Mrs Jeffries and her state of mental health
129Having regard to the nature of the issues, and in particular the submission of Vero that I should be satisfied that Mrs Jeffries committed suicide, it is appropriate to examine the evidence about the state of Mrs Jeffries' mental health at the time of the collision.
130The information about Mrs Jeffries comes principally from those who knew her, including her son Rodney, a neighbour and friend, Mrs Shirley Allaway, and Mr Donald Nott. As well, Dr Moroney, who was her general practitioner for over 30 years prior to her death, gave evidence about Mrs Jeffries.
131This description of her life and background is drawn from that evidence, much of which was undisputed.
132At the time of her death, Mr Jeffries was 54 years old. There was little in the evidence about her early upbringing, but her parents were still alive at the time of the accident. They were not called to give evidence, nor were statements tendered from them.
133Mrs Jeffries was married and had two children. Her son, Rodney, was born in 1966 and her daughter, Tanya, was born in 1968. She divorced her husband, who was the father of her two children, in about 1994. At that time, she lived in Narrabri with her family. After her divorce, she purchased a house in, and moved to, Baan Baa. Her house was unencumbered by any borrowings at any stage.
134At the time she moved to Baan Baa, she told her son Rodney that she wanted to move closer to her parents to look after them. She was diligent about doing this and saw them at least once a day.
135From about 1971, Mrs Jeffries attended at the Bridge Medical Centre in Narrabri where she was seen by Dr Moroney, who was her general practitioner. An extensive report is in evidence from Dr Moroney listing each occasion when he saw Mrs Jeffrey, and made notes, throughout the period up to her death.
136It is unnecessary to record in this judgment all of the details of the consultations with Dr Moroney. They are almost entirely irrelevant.
137The first occasion upon which he makes any reference at all to her mental state, is on 19 April 1977, when he prescribed two drugs relating to her anxiety and stress which seems to be related to her marital relationship. The children were aged about 11 and 9 at that stage.
138There are a few, but not many, subsequent references, contained in the notes to a similar complaint of stress and anxiety. These are largely in the period up until July 1984. In late 1989, Mrs Jeffries again complained to Dr Moroney of increased stress which was associated with difficulties in her marital relationship.
139The first mention of depression (as opposed to anxiety or stress) occurs in a note of 2 September 1996, when Dr Moroney records that she presented "... very depressed". He did not prescribe any medication for this symptom.
140In a note of 11 September 1999, which is the next mention of depression, Dr Moroney records:
"She had been depressed so I started her on Zoloft one of the later, more useful antidepressants."
141There were three further notations of depression. The first on 26 April 2001, when Dr Moroney noted that she was still depressed, and that he continued the Zoloft. The next on 6 May 2001, when there was obvious depression. The final mention was on 8 October 2003, when Dr Moroney noted that Mrs Jeffries was still depressed but had refused treatment for that condition. It is unclear from the notes when she ceased being prescribed, and taking, Zoloft or other like medication.
142Dr Moroney's report contains this statement and commentary toward the end of it:
"I have described my various consultations with Mrs Jeffries but you will notice that two words stand out from nearly the first consultation. They are stress and depression. The original stress caused a few problems ... Also the diagnosis of depression followed later after years of stress. This means she had acute followed by chronic stress followed by depression. She was not happy [with] my using the word depression and even less happy with my prescribing antidepressants which is why I prescribed so little of them. ...
Towards the end she would not let me use the word depression or write it in the notes as she was paranoid about my girls or anybody finding out the true problem."
143It will be necessary to return to Dr Moroney's opinion about the cause of Mrs Jeffries' death, in due course. I note that generally speaking, so far as the notes record, Dr Moroney saw Mrs Jeffries a little less frequently than once every two months, in the five years before the collision. Most of these consultations occurred in 2001 in association with a number of identified physical symptoms. He clearly did not see Mrs Jeffries as often, or for as long a period, as did Mr Rodney Jeffries or Mrs Allaway.
144Rodney Jeffries described his mother as a person who was generally "... a happy and independent soul", who took great pride in her appearance up to the time of her death. He said she was very particular about her clothing and was always very presentable and well dressed. He said that she was very proud of her house, its yard and garden which she kept in a good state. She regularly mowed the lawn and maintained a flower garden. She kept the house to a high standard of cleanliness by her regular housework and the house was generally very tidy.
