29The First Defendant challenged the Plaintiff's account of the events. In particular challenge was made to the assertion by the Plaintiff that his lower back problems arose from a particular lifting incident in February 2005. The date of 20 February 2005 is first mentioned in a report of Dr Patrick of 10 October 2005. It was simply described as the date of injury to the Plaintiff's neck/shoulders/upper mid-back. Dr Patrick later clarified his reference to it, as I shall presently discuss.
30I note in passing that neither in the Statement of Claim filed 4 February 2008 nor the Amended Statement of Claim filed 26 March 2008 is there any mention of an incident in February 2005 nor of the lifting of a bath at any time. Both of these pleadings were put forward on the basis that the Plaintiff suffered injury through a course of work. Indeed, in the original Statement of Claim the only injuries are said to be to the shoulders, the cervical spine and the thoracic spine. The Amended Statement of Claim refers to the lumbar spine but does not say how or when the injury occurred.
31The Further Amended Statement of Claim filed 22 April 2010 pleads that the Plaintiff first noticed pain in his back, neck and arms on 20 February 2005. The Particulars do not mention a specific incident of any sort, let alone the lifting of a bath. It is only in the Second Further Amended Statement of Claim filed 22 September 2010 that the matter of lifting a bathtub on 20 February 2005 appears for the first time.
32The Plaintiff was not cross-examined about this. I do not think, therefore, that I should draw any inference adverse to the Plaintiff from it. Of course, the bathtub incident of 20 February had been mentioned to doctors long before the original Statement of Claim was filed. That makes it even more curious.
33In challenging the Plaintiff's account of the bathtub incident, the First Defendant relies on the evidence of Mr Burns, Mr Crowe and especially the contemporaneous medical records. It is necessary, therefore, to examine those records to see if they provide support for the Plaintiff's account of events.
34On 20 April 2005 the Plaintiff signed an Employee's Report of Injury. Not all of the document was in his handwriting but under the heading "What Happened" the Plaintiff wrote this:
*Lifting heavy furniture and green waste.
He said that he suffered strain to his neck and back. No date was mentioned. He said his treating doctor was Dr Rowe at Miranda Medical Centre.
35There was a medical certificate from Dr Rowe saying that he examined the Plaintiff on 19 April, and the Plaintiff said he was suffering from neck and back strain. Dr Rowe said the Plaintiff would be unfit for duty from 19 - 26 April. Dr Rowe's notes for 19 April say this:
I get too much pain this (L) arm and shoulders. R shoulder 2/12 & L 1/12.
O/E L & R arm raising painful but full neck mvts [movements] painful but full
XR Neck & both shoulders.
Works on clean up truck for council. Says man he works with is loading 10 tonnes and the limit should be 7 tonnes
Dr Rowe prescribed Voltaren emulgel, Panadeine Forte and Panamax for the neck and back strain.
36The Plaintiff seems to have been sent for some sort of radiography because there is a report from Dr Wong of 19 April reporting on the radiological investigation. The investigation was to both shoulders, the cervical spine and the dorsal spine. There was no mention of the lumbar spine.
37The report in relation to the shoulders said this:
No joint or bony abnormality in both acromio-clavicular or
gleno-humeral joints.
Joint spaces not narrowed.
No osteoarthritis, subacromial spur or rotator cuff calcification.
38The report on the cervical spine said this:
Slight narrowing of C3-C4 disc space suggestive of an
early/mild disc-lesion.
Mild C3, C4 and C5 spondylosis with encroachment onto the
left C3-C4 foramen.
No cervical rib.
Normal alignment in functional views.
39The next medical report is a report from Southern Radiology to Dr Ajam of 5 May 2005 in respect of an ultrasound to the Plaintiff's shoulders. The report says this:
No rotator cuff tear nor tendinopathy was seen. No bursal effusion or impingement has been identified. There is mild AC joint arthritis bilaterally.
40There is then a further report from Southern Radiology to Dr Ajam of 31 May 2005 reporting on the CT of the cervical spine. The report notes that the Plaintiff complained of tender neck with paresthesia in arms. The report concluded:
There are degenerative changes on the left side of the C2/3 and C3/4 levels but no significant foraminal narrowing or obvious nerve root compression can be seen.
