(b) Medical evidence
108Any assessment of the plaintiff's damages will depend to some degree upon a comparison between her condition prior to the assault, and her present condition. The Court was assisted by a joint report prepared by the four relevant psychiatrists, Dr Heiner, Dr Klug, Dr Bertucen and Dr Smith, who were, respectively, the plaintiff's treating psychiatrist and the plaintiff's, Insurer's and Club's expert psychiatrist retained for these proceedings.
109The joint report recorded agreement between Dr Heiner, Dr Bertucen and Dr Smith on most matters of significance, less so by Dr Klug, the plaintiff's expert psychiatrist.
110The joint report was drafted by Dr Heiner and signed by him and Dr Klug. Dr Smith and Dr Bertucen largely agreed with an earlier draft of the joint report, not relevantly different from the final version signed by Dr Heiner and Dr Klug. Relevantly the joint report stated, in respect of the condition of Ms Nicoll prior to the assault:
"There was agreement that Ms. Nicolls [sic] was psychologically, emotionally, cognitively and socially impaired prior to the events of 2006. The traumas and deprivation that she outlined in childhood, and her long history of abuse as a young woman, along with her reported history of dependent relationships on frequently violent and unstable males were all seen as evidence pointing to psychological pathology. She did appear to be functioning well, in the longer term relationship with her husband prior to the 2006 incident, but she was still socially isolated and maintained minimal interaction with others in the community. Likewise, the medical record from Dr. Killilea (General Practitioner) prior to the 2006 incident outlines a long history of chronic pain, frequent opiate use and at times evidence of pointing to misuse and abuse [of] these substances."
"We believe the consensus diagnosis is as follows...
Pre-existing psychopathology. There was consensus that Ms. Nicoll does suffer from significant and severe pre-existing psychological psychiatric pathology. There was agreement that this personality disorder had strong 'dependent and socially avoidant' traits, but some disagreement as to whether there was sufficient symptoms to use the label 'borderline personality disorder'.
There was agreement that Ms. Nicoll had a chronic pain/opiate dependent problem. This [is a] chronic disorder, and it has been present for many years prior to the events of 2006. There was no consensus as to whether the best description was Chronic Pain syndrome or Opiate Dependence. Further information would be required to resolve this.
There was agreement that there was little evidence to substantiate a diagnosis of either Attention Deficit Disorder, or Bipolar Disorder Type 2.
The question of Ms. Nicoll's underlying intellectual functioning or cognitive deficits was discussed. There was agreement that she was impaired, but whether this was congenital, the result of her childhood trauma or an acquired state as a result of her long history of physical assault in adulthood was unclear..."
" Did the plaintiff have a pre-existing condition(s) which affected her capacity for work as at the time of the incident on 7th October 2006? If so, please identify the condition(s) and advise to what extent the pre-existing condition(s) affected her capacity for work as at 7th October 2006.
This had been discussed above, but we will attempt to provide some of the details in which those decisions were made.
History suggests that Ms. Nicholl's psychological, emotional, physical and social environment and lifestyle had been consistent throughout her life. The history we had is of a number of short term, casual jobs without any sustained or prolonged periods of employment. This history we have is of chronic physical difficulties with migraines, and other symptoms for which Ms. Nicoll's frequently sought and was prescribed opiates. There is evidence that indicates excessive use of these medications, and a passive reliance on medications to solve her problems. The history suggests a long history of social avoidance and isolation, with a dependency on others to survive."
111In respect of the effect on Ms Nicoll of the assault, the joint report additionally stated:
"...There was general agreement that there had been some symptoms development and some psychological and social impairment following the incident of 2006, however, as this was superimposed the preexisting pathology, and the disagreement was about the extent of change and the relative contribution of these two components"
" There was agreement that Ms. Nicoll did suffer a deleterious psychological response as a result of the assault of 2006. There was agreement that Ms. Nicoll's pre-existing 'chronic psychiatric pathology was exacerbated by the assault of 2006, and that there were some additional symptoms as a result of the assault of 2006'. There was agreement that this did qualify for the diagnosis of 'an adjustment disorder with mixed features' but there was a lack of consensus that it qualified for a diagnosis of 'post-traumatic stress disorder'. Dr. Peter Klug is of the opinion that a diagnosis of 'Reactivated Post-Traumatic [Stress] Disorder was appropriate."