145Mrs Jeffries had three grandchildren at the time of her death and her daughter Tanya, was pregnant with her fourth grandchild. She greatly enjoyed her grandchildren, and kept photographs of them which she shared with friends and visitors.
146During the years 2000 to 2004, Mrs Jeffries worked on average two days a week, doing housekeeping and home maintenance duties on a property at Wee Waa, which is about 80 km from Baan Baa.
147It was apparent in the years leading up to 2004, and Mrs Jeffries told her son Rodney, that she was suffering from some incontinence problems. She was booked in for surgery at the Inverell Hospital on 5 May 2004. In a conversation with her son on the day before her death, Mrs Jeffries did not appear to be overly concerned about the operation.
148In the five years leading up to her death, Mr Rodney Jeffries saw his mother for hours at a time and on regular occasions. It was his evidence that he did not observe any change in her outgoing, contented and happy personality or demeanour. He expressed this view about his mother:
"At no time during the 38 years I knew my mother did she ever mention or suggest self harm. Such behaviour would be totally inconsistent with her personality and her enthusiasm for life and particularly her enthusiasm for watching her family, including her young grandchildren, grow up."
149Mr Rodney Jeffries was an impressive witness, with a good recall of events. He said that his mother dropped in to see him at his place of work in Narrabri between 3pm and 4pm on the afternoon of her death. The visit lasted between 15 and 20 minutes. He expressed the view that his mother was her "usual happy, bubbly and talkative self".
150It was Mr Jeffries' understanding that his mother was going to return home to Baan Baa after she left her meeting with him. He said that it was her almost daily practice to visit her parents, who lived between 1.5 and 2km along the Barranbah Road from the level crossing.
151Mr Jeffries was completely unaware that his mother suffered from any depression, nor did he realise there was any issue with her mental health. He said that whenever he spoke with her, she did not show any signs of depression.
152He described his mother as a proud, very outgoing and very popular woman in the community.
153It is fair to say that the picture one obtains from Mr Rodney Jeffries was not one of a woman intending to take her own life, let alone within no more than a couple of hours from when he last saw her. The impression was that she was a happy woman with much to live for and look forward to.
154Shirley Allaway was a close friend of Mrs Jeffries. She lived in a house a few doors along from where Mrs Jeffries lived in Baan Baa and saw her, if not every day, then almost every day.
155A measure of their friendship was that in February 2004, Mrs Allaway went and stayed with Mrs Jeffries at the Tamworth Base Hospital when Mrs Jeffries needed to be admitted for surgery. She was again intending to accompany Mrs Jeffries on her admission to Inverell Hospital, scheduled a day after the collision.
156She gave this description of her friend:
"Phyllis was a happy go lucky person. If something were worrying her she would make a joke about it. Phyllis had no more worries than anyone else. ...
Phyllis would tell me things that she would not tell other people we were that close. Phyllis had no real money worries, no more than anyone else. I think she had money invested. ..."
157Mrs Allaway described the relationship between Mrs Jeffries and Mr Nott, which had been terminated by Mr Nott in or around Christmas 2003. Mrs Jeffries had confided to Mrs Allaway that if Mr Nott were to come back, then she would accept him and resume their relationship. Of the relationship between Mrs Jeffries and Mr Nott, Mrs Allaway said this:
"However this relationship with Noddy [Mr Nott] was not a major factor with her. It was not enough that she would have killed herself; she was always out and about perving on other blokes. She was a happy go lucky person."
158On 4 May 2004, Mrs Allaway met up with Mrs Jeffries in Narrabri. It is unclear how it was that they came to meet each other, in the sense of whether it was planned or not, but they certainly spent time together in Narrabri. They discussed the upcoming operation which Mrs Jeffries was to have at Inverell Hospital. Mrs Allaway had the impression that Mrs Jeffries was not concerned about the operation. They did some shopping.
159Mrs Jeffries drove Mrs Allaway to a doctor's appointment and then sat in the waiting room whilst Mrs Allaway was being attended to. They went for a coffee in west Narrabri and then made their way home, albeit in separate vehicles.
