183 I will deal with the claims for future expenses that are in issue in turn.
184 The plaintiff claims $60.00 per week for attendance on a psychologist fortnightly at $120.00 per consultation over the next ten years. The defendant queried the basis of this claim by pointing to the evidence of Dr Jones, who in her report of 5 July 2005 observed (at p 2 Q. 8):
Regarding Leigh's psyche, she is a very pleasant young woman. We have not discussed her emotional reaction to her amputation in the last few years. She certainly is trying to get on with her life and work out some career.
I note the report from the psychologist who described her emotional distress to her amputation. At this stage she is just keen to re-establish a career for herself.
185 A number of reports by Agnes Rappaport were tendered on the plaintiff's behalf. Ms Rappaport commenced seeing the plaintiff for neuropsychological assessment in September and October 2002. She has continued seeing the plaintiff on a regular basis for much of the time since then. In a report dated 11 October 2005 Ms Rappaport said that she had been seeing the plaintiff every two to three weeks as an outpatient. The contact was for disability adjustment relating to the loss of the lower right limb. The issues she identified the plaintiff as dealing with included poor body image, loss of confidence, avoidance of people and places associated with the accident. Ms Rappaport said that the plaintiff has difficulties associated with the fact of the prosthesis, these include feelings of grief over her inability to wear high-heeled shoes or mini skirts and sadness over not being able to, "dance the way I used to".
186 The plaintiff's appearance had been important to her self-confidence and self-esteem. She reports anxieties about her future in finding and maintaining employment and in meeting and keeping a boyfriend, marrying and having children and being able to live independently. Ms Rappaport said that the plaintiff's nightmares experienced since the amputation, had decreased in frequency, but were still occurring. She considered that the plaintiff had made progress in a number of areas and that psychologically she had stabilised. However, in her view, the plaintiff needs ongoing psychological intervention to ensure that her progress is maintained.
187 Ms Rappaport says that the plaintiff's' need for psychological support will increase at the time she is ready to seek employment or work training. She also considered that the plaintiff may find it difficult to start an intimate relationship because of her self-consciousness about her amputated limb. The plaintiff had not been in a relationship with anyone since the amputation. In Ms Rappaport's opinion, the plaintiff needs ongoing psychological intervention to work through these problems. Ms Rappaport anticipated the need for fortnightly, one hourly treatment until such time as the plaintiff has suitable employment and, ideally, is in a stable relationship.
188 Ms Rappaport provided a supplementary report on 24 March 2006. In this report she recorded that she had seen the plaintiff regularly as an outpatient for a total of 26 sessions, until March 2003. Treatment resumed in April 2004 and since that time and the date of the report on March 2006 she had seen the plaintiff every two to three weeks, but sometimes every three to four weeks depending on her availability. As at March 2006, she was seeing the plaintiff approximately every four weeks. She considered that more frequent contact was desirable, but the plaintiff was being seen as a public patient and Ms Rappaport's workload did not permit the additional contact.
189 Ms Rappaport confirmed that the plaintiff has made psychological progress since her amputation, but that she continues to experience high levels of stress and anxiety and, at times, a depressed mood. The plaintiff needed regular contact, ideally every two to three weeks, for the next two years or until her TAFE course is completed and she has been in suitable employment for at least six months.
190 Dr Morse, in his report of 10 February 2005, commented that the plaintiff was continuing to see a psychiatrist (scil. psychologist) once a fortnight and that she appreciated the assistance that this counselling had given her. In Dr Morse's opinion, given the plaintiff's vulnerable state, on-going counselling should continue indefinitely.
191 In a further report, dated 4 April 2006, Dr Morse was asked whether the plaintiff was likely to require regular psychiatric supervision. He commented as follows:
I do not consider there is any indication that Ms Russell is suffering from any psychiatric condition that needs psychiatric treatment. She has been attending a psychologist, Ms Rappaport, to talk over her thoughts and feelings, to get some assistance in various areas of her life such as study, activities etc. Given the particular problems are very much related to intellectual handicap, her prosthesis and all the other social and factors in her life I do not consider any particular psychiatric or psychological therapy would be of help.
192 I do not understand Dr Morse to be departing from the view earlier expressed that the regular psychological sessions with Ms Rappaport were of help to the plaintiff and that it was desirable that she continue with them in the indefinite future.