"...Ms. Nicoll did develop some psychological consequences as a result of the 2006 assault. There was consensus that these psychological consequences were superimposed on pre-existing psychopathology, and were transient. With the exception of Dr. Peter Klug, who felt that Ms. Nicoll's ability to be employed in the future had been destroyed by the assault of 2006, the consensus was that Ms. Nicoll had best suffered transient psychological symptoms that may have lasted for a year at most. The major reason for this disagreement was a lack of details about exactly how long and in what capacity she had previously worked. She had only just begun the work at The St. Basin Club and had only completed a few shifts at the time of the incident of 2006, as the information suggested no work since her previous PTSD history.
The fact that she attempted a return to security work in 2009 and that her overall life style appears to have been very similar to what it had been prior to 2006 all point to the transient nature of the psychological and social sequelae of the 2006 event, is evidence in support of this."
"In the absence of concrete evidence to the contrary (group certificates, records from employers) there is no evidence to suggest that her capacity for work has been substantially altered since the incident of 7th October 2006."
112Dr Klug clarified in an addendum that this last sentence should not be read as representing his opinion. There is some uncertainty about the meaning of this sentence in any event, which I have understood to mean that, other than Dr Klug, there was consensus that, apart from transient consequences, Ms Nicoll's capacity for work was not substantially altered by the assault.
113In respect of Ms Nicoll's ongoing condition, the joint report also stated:
"The consensus was that Ms. Nicoll has a poor prognosis. There was pessimism that her long term psychological problems would resolve, and an expectation that these long term psychological patterns of behaviour would continue into the future. As stated above, Dr Peter Klug believes that Ms. Nicoll's employability had been reduced significantly since the result of the assault of 2006, but the consensus of the other three (3) psychiatrists was that Ms. Nicoll's employability was impaired prior [to] the assault of 2006, and that at best the assault reaffirmed what had already been an entrenched pattern of behaviour.
Does the diagnosed injury or condition affect her capacity for work, and if so, to what extent?
There was consensus that Ms. [Nicoll] was totally unemployable."
" Does the diagnosed injury or condition give rise to a need for attendant care services, and if so, to what extent?
There was consensus that Ms. Nicoll has a pattern of being in 'dependent relationships'. This predated the assault of 2006, and has continued since then. There was no evidence that her need for attendant care had changed as a result of the assault of 2006, or as a result of the 2012 incident."
" Does the diagnosed injury or condition make likely a need for any future treatment, and if so, what is the nature and likely cost thereof?
There was consensus that Ms. Nicoll's problems are long standing and entrenched. There was pessimism that 'any psychological treatment may be of benefit'. This is based on the nature of Ms. Nicoll's long term problems, but also because Ms. Nicoll herself does not identify these long term difficulties as a reason to seek treatment. Compensation and the financial reward that this would bring are important, but she is not currently and has not indicated that she intends to seek treatment in the future.
In view of this, there would not be expected to be any ongoing cost."
114The experts also manifested some disagreement about the incident in 2012 where Ms Nicoll drove to pick up a friend, travelled to Sydney, and while alone was apparently sexually assaulted. She was hospitalised for a day or two and discharged herself against hospital advice. The report stated:
" The assault of July 2012 was also a source of disagreement. There was agreement that the assault occurred, and that Ms. Nicoll was injured and hospitalised as a result. The incident was confusing in that she initially reported having been assaulted, and she was given potent opiate pain killers for her complaints of pain."
115Dr Bertucen was not persuaded that an assault occurred, but the joint report indicates that the other doctors appeared to agree as to the incident. The incident indicated that Ms Nicoll was not so unable to leave the home as her evidence of social withdrawal indicated. That she met her current partner in Cairns, as she told Dr Smith, is also inconsistent with her evidence of inability to leave the home.
116Dr Klug wrote an addendum to the joint report. He noted that he was "unhappy with aspects of the Report". The only matter of relevance he specified is the one outlined earlier.