160When they arrived at Baan Baa, Mrs Jeffries accompanied Mrs Allaway into her house. They had a conversation and then walked out to Mrs Jeffries' car. They continued to converse. Mrs Allaway indicated to Mrs Jeffries that, subject to some illness with her parents preventing her, she would accompany Mrs Jeffries to Inverell Hospital and stay with her during her operation. Mrs Jeffries left and waved to Mrs Allaway as she drove off.
161Mrs Allaway described Mrs Jeffries at the time of their final parting in these words, which I accept as an accurate picture of Mrs Jeffries as she drove off to visit her parents:
"Mrs Jeffries' manner appeared to me to be no different than to what I had observed earlier in the afternoon. She appeared to me to be relaxed and unconcerned by anything ... she appeared to me to have no concerns about her procedure the next day."
162Mrs Allaway was told by Mrs Jeffries that she was going to visit her parents. Since Mrs Jeffries had been working in Wee Waa that day, and was accustomed to visiting her parents at least once every day when she was working, and if not working, twice daily, Mrs Allaway was confident that Mrs Jeffries was going to visit her parents. It was a short time later that the collision occurred.
163In her statement, Mrs Allaway described her friend Mrs Jeffries, in this way:
"When I saw Phyllis on the day of the accident, she was in a good mood and there were no indications what-so-ever that she would commit suicide. Phyllis would not have taken her own life, she was in her good normal spirits that day. Nor would she [have] hurt any other person."
164When she gave evidence, she was specifically asked whether she had observed Mrs Jeffries to be depressed at all, or whether her close relationship with Mrs Jeffries had given her any inkling that Mrs Jeffries might be depressed. Mrs Allaway said that she had never, on any occasion, seen Mrs Jeffries displaying any signs of depression.
165When she was asked whether she thought that it was unlikely that Mrs Jeffries would have discussed matters of depression with her, she rejected that and said that she thought that if Mrs Jeffries were depressed "... she would have told me because we were pretty close".
166I thought that Mrs Allaway was an impressive witness. I accept her evidence. Clearly, in the five years, or perhaps more, preceding the collision, she saw, and spent more time with, Mrs Jeffries than anyone else.
167Other non-expert evidence is also relevant to the possible state of mind of Mrs Jeffries.
168About four to five months before the collision, Mrs Jeffries spoke with Ms Caroline King. According to Ms King's unchallenged statement, Mrs Jeffries was deeply unhappy that her relationship with Mr Nott had come to an end. Ms King said that Mrs Jeffries had told her that she felt like "... ending it all..." and that she was "... unhappy with life ...". It is not clear from Ms King's statement how well she knew Mrs Jeffries, nor how frequently she saw or spoke with her. It is not clear if Ms King spoke to Mrs Jeffries between this conversation and the collision. I am satisfied from the evidence of Mr Rodney Jeffries and Mrs Allaway that Mrs Jeffries was not "unhappy with life" in May 2004.
169About six months before the collision, Mrs Jeffries spoke with Mr Robert Shields, a grazier with whom she was friendly. She told him that she was "... a bit depressed ..." and that she had thought that she might sell and leave Baan Baa. Having regard to the proximity of this conversation to the ending of her relationship with Mr Nott, I would infer that these expressions were reflective of the breakdown in that relationship.
170However, Mr Shields went on to say that Mrs Jeffries had remarked to him that she "... often feel[s] like driving straight under a semi and ending my life". After a discussion about harm to other blameless people if such an event occurred, Mrs Jeffries said that "... possibly a train would be better".
171Mr Shields recorded that in the few months after that conversation, Mrs Jeffries had told him that she was still feeling much the same and that he thought she felt life was not worth living. Again, these expressions do not appear to have been reflected in anything said by Mrs Jeffries on 4 May 2004.
172After the collision, the contents of Mrs Jeffries' handbag were examined by Ms Tanya Jeffries. According to Detective Senior Constable Sims in an envelope in the handbag, there was a handwritten letter from Mrs Jeffries to Mr Nott. It seems to have been written on 28 April 2004, but further material seems to have been added after that date.
173The letter, which was in evidence, did not contain any threat of, or suggestion that, Mrs Jeffries was intending to commit suicide. It could not be regarded, and was not so regarded by the three expert psychiatrists, as a suicide note. It expressed no suicidal ideation or intention. It professed Mrs Jeffries' care for, and affection for, Mr Nott, and her desire to resume their relationship. It invited Mr Nott to make contact with her, saying;
"If you would like to talk to me, it will have to be this Wed (to-day) or Friday week Nite as I will be in hospital this Friday till Monday."
