The Plaintiff's Injuries, Treatment And The Medical Evidence
75After the plaintiff's fall she was taken by ambulance to the Liverpool Hospital where she said she was X-rayed and remained for some three and a half hours but then left without seeing a doctor apparently due to a further likely waiting period of four hours. She then went to her usual GP, Dr Goyal, whom was on holiday, seeing a Dr Singh instead, who recommended physiotherapy that she undertook.
76The plaintiff did not tender an ambulance report, any report relating to the x-ray mentioned, any records, as stated, from Dr Goyal's practice, any report from Dr Singh or from the physiotherapist mentioned. Indeed, the first document in time contained in the plaintiff's bundle of medical reports (Exhibit F) is a left knee and ultrasound report from a Dr Ecker addressed to Dr Goyal dated 18 September 2008 which is over 5 months after her accident. The balance of such medical evidence postdates this report.
77However, the plaintiff did tender the above mentioned four photographs of the back of her left leg taken two days after her subject fall (Exhibit E) which show quite considerable and extensive bruising.
78In evidence, the plaintiff described having significant pain down her left leg from the hip area shortly after her fall. Nevertheless, she said that by the time she went overseas on 4 May 2008 such pain was "occasional" to which she "didn't pay much attention". Whilst overseas she said that she did a lot of walking but after a while developed a strong pain in her left knee, hip and thigh and had considerable difficulty sleeping and utilising stairs as well as dressing. As a result, she said she "had to see a specialist over there who performed ultrasound and suggested physiotherapy" but as it was apparently close to the time that she was coming home she did not undertake this treatment.
79As mentioned, the plaintiff and her husband returned to Sydney on 9 September 2008 and she said she immediately had problems with housework, all of which she said that before her fall she managed by herself. She also said that she was able to clean her house "from top to bottom in 3 to 3.5 hours before the accident".
80Due to these problems, she said that her husband started assisting with such tasks as vacuuming and mopping and taking the washing basket out which continued as at the date of trial. The plaintiff went on to say that she was very house proud before her accident doing things "to perfection" and whilst she has returned to some tasks she has "to close (her) eyes and not see you know the parts that nobody else sees".
81The plaintiff described her home as a four-bedroom duplex with two living areas, a laundry, toilet and kitchen downstairs and with four bedrooms, two bathrooms with a separate toilet upstairs. She continues to live there with her husband and son who is 31.
82As mentioned above, consequent upon her return to Australia, the plaintiff had an ultrasound which was reported on by a Dr Ecker as showing the presence of a moderate volume of fluid within the synovial space of the left knee joint.
83The plaintiff also apparently saw another general practitioner, a Dr Sorrenti, for the first time on 25 September 2008 although there is no report from this practitioner either. Nevertheless, there is a MRI scan report pertaining to the plaintiff's pelvis and left thigh addressed to Dr Sorrenti from Dr Gale, radiologist, dated 7 October 2008 which raises the possibility of an avulsion of the plaintiff's left hamstring from the ischial tuberiosity.
84Exhibit F also contains two further radiological reports both dated March 2009, the first from a Dr Patel to Dr Goyal which revealed some arthritic changes in the plaintiff's low back and both knees. The second is from a Dr Moses addressed to a Dr Ong, from whom there is also no report, which relates to an x-ray of the plaintiff's left knee and a CT scan of her lumbar spine. Dr Moses concludes in relation to the former that there was a moderate joint effusion present with suggestions of mild degenerative changes. In relation to the latter, his impression was of the existence of moderate multi-level degenerative changes consistent with, inter alia, a moderate disc protrusion of L2/3 impinging on the L3 nerve root.
85The first substantive medical report contained in Exhibit F is that from a Dr Hisu, orthopaedic surgeon, dated 2 April 2009, relating to the plaintiff's attendance upon him on 26 March 2009 on referral from Dr Ong. Based upon his examination and assessment of the radiology be recommended an MRI of the lumbar spine and suggested conservative measures in relation to her pains in the left knee and hip.
86The plaintiff underwent MRI scans to her lumbar spine, left knee and left hip in March and April 2009. The lumbar MRI revealed similar findings to the abovementioned CT scan. The MRI of her left hip revealed, inter alia, a complete avulsion of the left hamstring origin and a tear at the left acetabulas labrum. The MRI of the left knee recorded, inter alia, a tear in the medial portion of the posterior horn.
87The plaintiff was referred to Dr David Wood, orthopaedic surgeon, by a Dr Sullivan from whom there is also no report, in May 2009. In light of the recent MRI findings, Dr Wood admitted her to the Castlecrag Private Hospital and performed a surgical repair of her hamstrings to the ischial tuberosity on 30 June 2009. He was in no doubt that this injury occurred in the subject fall. Post operatively and over the next 6 months, Dr Wood was pleased with the result of the surgery and with her "excellent pain relief". He expected her to "end up with 95% normal function of the hamstring area". His last report dated 17 December 2009 is to Dr Ong in which he states she "continues to do well with her hamstring repair" but notes, inter alia, ongoing sciatic pain "but that is from her back".
88As to her left knee, Dr Ong referred the plaintiff to Dr Graham, orthopaedic surgeon, who first saw her in May 2009. He diagnosed a tear of the medial meniscus but delayed performing an arthroscopy until November 2009, apparently to enable Dr Wood to operate on her hamstring. At that time, he debrided the meniscal tear noting that moderate arthritis was present in the medial compartment and in the under surface of the patella. Over the next few months, he noted her knee pain had improved and, at the time of his last review in late January 2010, that she had slight knee pain and some swelling "when doing free style kicking". She was also complaining of some bilateral buttock pain. As to causation of her knee symptoms, Dr Graham was of the view that "it is reasonable to suspect a fall may have caused the injury to her left medial meniscus". He appears to conclude that any then current work incapacity arising from the knee was minimal.
