury that same year.
- Section 151E(1) of the Workers Compensation Act 1987, as applicable, contemplates an award of damages being available for an injury caused by the negligence of Ravensworth. Damages for Mr Fry's non-economic loss must be awarded in accordance with s 151G. [4]
- Section 151G(2) provides that:
"The amount of damages to be awarded for non-economic loss is to be a proportion, determined according to the severity of the non-economic loss, of the maximum amount which may be awarded".
- The parties agree that the maximum amount of non-economic loss is $411,275, to be awarded "only in a most extreme case". [5] Thus, the Court must determine the proportion which Mr Fry's non-economic loss damage bears to a most extreme case.
- Mr Fry accepted that he has, apart from a short two to three-week period in November 2018 when his condition was being assessed, continued to work the same hours and the same 12.5-hour shifts day and night since the incident as he had prior to the incident. His duties have changed in that he now works mainly on the water cart, whereas that was a relatively small proportion of his total work prior to the incident.
- In cross-examination, Mr Fry gave evidence that he commenced working on the water cart from the date of the incident. He had made no earlier reference to this change of duties, neither in his evidence nor in his accounts to doctors.
- However, in a chronology, the accuracy of which Mr Fry verified in oral evidence, he recorded that he "commenced performing full duties as the water cart operator" on 20 November 2018. There was no prior reference to the water cart in his chronology. Mr Fry also gave evidence that his injuries worsened over time.
- The medical evidence recorded that Mr Fry was doing "full duties at work". [6] A return to work evaluation on 31 October 2018 records that he "is currently working full time pre-injury duties as a Production Operator". Mr Fry is recorded to have, after the incident, complained not of operating the front end loader, but of the occasion of training another operator on it, a duty which required him to sit on the less comfortable seat.
- All these matters lead me to find that Mr Fry's duties over time changed so that they now largely consist of operating the water cart. I do not accept that a substantial change in duties occurred immediately or shortly after the fall.
- Mr Fry gave evidence that he did less domestically nowadays, and no longer went on long coastal walks with his wife. Yet in October 2016 he reported to Dr David Dewar that "the pain is better with walking". [7]
- Mr Fry's primary concern with his lessening domestic capacity is that he is unable to polish his car. Currently, on the days he is not working, he rises early, around 4.30am, and then swims and does hydrotherapy exercises for some hours at the pool. He finds that these activities alleviate his pain. He disavowed any claim for past and present domestic assistance, but maintained a claim for future assistance.
- Mr Fry's activities have changed over time since the accident, as have his work duties. He is still engaged in exercise to keep fit, which he evidently enjoys. I am not persuaded that the change in the nature of his work or personal activities contributes substantially to damages for non-economic loss.
- Mr Fry argued that the primary component of his non-economic loss was his constant pain from his hip and shoulder problems. His absence of movements in the witness box did not indicate constant pain, but that may be because he took some painkillers beforehand. Mr Fry accepted that he went periods without taking painkillers, but his account of worsening pain since the accident, especially in his hips, requires some exploration of his hip and shoulder pathology.
- Mr Fry initially could not recall any problems with his hip or any treatment to his hip prior to his fall.
- Although I must be cautious in placing reliance on doctors' notes to controvert a witness' testimony, [8] Mr Fry was asked about the medical notes and generally accepted their accuracy. When directly asked about the contents of medical notes, he gave no evidence recalling that his condition, at the time of any note, was contrary to that recorded.
- Mr Fry was treated by an acupuncturist named Fong both before and after his fall, including for his hips. Documentary evidence from Mr Fong showed that Mr Fry had been receiving treatment, including for his hips, in 2015 in March, April, May, August, September and multiple times in October, before and after the incident, as well as three times in November, once in December and once in April 2016. Mr Fry accepted that this treatment occurred, although he did not recall treatment on his hips.