Dr Skinner, an expert psychiatrist concluded this was not "... a particularly positive letter". Dr Phillips, an expert psychiatrist, saw it differently. All of the expert psychiatrists were not persuaded that the letter itself evinced any suicidal intentions.
174Ms Helen Starr also saw Mrs Jeffries for a period of up to half an hour on the afternoon of the collision. Her evidence is discussed in some detail later in this judgment.
175Against the background of these statements, and the evidence of and about Mrs Jeffries in the time prior to the collision, it is necessary to consider the evidence of the expert medical practitioners. Dr Moroney gave evidence and expressed the view that he thought Mrs Jeffries committed suicide. The three expert psychiatrists, Dr Phillips, Dr Klug and Dr Skinner, expressed conflicting views. Dr Klug and Dr Skinner thought on the basis of the factual material, which they had been given, that Mrs Jeffries did commit suicide. Dr Phillips thought that she did not.
176It will be necessary to examine each of these opinions. It is also necessary to comment that each of these four medical experts had a different factual basis for the expression of their views. The factual bases, at least initially, were not consistent. As well, each of the expert psychiatrists engaged in the interpretation of the facts given to them, and placed a different emphasis on various facts.
177It is convenient to commence with Dr Moroney. Although not as expert in the matters of mental health as the psychiatrists, his opinion nevertheless warrants careful consideration.
178Dr Moroney gave evidence before the Coroner when the Inquest was held into Mrs Jeffries' death. He had about 25 years' experience in Narrabri performing post mortems and giving evidence to the Coroner.
179He said in his evidence before this Court that in 2009 at the Inquest, he expressed the view that Mrs Jeffries had committed suicide, and expressed it with a level of confidence between 90 and 95 per cent.
180He said that he based that opinion, at the time he expressed it, upon a number of features of Mrs Jeffries' life of which he was aware, namely:
(a)the prospect that Mrs Jeffries' job might come to an end and that she would cease to obtain a significant part of her income;
(b)persistent contact by her ex-husband with her;
(c)her concerns about her daughter's drug taking, alcohol consumption and general behaviour;
(d)her relationship with Mr Donald Nott, which had come to an end a fairly short time before the collision;
(e)her concerns about her living arrangements;
(f)her concerns about her personal health and the upcoming operation at Inverell Hospital;
(g)her concerns about her financial incapacity to replace her aging motor vehicle; and
(h)a breakdown of her previously cordial relationship with her former mother-in-law during the six months prior to the collision.
181Dr Moroney confirmed that Mrs Jeffries had ceased to take any prescription drugs for her mood or her depressive state well before the collision because she had expressed a view that she did not wish to take them anymore. The precise period is in dispute between the parties, but was, at the least, seven months before the collision.
182Dr Moroney was cross-examined about the accuracy of his report. It was a comprehensive report and Dr Moroney affirmed its accuracy in all respects in his evidence-in-chief. In cross-examination, it became apparent that the list of drugs contained in the report may not be a complete list. Dr Moroney said that there may have been occasions where he did not make a note of any drugs associated with Mrs Jeffries' mental health, because she had asked him not to. He could not point to any particular occasion where this had occurred, but sought, in effect, to reserve the possibility that it had occurred.
183As well, he said that he would not ordinarily note in that "comprehensive" list, drugs prescribed by specialists or else occasions when he gave a repeat prescription of drugs which he had previously prescribed without having a formal consultation.
184I accept that Dr Moroney wished to be careful answering the questions in cross-examination, but having regard to the length and detail of his report, and the fact that he did note the prescription of drugs directed to alleviating Mrs Jeffries' mental health, I could not be satisfied that he prescribed any other drugs for a lengthy period, or else on many occasions, which he had not noted. I accept that it is possible that on one or two occasions at some stage over the long history of his caring for Mrs Jeffries, that he did not record the prescription of a drug. However, I do not regard these occasions as being of any substance in the determination of the state of Mrs Jeffries' mental health at the time of, or in the months leading up to, the collision.