89After her hamstring surgery, Dr Hsu noted upon examination on 25 August 2009 that in relation to her back pain "most of her symptoms in her let thigh seem much improved...". Consequent upon her knee surgery, Dr Hsu reviewed her again in January 2010 when she was complaining of some hip pain which he felt was in the province of Dr Graham but thought that her complaints of left calf numbness were "likely coming from her back". He noted that an earlier cortisone injection in relation to her "L2/3 disc herniation" had "greatly helped her" and suggested only "some gentle physiotherapy and back strengthening exercises" for the future.
90In February 2010, whilst at home, the plaintiff "stepped out of" her kitchen and felt a sharp pain across her left calf. This occurred after some physiotherapy that she undertook that day. As a result, the plaintiff underwent a left calf ultrasound upon referral from Dr Ong and the relevant report describes a partial thickness tear of the superficial fibres of the gastrocnemius muscle approximately 18 centimetres below the knee.
91In December 2010, the plaintiff's solicitors referred her to Dr Bodel, orthopaedic surgeon, who was provided with a considerable amount of documentation including various radiographic studies. Her then complaints included "widespread pain involving all of the injured areas" with the main area of pain being in the left buttock, hip and down the left thigh. She also complained of pain in the left groin and left knee together with numbness and tingling down the lateral border of her left leg to her ankle. She told Dr Bodel she could drive both an automatic and manual car but rarely did so due to her pain and that she "struggles with her housework and her husband helps with the vacuuming, mopping and hanging out the clothes".
92Upon examination, Dr Bodel noted, inter alia, wasting in her left calf and that her "left thigh is 1cm smaller than her right".
93As to a diagnosis, Dr Bodel said that this "is a very difficulty issue" but that she "has probably torn the medial meniscus in her left knee, the hamstring origin in the base of the pelvis at the left hand side but also has suffered significant aggravation of longstanding pre-exiting disease through the lumbar spine" which he felt was the "main pathological area". He regarded her prognosis as guarded "because of the severity of her pathology". As to work capacity, Dr Bodel was of the view that the plaintiff's "ongoing disabilities have significantly impaired her employment capability as an employment services consultant". Finally, as to future treatment, he described this area as a "difficult issue" but "suspect(ed) that she will require further treatment specifically for the back" and that she "may need to consider de-compressive surgery if a single level of disc pathology can be found as the main cause factor of her ongoing complaints." In a short follow up report he gave various costings of between $11,500 to $19,500 for such treatment including prior testing although the upper range related to a spinal fusion rather than a "simple decompression".
94Heather Tchan, occupational therapist, assessed the plaintiff in January 2011 and her lengthy report is Exhibit G. In short, Ms Tchan regarded the plaintiff as requiring 7.3 hours per week future "domestic attendant care". As to past care, Ms Tchan sets out a very complicated table detailing many different periods requiring between 7.3 and 23.3 hours per week in relation to "personal, domestic and outdoor maintenance tasks". It is costed, "based on Average Weekly Earnings" at some $45,077 and, alternatively, "based on commercial rates" excluding GST at some $68,000.00. Both estimates are for the period from the accident until 28 January 2011.
95I have found Ms Tchan's report generally very had to follow, especially in relating the calculation tables to the recording of the relevant complaints. Ms Tchan also noted that the plaintiff's son did not live at home at the time of her visit whereas he did at trial. She further noted that the plaintiff at the time of her assessment worked full-time which she still does. It is tolerably clear that Ms Tchan's calculations include allowances for the plaintiff's inability to perform normal household duties not only for her own benefit but also for that of her husband although no break-up as between the two has been attempted.
96The plaintiff's own evidence in relation to the effect the accident has had on her ability to undertake domestic duties was far from detailed. She described receiving help from her husband in relation to, inter alia, vacuuming, mopping, washing and "low down" tasks as well as with some aspects of the cooking but no evidence as to the time this assistance was provided over an average day or week was led from her. Nor was any attempt made to elicit the precise periods that the plaintiff was incapacitated for housework post-surgery other than her stating that in relation to her hamstring surgery she was "in bed for 2 weeks" after which she was able to get out of bed but, apparently, thereafter took another three or four months "when I was recovering completely to be able to do little bit round the house".
97The plaintiff's husband gave evidence that before her accident he did "very little, nothing" around the house apart from some cooking which he enjoyed. After her accident when they returned from overseas things changed. In answer to a question as to "how many hours a week did you assist the plaintiff in or around the house in the period of say six months after your return from Croatia" he answered "at least 6 hours" a week. As to the position at trial, he answered "about six hours" In addition, he said he assisted more after her surgical procedures when she was bedridden for two weeks consequent upon the first and "maybe one week" after the second. He said he continues to assist in such tasks as vacuuming and mopping and doing the washing. He says his son does not assist at all as he's "all the time in the work".
98In cross examination, Mr Alat denied knowing that six hours was "a legal minimum" in relation to any claim for assistance with domestic matters. At one point he said his evidence as to such a period of six hours was "approximate" but then said it represented "the minimum".
99As to the plaintiff's employment, Mr Rowe tendered a document setting out her history in this regard up until May 2009 which became Exhibit 'A'. The plaintiff herself gave very little evidence as to any effect the subject accident has had upon her various jobs since, nor as to her reasons for moving between them. She also gave no evidence as to sustaining any consequential delay in returning to the workforce after her return to Australia because of the accident. She did say that in her job with the YMCA she had some problems with sitting for "long periods" and that her primary reason for leaving it for the aforementioned higher paid position was the number of stairs at the YMCA office. Overall, she was asked very few questions about her employment situation post accident and her evidence in this regard was quite lacking in any detail.