117Dr Klug, Dr Heiner and Dr Bertucen gave evidence in conclave. At an early stage of this conclave, senior counsel for the plaintiff sought to establish a pre-assault level of functional capacity beyond that stated in the joint report. The following question, or history, was put without objection to the three doctors:
"I want to give you some matters that may or may not have been part of your pre-October 2006 history, but which are in evidence before the Court and I am going to ask each of you in turn whether this history affects the conclusions to which each of you have come. Given the consistent prior history of abuse, the evidence is that from 1994 to the time of the assault, she was in a stable relationship, that in those years she had three children, two of whom provided health difficulties, with which she coped, that she interacted with the schools providing education to her children, including teachers, given the eldest one had ADHD and the eldest one was an insulin-dependent diabetic, that socially she was involved in the Erowal Bay Tennis Club, played regularly, socialised regularly with members - I'm not suggesting she was another Yvonne Goolagong, but she played tennis and socialised.
She was involved in social gatherings with family, extended family, friends, neighbours. Sometimes her husband was away with work and she coped with the three children and running a household; that from time to time she did the shopping by herself. She maintained social friendships, girlfriends, other mothers, lunches, drinks, horse riding. She maintained, not entirely by herself but certainly to a significant degree, a home and in 2005 evinced an intention to qualify to work as a security guard, followed that through, did various exams and tests, passed those, was licensed in early 2006 - perhaps it was March 2006 - but she worked from time to time over the next six months.
I think there is evidence that she worked at a Legends nightclub in Nowra, worked at the Royal Easter Show and in the immediate either weeks or months before the incident had worked three, possibly four shifts at the RSL club but given that history, Dr Heiner, first, would you agree that she is firstly, socially involved and to an acceptable level of interaction with others?"
118The three doctors were asked in respect of this history: "The material I have provided you with, does that indicate a level of functional capacity beyond that referred to in your joint report?" Each responded affirmatively.
119The primary concern I have with this evidence is that the history delineated in the question is necessarily incomplete. Ms Nicoll's pre-2006 problems are summarised inaccurately by the words "prior history of abuse" and as a whole the summary is unduly positive. Yet the effect of the question is to present a history that the doctors must accept irrespective of what Ms Nicoll has told or manifested to them, or what they have read from other reports, or what the evidence before the Court actually comprised. I do not think this history fairly represents the position of Ms Nicoll at the time of the assault.
120I prefer the conclusion in the joint report. It reflects an agreed position of three of the doctors including Dr Heiner, who was Ms Nicoll's treating psychiatrist. Further, the agreement came after a period of reflection on the contents of the written draft, and involved a consideration of the views and information of the other experts shared as part of the process. The oral evidence on the other hand, resulted from the doctors being compelled to assume a certain set of facts, necessarily abridged and inaccurate, and allowed no period of reflection. To the extent that the doctors gave evidence contrary to their opinion contained in the joint report, the inconsistency would diminish the value of that evidence.
121Dr Klug did not agree with all the contents of the joint report, but I prefer the conclusions reached by the other three doctors, particularly as they include the treating doctor, Dr Heiner, and because they are more consistent with the undeniable and significant problems faced by Ms Nicoll prior to the assault, problems referred to by Dr Klug, among others, in his earlier reports.
122When the five years prior to the assault is considered, I do not accept that Ms Nicoll was functioning at a significantly higher level than she is now. So far as her employment is concerned, she had no earnings until 2006. Details of her earnings over 10 days at Easter 2006 were not in evidence. In the 2007 financial year (presumably in the 14 weeks before the assault) she earned $2,479. She did further training as a security guard in 2008, but her return to physical duties was unsuccessful. She was restricted to office work after the assaults. In the 2008 financial year she earned $6,133.
123The joint report states that Ms Nicoll is unemployable. I accept that she is not capable of holding down a permanent job. Whether she is capable of occasionally being engaged in remunerative work is not so clear: she was able to earn as much as $10,000 after the assaults. But accepting unemployability, her pre-assault earnings do not fairly establish that she was employable in any substantial capacity prior to the assault. Even if it did, that she is now unemployable should be attributed to her pre-existing condition, as the Report concludes. I accept the joint report as to her pre-assault functionality.