185This approach is confirmed by the fact that it was accepted by all parties, and by Dr Moroney, that Mrs Jeffries had not consumed any prescription medication for her mental health for a period of at least seven months prior to the collision. This period reflects the time between a consultation on 8 October 2003 and the collision. The last date upon which there is recorded the prescription of a drug for her depression is 26 April 2001. The evidence is silent as to whether she consumed any drug after that time for her mental health.
186It was also accepted by the parties, the expert psychiatrists and Dr Moroney, that the effects of such medication as she had been taking would have ceased within a period of three to four weeks after she ceased taking the medication.
187It also appears from Dr Moroney's notes that he did not refer Mrs Jeffries to any psychologist or specialist psychiatrist at any time after the late 1980's. He did not give evidence that at any time in the ten years (or longer) before the collision, he had advised Mrs Jeffries to consult such experts. I infer that he did not regard Mrs Jeffries' mental health as being sufficiently affected to warrant such a referral.
188As a consequence, at the time of the collision, and in the days leading up to it, Mrs Jeffries' state of mental health has to be assessed upon the basis that it was not alleviated in any way by prescription medication and that during his consultations in the period since April 2001, Dr Moroney had not specifically prescribed any such medication for Mrs Jeffries.
189In formulating his opinion, Dr Moroney did not regard the statements of Mrs Allaway and Mr Rodney Jeffries, which he had read prior to giving evidence, as being of enough importance for him to take into account. He disregarded their statements when formulating his opinion.
190A significant factual issue emerged in cross-examination about one of the facts underlying Dr Moroney's opinion. In his report, Dr Moroney records the following note with respect to events of which he had been informed. His report records this:
"On 24.5.04 I was told by my Practice Manager [that] Mrs Jeffries had been to the surgery on 4.5.04 at about 4pm hoping to see me but left without making an appointment. I normally return to the surgery at about 4pm so I must have missed her. The Practice Manager told me she was in a highly agitated state and did not wait for me, and she died about 2 hours later. This information was conveyed to my Practice Manager Carol Connole by one of my receptionists Helen Starr who has since left Narrabri."
191In cross-examination, Dr Moroney noted that the information conveyed to him by his practice manager, about Mrs Jeffries coming to see him on 4 May 2004, was communicated to him in May 2008, not 2004 as his typed report contains. As this was checked and confirmed with him during the cross-examination, I conclude that the date written in his report was an error, which should have read "24.5.08".
192Dr Moroney agreed in cross-examination that he had placed this information into his report because he regarded it as very significant and critical. I have no doubt that he did so because it was important for the purpose of supporting his opinion about whether Mrs Jeffries committed suicide. Dr Moroney agreed that the words of central importance in the note were that Mrs Jeffries' presentation had been described as being in "... a highly agitated state ..." and that she didn't wait for the doctor to attend within what must have been a relatively short period of time. This was in the context, as he understood it, that Mrs Jeffries had sought to see him in consultation.
193Dr Moroney said that he concluded from the description that he had been given, that Mrs Jeffries was in a period of turmoil, seeking his help and "... was deciding what she was going to do". The end point of this decision making exercise was, as he saw it, her decision to commit suicide.
194It is necessary to examine the factual evidence about this incident apart from the material recorded in his notes. After all, Dr Moroney received the information in a second-hand way.
195The factual evidence of what occurred at the Medical Centre, consisted of the unchallenged statement of Helen Starr, who was working as a receptionist at the medical centre at which Dr Moroney practised. It was she to whom Mrs Jeffries spoke on the afternoon of the collision. Her statement contains the following account of what happened:
"8. I was doing the banking at the front desk when Phyllis arrived and I recall looking up and seeing her standing there. She was leaning over the counter.
9. Phyllis was well dressed and groomed on the day, and I recall complimenting her on how well she was dressed and how nice she looked.
10. She was very chatty with me on the day which was a bit unusual, because, whilst I knew her, she generally spoke with Carol rather than me when she came into the Medical Centre. Carol was not there on the day as she was on leave.
11. Phyllis seemed bright on the day but she lingered around longer than usual and it seemed to me that she wanted someone to talk to. I thought it was [a] bit unusual that she talked to me for as long as she did because I did not really know Phyllis on a personal level ...
12. Phyllis left after chatting for about half an hour and I recall thinking that I should ask her out for a cup of coffee one day ... and I thought she may enjoy a chat over a cup of coffee."