193 Dr Brown, a consultant psychiatrist, assessed the plaintiff on behalf of the defendant. In her report dated 17 January 2006 she recorded that the plaintiff had described a reduced level of self-esteem and confidence. In Brown's opinion, individuals with amputated limbs and those with intellectual disabilities can and do marry. The reported level of the plaintiff's reduced self-esteem did not impress Dr Brown as being contradictory to her long-term goals. Dr Brown noted that the plaintiff had required psychological treatment of a counselling type to assist with the adjustment process. Dr Brown commented that some individuals do require at least several years to undergo a full level of adjustment to their amputee status. In Dr Brown's opinion, the plaintiff is more likely to undergo a slow and gradual improvement and better adjustment to her predicament.
194 Dr Brown concluded her report, stating:
In terms of treatment to date, the psychological counselling she has received sounds to have been of an appropriate nature. At this stage of events, very intensive or long-term psychological counselling is likely to be of less benefit and the plaintiff may require a total of a further eight to ten sessions of such treatment over a further several year period. Her pre-existing intellectual disability may limit her from making benefit from more intensive treatment.
195 I consider that it is appropriate to make an allowance for attendance upon a psychologist at fortnightly intervals for a considerable period. Ms Rappaport considered the need would continue until after the completion of the TAFE course and after the plaintiff had settled into employment. She considered the plaintiff would suffer increased anxiety at the completion of the TAFE course in association with her endeavours to obtain and maintain employment. I consider it likely that the plaintiff will not obtain employment and that there will be distress associated with this for a considerable period. In all the circumstances, I consider that the claim for continued psychological assistance for the next ten years is reasonable. I propose to allow the sum of $24,774.00, being $60.00 per week over ten years using the five per cent multiplier.
196 The plaintiff claims $15.00 per week for attendance upon a general practitioner monthly at $60.00 per consultation. The defendant queried the justification for attendances arising out of the plaintiff's injury with this level of frequency, given the contents of Dr Jones' report.
197 Dr Salem, in a report dated 14 July 2005, set out the details of 31 attendances on the plaintiff in the period since 16 September 2002. The problems that Dr Salem identified were stump problems, which it appears had led to a number of consultations. Doctor Salem recorded that the plaintiff had an episode of major depression, the factors accounting for this were identified as phantom limb pains, dependency on strong analgesics, thoughts of hopelessness and despair, concerns about employment and the future. Dr Salem also noted the plaintiff's concerns over her inability to have a relationship with a member of the opposite sex, her isolation, loneliness, boredom and miserable lifestyle. She had been prescribed Zoloft and had responded well to this medication. Dr Salem commented that the plaintiff had "severe and major issues of limb loss for a very conscious female - who has always had high self-pride". In Dr Salem's opinion, the plaintiff's depression will surface intermittently throughout her life for years ahead, and her phantom pain will continue. This is constant, nightly and very distressing, requiring constant Endep 50 mg, Tramal SR 100 mg twice, three times a month. In Dr Salem's opinion, the plaintiff will always need supervision by a medical practitioner and appropriate supportive counselling.
198 I accept that the plaintiff will have a continued need for frequent attendance upon her general practitioner in connection with her physical and psychological state arising out of the injury. Dr Jones has seen the plaintiff on average once every three months in connection with her prosthetic adjustment. The claim made is for attendance upon a prosthetist only twice per year. In the intervals it is reasonable to expect the plaintiff would continue frequent attendances on her treating family doctor in connection with stump problems and associated difficulties. I propose to allow the claim for monthly attendances upon the general practitioner at $60.00 per consultation for the remainder of the plaintiff's life.
199 The plaintiff claims $30.00 per week for painkilling and analgesic medication. The defendant acknowledges some allowance should be made, but submits that this is excessive. I have already referred to Dr Salem's evidence concerning current antidepressant medications. The evidence does not establish the cost of the medications or the frequency with which new prescriptions are required. There is need for painkilling medication, having regard to the phantom limb pains. As I read Dr Salem's report, this will be a problem for the plaintiff throughout her life. It is not clear that she will require ongoing antidepressant medication for the remainder of her life. I consider an appropriate allowance to make is provision for $20.00 per week to cover medications for the remainder of the plaintiff's life.
200 The plaintiff claims for attendance upon a specialist once per month at $150.00 per consultation. Allowance has already been agreed for attendance upon a prosthetist twice per annum. It is not clear that the plaintiff's future needs require specialist supervision once per month. In submissions it was put that:
"sores of the stump are going to be dealt with some of the time by seeing a GP and some of the time by seeing a specialist, but on the history to date, which appears at pages 55-56 in exhibit C, Dr Jones says she has been seeing the plaintiff, on average, once every three months. We are only claiming half that, but what that does, in turn, is support other medical practitioners supplementing Dr Jones' assistance" (T 275.8-19).