41On 6 July 2005 there was a further report from Southern Radiology to Dr Ajam in respect of an MRI on the Plaintiff's cervical spine. The most significant matter reported was a significant central and left posterolateral disc herniation at C3/4 which contributed to a narrowing to the left C3/4 exit foramen. It was said that that might well impact upon the ventral rootlets of the left C4 root.
42It appears that Dr Ajam must have sent the Plaintiff to Dr Bernard Kwok, a neurosurgeon because he reported on 25 November 2005 to Dr Ajam. The report relevantly reads:
Thank you for asking me to see Mr Milich regarding his neck and arm pain. I saw him on 25 November 2005. The patient is a 46 year old truck driver. According to the patient, the pain started In January 2005 with gradual onset of neck and bilateral arm pain. The arm pain radiates to the elbow and I cannot pin him down to which side is being the more painful of the two. So far, he has failed to respond to physiotherapy or exercise. He is using Voltaren Rapid, Panadol Rapid and Nurofen Plus. Because of the pain, he had to stop work in April and there is no history of sphincteric incompetence, The patient denies any previous attacks and there is no other relevant history.
On examination, the patient is a heavy built person, Cervical spine movement is only slightly reduced with extension. There is no tenderness on palpation. He had difficulty with abduction of either arms and also had difficulty keeping the arms in an overhead position. The motor function testing is hampered by pain restriction. Sensation is intact and his upper limb reflexes are intact.
CT scan performed in May shows mild C3/4 anterior spondylotic changes. There is no evidence of canal or foraminal stenosis. The MRI scan on 6th July again shows mild C3/4 bulges. I did not find any evidence of canal or lateral recess stenosis. This is different to the radiology report,
Currently, I do not have an answer for Mr Milich's pain, His complaint is not supported by evidence on examination and the scans are fairly innocuous, I have suggested he should consult you regarding a rheumatological consult. He also mentioned about Dr Davies and I am certainly happy for him to have a second opinion from Dr Davies. (emphasis added)
43By October 2005, it would seem, the Plaintiff had consulted his solicitors because there is a report from Dr Patrick to those solicitors of 10 October 2005. The report discussed what the Plaintiff told Dr Patrick about the nature of the work at the Council. It was said to be quite physical involving street clean-ups of furniture etc and also green waste. The Plaintiff described having to work with what was described as a "workaholic somewhat manic truck driver" called Alan.
44Dr Patrick recorded the date of the injury as "about 20 February 2005; October 2003 - 2005". The nature of the injury was described as "Work-related injuries to neck/shoulders/upper-mid back". It went on to say:
As a result of the nature and conditions of his work handling the quite heavy furniture, green waste, and other loads, he began to develop significant pain initially mainly at both shoulders, symptoms coming on on or about 20 February 2005, but there was also significant neck pain and upper-mid back pain. The initial symptoms were mainly at shoulders and upper arms.
45Dr Patrick listed the Plaintiff's present symptoms and it is to be noted that there is no mention of the lower back or the legs. Dr Patrick's conclusion was that the Plaintiff had sustained significant injury as a result of the nature and conditions of his work with the Council with "symptoms coming on relatively acutely on or about 20 February 2005" and resulting from the nature and conditions of his work between October 2003 and 2005. He assessed the Plaintiff within the AMA 5 Guides and the WorkCover Guides at 22% Whole Person Impairment. This was made up of 13% for the cervical spine, 5% for the thoracic spine, 2% for the right shoulder and 4% for the left shoulder. It was not made clear how those figures produced a 22% WPI rather than 24%.
46On 8 February 2006 Dr Patrick wrote again to the Plaintiff's solicitors saying this:
I have reviewed material in my possession in relation to Mr Milich's work-related injuries to his neck/shoulders/upper-mid back, and although I have set out the date of injury as being "about 20 February 2005; and October 2003 - 2005", the reality is that there are not really two separate injuries. There has been no frank accident or injury which has occurred on 20 February 2005. This date merely reflects the date when he became significantly aware of his symptoms. I believe that the percent WPI of 22% as outlined in the table paragraph on page 5 of my report of 10 October 2005 should appropriately be regarded as resulting entirely from the nature and conditions of his employment between October 2003 and 2005. (emphasis added)
47That appears to be a very significant report in that it suggests that no complaint was made to Dr Patrick about any particular incident on 20 February 2005, let alone an incident that involved the Plaintiff's lower back. But it also suggests (as does Dr Kwok's report) that the Plaintiff was experiencing some pain, discomfort and/or symptoms prior to 20 February 2005.