- Records from the Singleton Medical Centre also evidenced that Mr Fry had complained of sore hips in 2011. [9] Mr Fry accepted the accuracy of Dr Develach's notes that this complaint had occurred.
- Mr Fry did not accept that he walked freely after the fall, but with some reluctance conceded that he drove home and returned to work the next day. He did not dispute the medical records of his recovery after the incident, including that he made no complaint of hip problems in the three months after his initial visit, although he attended his GP on five or six occasions. He accepted that his hip was "probably not" troubling him.
- Mr Fry attended upon his GP, Dr Jeff Regnis, on the day following the incident, and made reference to his right hip and right shoulder being grazed. He was prescribed Temaze, a drug that assists sleeping, and Tramadol, an opioid analgesic.
- Mr Fry visited Dr Regnis three weeks after the fall, on 12 November 2015. The notes recorded that Mr Fry "recovered well from injury", but there was a complaint of right-hand numbness, but no reference to the hip. An X-ray of the shoulder was ordered. No complaint or issue with Mr Fry's hip was mentioned in the notes reporting subsequent visits on 4 December 2015, 14 December 2015, 15 December 2015 and 12 January 2016, although reference to shoulder pain was repeatedly mentioned.
- On 29 January 2016 a complaint about the hip is mentioned for the first time since the day after the accident. The prescription for Tramadol was continued.
- The contemporaneous reports of Dr Regnis to the insurer in respect of the earlier visits are to the same effect as his brief notes in Mr Fry's medical file.
- Mr Fry had a MRI on his right hip on 9 September 2016, a little under a year after the fall. The report by Dr Josey recorded:
"History: Ongoing right hip pain after workplace accident.
Findings: A degenerative arthrosis is present at the right hip, characterised by full thickness chondral fissuring, juxtacortical sclerosis and oedema. In addition, the labrum is degenerate with extensive mucinous degeneration throughout the labral substance and the presence of small ganglia measuring 2-3mm in size present at the chondrolabral junction posteriorly. No evidence of fracture of the acetabulum.
The femoral head is within normal limits, no avascular necrosis or stress fracture.
The gluteus minimus and medius tendons are within normal limits.
The periarticular tissues are normal.
No injury of the superior or inferior pubic rami.
No mass lesions within the limited views of the pelvis.
IMPRESSION:
* A relatively severe degenerative arthrosis is present at the right hip, characterised by juxtacortical sclerosis, intraosseous ganglion development and extensive degenerative change of the labrum. However, no MRI evidence of acute fracture of a vascular necrosis of the femoral head.
* No fracture of the femoral neck or injury of the periarticular musculature or ligament.
Dr Lawrence Josey." [10]
- Dr Regnis referred Mr Fry to Dr Stuart MacKenzie, orthopaedic surgeon, on 29 September 2016. Dr MacKenzie then reported that Mr Fry:
"has been having trouble with his right hip since he had quite a severe fall on a machine at work 12 months ago. He suffered severe bruising around the hip at the time and has had ongoing pain ever since. Prior to this fall, he was not having any problems in his hip whatsoever." [11]
- Dr MacKenzie's history of Mr Fry having no prior hip problems and "ongoing pain ever since" the fall is both inconsistent with the contemporaneous medical reports and Mr Fry's concession in the witness box, and tend to diminish the value of Dr MacKenzie's conclusion that Mr Fry's symptoms of arthritis were "triggered by the fall". [12]
- Mr Fry in October 2016 was also referred by Dr Regnis to Dr Dewar, another orthopaedic surgeon. Dr Dewar reported that Mr Fry:
"came in with a picture of him standing next to his front end loader and he showed me how and where he fell. Apparently 12 months ago, as per his report, he fell while cleaning the front end loader and he hit the loader on the way down. He hurt his shoulder and his hip. He tells me the lateral aspect of his hip swelled and became black and was quite painful. He didn't have any imaging at the time and he saw the physiotherapist who predominantly worked on his shoulder. He tells me that his shoulder has improved significantly since that time. He now has deep seated groin pain as well as buttock pain." [13]
- Dr Dewar did not express any opinion of the cause of Mr Fry's hip pain, and gave him a cortisone injection the following day. Dr Dewar reported in December 2016 that Mr Fry gained "great benefit from his Cortisone injection". [14]
- Mr Fry appears not to have consulted his treating surgeons since 2016. An X-ray in mid-2018 reported:
"XRAY RIGHT HIP AND PELVIS
Details: Right hip pain.