196It is plain from the statement of Helen Starr that the second-hand description which Dr Moroney received from Carole Connole some four years after the incident, and which he recorded in his notes, and relied upon, was not supported by the primary evidence of what had in fact happened. There is no evidence that Mrs Jeffries was in a highly agitated state, nor that she attended at the Medical Centre asking to see the doctor. The evidence does not support the inference that when she was told that Dr Moroney was not able to see her at that time, because he had not arrived, she left, rather than waiting for the consultation which she wanted. There is no support for the conclusion that she was in turmoil.
197Importantly, Dr Moroney's note suggests that Mrs Jeffries had been to the surgery in order to consult with him. No doubt, it was that wish to consult him, and the fact that she was in an agitated state and then left without consulting him, which caused Dr Moroney to place a good deal of weight on this event when considering whether or not Mrs Jeffries committed suicide.
198In fact, the statement of Helen Starr does not suggest that Mrs Jeffries sought an appointment with Dr Moroney. On the contrary, it emerges from Ms Starr's statement, that Mrs Jeffries was friendly with the practice manager, Ms Carol Connole, and that from time to time Mrs Jeffries called in to the surgery to have a chat with Ms Connole. What in fact Ms Starr said was this:
"5. Phyllis came into the surgery about once a month, either for an appointment with Dr Moroney, to pick up some prescription or for [a] chat with Carol Connole, who was a friend of hers. ...
6. ... she sometimes came into the Medical Centre just to talk with Carol."
199As the extract of Ms Starr's evidence, to which I have earlier referred, demonstrates, at no time on this afternoon did Mrs Jeffries in fact seek an appointment with Dr Moroney. On the contrary, her attendance at the Medical Centre on that day, and her staying there for about half an hour talking with Ms Starr, is consistent with her calling in to the Medical Centre to catch up with Ms Connole for a chat, having that friendly conversation with Ms Starr in Ms Connole's absence, whilst she was waiting for Mrs Allaway to complete her consultation at the other medical centre, or else the other activities upon which she was engaged. It seems that she then left to go about the rest of her afternoon in Narrabri.
200There is simply nothing in the evidence that supports in any relevant respect the note made by Dr Moroney as to what occurred on 4 May 2004, and which has formed a critical basis for the opinion which he expressed in Court, that Mrs Jeffries committed suicide. In particular, the words which were of central importance to Dr Moroney, to which I have referred above, were not substantiated by the evidence.
201It is necessary to return to the evidence of Dr Moroney. In a statement prepared by him for the Inquest on 11 August 2004, he said:
"I feel that everything seemed to be getting on top of her and she refused to take any medication to help her overcome her increasing depression. Thus I feel she may well have stopped on the railway tracks deliberately."
This statement assumes that Mrs Jeffries stopped her car on the railway tracks. Dr Moroney must have been told this prior to making his statement, although it is unclear by whom he had been told.
202In his evidence before this Court, Dr Moroney asserted that he had told the Coroner that there was a 90 to 95 per cent chance that Mrs Jeffries had committed suicide. It is accepted by both parties that the transcript of his evidence at the Inquest contained no such mathematical calculation or expression of certainty. In his cross-examination, Dr Moroney asserted that when he used the word "may" in his statement of 11 August 2004, that in his mind it meant almost certainly. He said:
"May, meaning almost certain. When I wrote the word 'may' in mind I meant almost certainly. I could not say she did because did means 100 per cent and I could not say 100 per cent."
203When cross-examined in this Court about the meaning of his Inquest statement, Dr Moroney agreed that at the Coronial Inquest, which it was accepted by the parties took place in 2006, his evidence was to this effect:
"She was - I'm saying she was in my official statement, my exact words were:
'I feel that she may have stopped on the railway line intentionally.
I'm not saying that she did. I said 'may' because she was depressed."
204The reference in this extract of his evidence to depression is clearly a reference to a "stressor" or "intercurrent stressor" of a kind which would demonstrate the existence of a risk factor for suicide. If by the use of the word "may" Dr Moroney was acknowledging the risk factor, and agreeing that because of its presence, there was a possibility of suicide, then such an opinion would accord with the opinion of the three expert psychiatrists who gave evidence before me. If it meant, without more, a 90 to 95 per cent certainty of suicide, then it would not reflect their view, or orthodox medical opinion.