48It should be noted that, in the medical material to this point, there has been no mention whatever of an injury to the lumbar spine, lumbar spine problems, or (on the basis of Dr Patrick's report of 8 February 2006) any report of a frank injury on 20 February 2005 or any surrounding date.
49The next medical record is a page of patient notes made by Dr Mark Davies on 22 May 2006. These notes contain the first mention of a bathtub incident on 20 February 2005. The notes read (inter alia):
Forced to pick up iron bath tub - ? 300k - injured 20/2/05.
Pain both shoulders ... back and left leg
50Elsewhere in the notes there is a reference to constant shoulder pain and pain in both arms, occasional lower back pain, left leg pain which is intermittent but daily. There is a reference to what appears to be the need for the Plaintiff to rest if he walks for more than 20-30 minutes.
51There is also an interesting note made in relation to work performed by the Plaintiff. It is not all easy to read but relevantly what it says is this:
Previously 16 months at Council ... stopped work last April. Never went back after injury "too risky".
There is then another connecting line to the word "work" which reads:
Some work now (4 nights) make up order/delivery.
52It is difficult to infer other than that last note is a reference to the Plaintiff working on the milk run. He certainly gave no evidence of any other work prior to the milk run job, and the description sounds like his evidence about the milk run. Some wage records show that the Plaintiff was working 32 hours per week (suggestive of 4 nights) until May 2007 when his hours increased to 40 per week. This note of Dr Davies was made some two months before the Plaintiff claims he commenced working on the milk run. Dr Davies' report of 22 May 2006 makes reference to this work also. It cannot be suggested, therefore, that those references in the notes were added later.
53There is a report from a physician in nuclear medicine on 30 May 2006 detailing the results of a bone scan. It is not clear what prompted this report, but it refers to multiple low-grade rib injuries. Nevertheless, the clinical assessment refers to chronic cervical and lower back pain and left lower limb pain. The report says:
There is disco-vertebral disease at L5/S1. There is mild arthritis of the superior margins of the sacro-iliac joints.
54The report also said:
There are multiple low grade rib injuries. This involves the right 6th rib in particular but there are also injuries within the R 7th and 8th ribs and the left 8th and 10th as indicated on the films.
The conclusion in relation to the ribs was:
Multiple rib injuries presumed post traumatic.
I note, again in passing, that the report seems to suggest the Plaintiff had suffered some trauma at about that time, at least to the ribs. That may have relevance because it is at this time (May 2006) that the problems with the lumbar spine are first mentioned anywhere. However, the matter was not explored in evidence, and I do not think I should draw any inference adverse to the Plaintiff from it.
55There is then a report on a MRI of the Plaintiff's thoracic and lumbar spine from the Department of Radiology at Royal Prince Alfred Hospital. The complaint noted as justifying the MRI was left sciatica pain. The report disclosed that at L3/4 there is a focal central disc protrusion which was indenting the anterior aspect of the thecal sac. At L4/5, there was a left paracentral disc extrusion abutting the anterior thecal sac and causing a degree of canal stenosis. It was said that that would appear to be abutting the exiting left L5 nerve root. That would account for the sciatica. At L5/S1 there was a minor broad-based disc bulge.
56It is clear, therefore, that by the middle of 2006, there was radiological evidence supporting the Plaintiff's then complaint of, at least, left sciatic pain and probably lower back pain. Why it apparently emerged at that time does not appear.
57The first doctor to report on such complaints, apart from the notes of Dr Mark Davies, was Dr Patrick in his report of 16 August 2006 to the Plaintiff's solicitors. Dr Patrick said he had perused multiple documents being mainly imaging study reports, bone study reports and other reports, and he went on to say:
Perusal of these reports does cause me to affect my previous report of 10 October 2005 and probably also opinion and assessment, in that it would appear that Mr Milich has developed some left lower limb sciatica since seen by me in October 2005 (no particular complaint of left lower limb sciatica when seen by me at that time). I note that he has been seen by Dr Mark Davies, experienced neurosurgeon/spinal surgeon of Kogarah, and sent for radionuclide bone scan, demonstrating multiple rib injuries, presumed post-traumatic, and also significant disc lesion at low lumbar spine, particularly at L4/5, consistent with a left L5 radiculopathy. I note that bone density studies have been normal.