Findings: Only minor loss of joint space of the right hip as well as subchondral sclerosis but no other appearances suggestive of significant degenerative-type change or other arthropathy. Appearance of the right hip is also similar to the left hip on the AP view of the pelvis. No other focal bony abnormality can be identified of the right hip or of the pelvis. There is an unremarkable appearance of the SI joints and pubic symphysis.
ULTRASOUND RIGHT HIP
Findings: There is no anterior right hip joint effusion although there is mild thickening of the capsule of the hip. There is a partial thickness tear of the gluteus medius tendon measuring up to 8mm. There is no further tear of the gluteal tendons or evidence of tendinopathy and there is also no thickening of the trochanteric bursa or obvious tenderness on probe compression over the trochanteric bursal region. No other soft tissue abnormality.
Overall Impression: Likely partial thickness tear of the gluteus medius tendon but there is no obvious feature suggestive of trochanteric bursitis and apart from a little thickening of the capsule of the hip joint noted anteriorly, no other soft tissue abnormality has been demonstrated. An injection was not performed on Mr Fry." [15]
- I did not understand Mr Fry to be claiming that the "partial thickness tear" reported in his right hip in mid-2018 was attributable to his fall in October 2015. His pleadings and particulars, as well as his expert medical reports, claimed an aggravation of pre-existing arthritis. The impact of the tear at the time on Mr Fry's symptoms remained unexplored in the evidence and submissions.
- Mr Fry was recorded in a work assessment on 31 October 2018 to have recorded his pain levels as:
"∙ Right Hip: 5/10
∙ Right shoulder: 5/10
…
∙ Right side of neck: 7/10". [16]
- Thus, the primary cause of pain to Mr Fry in 2018 appeared to be from pain in the neck. Mr Fry also made reference to this pain during the trial, but Mr Fry did not assert at the trial or in his pleadings that his neck pain was attributable to the fall.
- The report resulting from Mr Fry's assessments in November 2018 recorded that:
"Mr Fry reports currently experiencing a constant throb in his right shoulder, numbness in the thumb, index and middle fingers of the right hand. When waking in the morning, stiffness and discomfort with neck rotation to the right, a constant dull ache in the right hip, a constant ache in the right elbow, an occasional sharp pain in the right wrist and an occasional dull ache on the lateral side of the right knee. Mr Fry reported a pain level of 2/10 at the time of the assessment and during the assessment however noted on a bad day a pain level of up to 7-8/10… Mr Fry advised that the takes medication and uses a range of creams and supplements to manage his symptoms".
- The plaintiff's medico-legal experts included Dr James Bodel. Dr Bodel recorded that "[o]ver time the right hip seemed to improve but then later it deteriorated" when speaking about the period after the fall and said that the initial main concern was the shoulder. [17] This history shows some consistency with Dr Regnis' notes, although they were apparently not then available to Dr Bodel. Presumably, the quoted note above was the account given by Mr Fry.
- Dr Bodel concluded that Mr Fry had "aggravated some previously asymptomatic degenerative change in the region of the right hip". [18]
- Dr Neil McGill, a rheumatologist retained by Ravensworth, reported on 20 February 2019:
"The described fall would not have caused his osteoarthritis but could have caused an aggravation. If the fall caused an aggravation with the potential to continue to influence symptoms, I would expect him to have had substantial pain in the right hip region in the three months following the fall. Based on the history he provided, that was the case. The medical notes between the fall on 22 October 2015 and September 2016 were not available." [19]
- When the notes became available, Dr McGill prepared a further report referring to the error in his earlier conclusion. He stated:
"The notes from his general practice however indicate that [substantial pain the hip region in the three months following the fall] was not the situation. It was recorded that he experienced grazing over the lateral aspect of his right hip but, despite many attendances, there was no further mention of hip symptoms until 28 January 2016.