205As well, that was not what he said at the Coronial Inquest in the evidence to which I have earlier made reference. His evidence there is confined to the expression of the word "may" and an association of that with the fact that Mrs Jeffries was depressed. He did not say to the Coroner that he was 90 to 95 per cent certain that she had committed suicide. He did not even say that he was confident or sure that she did. Rather, when pressed, he adhered to the use of the word "may", that is, reflecting a possibility, and contrasting the use of the word with the expression "I am not saying that she did" which would be the logical phrase if he was 90 to 95 per cent certain that she had committed suicide.
206I am satisfied that all Dr Moroney was telling the Coroner was that since a risk factor existed, there was a possibility of Mrs Jeffries committing suicide. I reject his evidence to me, that at that time, he was satisfied to the point of certainty that she had committed suicide. It was not what he said, nor in my judgment, is it what he meant. Had that been what he wished to communicate, then he could have done so quite directly and plainly, but he did not.
207He agreed that this visit to the surgery was consistent with her obtaining the results of blood tests in advance of the surgery which was planned, but expressed the view that he thought that it was unlikely that Mrs Jeffries was coming to collect those results from him. There is an additional reason, the apparent social purpose of calling in for a chat with Mrs Connole, which may explain Mrs Jeffries visit to the Medical Centre, without the need to conclude that she was there for assistance with her mental health problems. Until the hearing in this Court, Dr Moroney seemed completely unaware that Mrs Jeffries had not requested to see him when she attended on 4 May 2004, nor did he seem to be aware of the two other reasons which may have been the cause of her visit to the Medical Centre. What I am satisfied about is that Mrs Jeffries did not call into the Medical Centre on 4 May 2004 for the purpose of consulting with Dr Moroney.
208In July 2004, his notes recorded the words "her state of mind ... possibility of suicide", which he said reflected the questions he was asked by the police at that time. His coronial statement followed in August 2004, in which he recorded his opinion that "... she may well have stopped on the railway tracks deliberately". In 2006 at the Inquest, his evidence did not indicate anything more than a possibility of suicide. In my opinion, at all times before receiving the information which he did in May 2008, Dr Moroney regarded Mrs Jeffries' death as being a possible suicide. That possibility became a near certainty after receiving the incorrect description of the facts of the May 2008 visit.
209There is no doubt that his notes record regular, but not frequent, visits to the Medical Centre during which Mrs Jeffries complained, or else the doctor made a note of, problems with anxiety, stress and depression. The notes record the prescription of medication ceasing some years before the collision, but I note the period of cessation may be limited to seven months as appears to be asserted by Dr Moroney.
210I am not satisfied that there has been any more than a small number of occasions when Dr Moroney has prescribed medication for the relief of anxiety or depression which he has not noted. Any such occasion is not a significant factor to which reference need be made, in assessing his opinion.
211At no time after 1987 had Dr Moroney referred Mrs Jeffries to a psychiatrist or psychologist for expert advice of treatment about her mental health. If he had been particularly concerned about her mental health, I am confident that he would have referred her to a psychiatrist for specialist care, as he was accustomed to doing for her other problems.
212I am of the view that Dr Moroney's certainty about Mrs Jeffries committing suicide has been a more recently developed view which has come about because of the incorrect information with which he was provided in 2008, about the incident of 4 May 2004. As a result of that additional information, he has concluded that she was suffering from an acute episode of her chronic mental illness, which required urgent treatment which he was unable to provide because he was not there.
213In one of his answers in cross-examination in this Court, Dr Moroney expressed the view that he felt guilty about Mrs Jeffries' death because he felt that he might have been able to stop what happened had he been available on 4 May 2004. When being asked about his making a record of the incident of which he had been informed by his practice manager, he said this:
"I consider that she was coming to see me for help. She had been to see me many, many times about her problems and she normally came to see me about a physical problem which developed into psychological one, and I feel a bit guilty that I might have been able to stop what happened."
214As well, from observing him give evidence and the answer which he volunteered about his feeling guilty, I am comfortably satisfied that his present opinion evidence is affected by that feeling of guilt, which must be viewed in the context of a lengthy doctor/patient relationship.
215In summary, I do not accept Dr Moroney's opinion expressed with a confidence of 90 to 95 per cent, that Mrs Jeffries committed suicide.