Defendant's medical evidence relating to the plaintiff
13 The defendant's medical evidence casts light upon the plaintiff's claims.
14 Dr B J Ireland, a consultant orthopaedic surgeon in his opinion of 3 October 2001, said that the plaintiff was a:
remarkably fit, powerfully built, well muscled man with a musculature such that one associates with body builders.
15 Dr Ireland said that the plaintiff showed no evidence of discomfort, at least in relation to his neck, as he sat and conversed with the doctor. The doctor took the view that if there was some discomfort in relation to the neck it was not inhibiting, in any way, the use of the neck in a 'significant' fashion. Dr Ireland could find no evidence of impairment of function in relation to the shoulders; doubted any major degree of weakness in the left elbow on the plaintiff's version of how the injury arose; and discerned only 'small radiological abnormalities' in the lower back. He saw no evidence of a rupture of the right leg, although he could find a 15% impairment of function of the left leg, with half of that impairment being a consequence of the injury at aged seventeen, and the remaining half the consequence of further incidents in 1998 and 1999. In short, Dr Ireland found evidence of 'discomfort' in various areas of the plaintiff's body and some 'limited ability to be doing heavy work' but that:
he should be able to do most forms of moderate work, other than those that require him to be getting a squatted situation or doing repeated work on stairs.
16 In a further opinion, dated 13 March 2002, Dr Ireland is sceptical of the need for occupational rehabilitation, continued weekly medical attendances, or consultation with pain management psychologists. The reason for this doubt is, as Dr Ireland opines (though perhaps outside the realm of his expertise):
…[the plaintiff] has to accept that he has certain continuing symptoms and he must learn to live with them and he must get on with his life…
17 The defendant tendered an opinion of Dr Sikander Khan dated 10 July 2003, which proffers the view that it should not be believed that because the plaintiff drove over potholes, this act 'would have lead to this injury'. Rather, it was Dr Khan's opinion that any injury more likely resulted from an 'abnormal posture' adopted by the plaintiff whilst driving. This view was shared by Dr Ireland. The logical consequence of this opinion is an inference that driving over potholes caused some injury but the extent of that injury was, perhaps, exacerbated by the plaintiff's posture while driving.
18 Dr Kim Edwards, surgeon, in an opinion of 31 January 2000, suggests that the plaintiff 'seemed to be engrossed in his symptoms'. The doctor also points to a suggestion of 'exaggeration or fabrication' of the plaintiff's condition in that he was not convinced that some of the range of movement demonstrated by the plaintiff on examination was genuine.
19 Dr Edwards considered the plaintiff fit:
for light work which does not require him to squat or kneel, climb, or to walk long distances if his complaints are genuine.
20 Reference to exaggeration or fabrication of the plaintiff's condition is also made in the opinion of Dr Edwards of 30 October 2002. The doctor states:
There is evidence of exaggeration or fabrication noted on examination, as is indicated by his ability to sit erect on the couch with his legs extended without complaining of pain despite the limitation of forward flexion and straight leg raising.
21 Dr Tim Anderson, in an opinion of 1 February 2001, noted an exaggeration of the plaintiff's restriction on movement regarding his back. Dr Anderson does not find the driving posture of the plaintiff abnormal but states:
[t]his unfortunately was the only way he was able to drive the forklift'.
22 Dr Anderson did not find 'a great deal wrong with his neck or back' though did associate the condition complained of to the fall in February 1999. Dr Anderson also noted:
I believe, however, that he could do considerably more in terms of physical activity if he chose to try.
23 This was reinforced in an opinion of 1 November 2002 in which the doctor deposes:
Although he continued to have genuine findings and dysfunction it was most unfortunate that there were non-organic features becoming more prevalent in his overall situation.
The best part of two years have past since I last saw him although there has been relatively little change of his views on his condition and similarly he does not seem to have made any effort at trying to improve himself or get back into the workforce.
24 Dr Anderson also noted improvements, in November 2002, to the forward flexion of the back despite complaint that the distribution of pain and tenderness 'was exactly the same as before'. There was also improvement to the cervical spine. Dr Anderson noted that there was 'grossly reduced' function of the left upper arm but was 'not convinced that he was voluntarily demonstrating maximum effort'. Similarly, the doctor noticed 'grossly reduced' movement of the lumbar spine to less than half the normal range but thought that this was a 'manufactured' restriction. Dr Anderson did note a 'minor partial rupture of part of the quadriceps femoris complex'. He said that:
It is still most important that Mr Jenkins should be maximally active. This is just not happening at present. I would suggest that his major contribution to improving his circumstances would be in the water. He does a limited amount of this but nothing like enough.
25 Dr Grant Walker, consultant neurologist, in his opinion of 2 July 2003, expresses the view that the fact that the plaintiff has developed further muscular skeletal problems in the absence of any work is further suggestion that his original complaints 'had little to do with the designated "injuries" that he reported'. He did find, in an opinion dated 12 October 2001, that the plaintiff had a 6.4 per cent loss of function of the upper left arm that equated to 4 per cent 'whole person loss'. Dr Walker also noted that the plaintiff did not 'give maximal effort at times'.
26 An assessment by Trevor Hawkins, Vocational Psychologist with the Vocational Capacity Centre, dated 24 May 2002, accepts that the plaintiff impressed as having 'mild depression' but presented with a more considerable focus on his physical condition. That is:
His potential to engage in some form of gainful employment, a more immediate issue, is thus being put off for consideration until he has resolved all of his physical problems. This approach is likely to see him unemployed for a considerably longer period of time.
27 The opinion goes on to assert:
His previous careers have been unskilled in nature and as a result he has developed a restricted range of transferable skills. His jobs in the past have involved customer service skills; driving; sales and routine administrative and clerical skills….There are certainly no major problems of a cognitive nature that would stand in the way of his entry into many alternate vocational options in the labour market…
28 Dr Wendy Roberts, a clinical psychologist, said in her opinion of 28 November 2002, that she was yet to be convinced that the plaintiff 'is clinically anxious, depressed or irritable now' about his injuries. Dr Roberts opined:
It is not at all clear to me that he meets diagnostic criteria for any psychological disorder, but I could not assess this accurately because his performance on paper and pencil testing was suggestive of exaggeration. I also note that with two of the accidents he continued working, did nothing about the repetitive arm injury until after February 1999 and then continued working after February 1999 until May when he went off work. I would like to see his employer's file and any statements. In terms of my area of expertise, I doubt that there are psychological barriers preventing him from returning to work of the sort which he did before, nor should they be problematic in the future. He is cognitively quite capable of doing further study to refrain if medical opinion were to be that he is medically unfit for work of the sort he did at the markets.
29 Magri MacMaster, Director of a Rehabilitation and Medico-Legal Consultancy, deposes in an opinion of 13 February 2002 that the plaintiff has 'demonstrated self-limiting movement and what appears to be exaggerated pain behaviour'. It is also said:
He appears to have some functional overlay and he is very preoccupied with his injuries. He said he spends some time reading at the library about them.
There was no evidence of physical discomfort or distress during any activities requested [of him].
30 Mr MacMaster did not think that the plaintiff required assistance with personal care or domestic tasks. This opinion was shared by Dr Roberts.