In light of the information provided from the contemporaneous notes, I think it is most likely that the fall on 22 October 2015 caused grazing of the skin and bruising of the subcutaneous tissue over the lateral aspect of the right hip and possibly temporary symptoms related to his pre-existing hip osteoarthritis. Combining the nature of the fall, the symptoms and clinical findings immediately following the fall, and the documentation over the next months, it is unlikely that the fall changed the pathology of his hip osteoarthritis and unlikely that the fall influenced his hip symptoms from January 2016 onwards.
Thus, based on the further documentation, there has been a change in my opinion. I now do not think that the fall on 22 October 2015 continues to aggravate his pre-existing right hip osteoarthritis." [20]
- In resolving the issue concerning the impact of the fall on Mr Fry's hip concerns, I note the following matters.
- First, prior to the incident, Mr Fry had complained of hip problems to Dr Develach and had had treatment for his hips from Mr Fong, the acupuncturist, but there is no record of hip complaints to Dr Regnis prior to the fall.
- Secondly, Mr Fry did not complain of hip pain from the day after the fall for more than three months, even though he attended his GP five or six times and complained of shoulder pain.
- Thirdly, Dr Bodel notes that Mr Fry's hip issue appeared to improve after the fall.
- Fourthly, Dr MacKenzie links the hip pain to the fall but relies upon there being no hip complaint prior to the fall and significant pain continuing in the period immediately after the fall, neither of which represents the correct history. Dr Dewar gives no opinion on causation.
- Fifthly, Dr McGill accepted that the fall had caused an aggravation of hip arthritis pain if there was substantial pain the three months following the fall, but after the records revealed no complaints in that period, he concluded that it was "unlikely that the fall changed the pathology of his hip arthritis".
- Sixthly, Mr Fry was reviewed by an orthopedic surgeon retained by Ravensworth but Ravensworth did not serve any report.
- Taking all these matters into account, on balance I accept the conclusions of Dr McGill that the present symptoms are not due to any aggravation by the fall of Mr Fry's pre-existing arthritis. I prefer those conclusions to those of Dr Bodel, who gave no explanation as to how the fall could cause a permanent aggravation of the hip osteoarthritis in circumstances where Mr Fry for three months felt no pain sufficient to complain, but rather found his hip to be improving.
- Once the hip pain Mr Fry now suffers is not properly attributable to the incident, Mr Fry's claim is left largely with his shoulder pain. He regarded this as less significant than his hip pain, and the assessment report noted it to be less significant than his neck pain.
- Dr Bodel reported that Mr Fry found the injection of cortisone to be helpful in respect of his shoulder and in 2018 "the right shoulder has not deteriorated too much" since the injection in December 2015. [21] Mr Fry has continued swimming. He told Dr Dewar in October 2016 that "his shoulder has improved significantly" since having some physiotherapy after the incident. [22] He has some restriction of movement and mild impingement but no instability. He accepted that he did not like taking painkilling medication and did not take it continuously.
- In these circumstances, I am left to assess the value of Mr Fry's non-economic loss, comprising largely of pain in his right shoulder, but noting neck and hip pain which are accepted to be, or I have found them to be, unrelated to the incident.
- I am not persuaded that the limited disability and pain that Mr Fry has experienced in his right shoulder, together with the immediate aftermath of the fall and its injuries, including the temporary aggravation of the right hip arthritis, reaches $72,577 in damages or 17.5% of the $411,275 damages awarded for a most serious case. In that event, no non-economic loss damages can be awarded.