It is likely, that if there is some work-related injury to the lumbar spinal region, that some further assessment in respect of lumbar spine may become indicated. I do not know whether or not there has been any further traumatic incident sustained by Mr Milich since seen by me on 6 October 2005. Clinical re-examination of him may be indicated. I will leave this to your judgement. (Emphasis added)
That report was based only on a review of reports and did not involve a re-examination of the Plaintiff.
58Dr Patrick then re-examined the Plaintiff on 5 October 2006 and reported on this on 9 October 2006. In relation to Mr Milich's working Dr Patrick said this:
Mr Bill Milich himself is attempting some part time work at present, doing some driving, and some delivery work in a milk franchise. He was doing this work just very part time initially, but his work hours have built up to about 40 hours per week. He is finding it difficult. The work does not involve significant lifting/carrying in that he is able to use a trolley, but he is "in pain every day" and believes he will probably only be able to keep this going until about Christmas.
59The Plaintiff also told Dr Patrick that his wife did not work outside the home. This may be contrasted with the Plaintiff's evidence to the effect that his wife assisted him from time to time on the milk run.
60In relation to the Plaintiff's complaints, Dr Patrick said this:
Details of Mr Milich's significant work-related injuries and subsequent progress are set out in my previous report to you of 10 October 2005. At this occasion of re-examination, he tells me that he has had some degree of low back pain also, ever since early 2005, and this has been mentioned to his doctors. He did also develop some symptoms into left lower limb.
61In relation to his symptoms at that examination Dr Patrick listed ongoing neck pain posteriorly with the neck being stiff, pain and discomfort at both shoulders superolaterally with pain at the tops of the shoulders, continued difficulty using the arms outstretched or overhead, and Dr Patrick noted:
He is having difficulty coping with his current work with the milk franchise, even using a trolley. ... He tends to be exhausted at the end of the day's work. He believes he will not be able to continue this for long.
62Dr Patrick also reported on back pain at the upper-mid thoracic spine and low back pain which goes intermittently into the left buttock and left lower limb.
63Dr Patrick's opinion was this:
Re-examination of Mr Bill Milich on this occasion does not cause me to significantly alter the opinion as expressed on the final pages (pages 4 and 5) of my report to you of 10 October 2005, except that there has been some settling of signs at his thoracic region, but he gives a history of low back pain going into left lower limb with left sided sciatica. On questioning, he gives no history of frank subsequent injury (such as assault, or motor vehicle accident) which might have accounted for the significant changes on radionuclide bone scan as ordered by treating neurosurgeon/spinal surgeon, Dr Mark Davies, and carried out on 30 May 2006.
I do note that this radionuclide bone scan has been carried out approximately just a little over a year subsequent to Mr Milich ceasing his very heavy and very physical work with the council (ceased work there in April 2005). Changes of increased blood flow/increased osteoblastic activity on radionuclide bone scan can be present for up to 18 months or so following traumatic incidents, and I believe in the absence of other history of injury, it is likely that the changes have represented stress fracture or fractures in the ribs, associated with his particularly physical work as described in paragraph 3, page 1 of my report of 10 October 2005.
64Dr Patrick's assessment of whole person impairment remained unchanged at 22% allocated as follows:
Cervical Spine13 %
Lumbar Spine5%
Right Shoulder2%
Left Shoulder4%
65The Plaintiff saw a Dr Katataris who is described on his letterhead as an Injury Management Consultant for WorkCover. Dr Katataris does not say when he examined the Plaintiff but his report is dated 10 December 2007.
66He reported that the Plaintiff told him that in February 2005 his symptoms began. They was pain in both shoulders, neck and lumbar spine "with no specific mechanism of injury".
67The Plaintiff told Dr Katataris that he had ceased work with the Second Defendant and in July 2006 had returned to work as a truck driver. He continued with that work for more than 12 months until the 31 August 2007 and Dr Katataris noted "he denies any problems or substantial difficulties during this time". He then related to Dr Katataris the incident on 31 August 2007 when he went to the Bank and had difficulty walking. Contrary to his evidence that he ended up in Auburn Hospital, he told Dr Katataris that when he arrived home he was taken by his wife to his General Practitioner. I shall return to this later, but that statement seems to be correct.
68At some point while he worked for Terry Degnan he became interested in buying the milk run from him. He said that he was close to signing a contract with Mr Degnan and that would have been a couple of weeks or a month before the incident of 31 August 2007.