RESOLUTION OF APPEAL
8 The appellant has sought a new trial. The appellant accepts that with issues of credit being important at the trial it would be impossible for this Court to take them into account without having seen the appellant personally. There was thus no submission put that this Court should attempt to determine damages if the appeal were to succeed. It was accepted that it would be unjust for this Court to do so when the issue turns on controversial questions resting on the appellant's credibility; see Bugeja v Hatgiantounio [2002] NSWCA 132 particularly paras 15-20.
9 The essence of the appellant's case on appeal was this. First, the trial judge misdirected himself that his task was to consider whether the threshold set out in s79A of the Motor Accidents Act applied in these circumstances, when s79A only applied to non-economic loss. This was also a case where, on the trial judge's own findings, the appellant was incapacitated for work from 27 July 1998 until 18 October 1998. Having made out at least a prima facie case that incapacity has resulted from the defendant's negligence, it must follow that "the onus of adducing evidence that his incapacity is wholly or partly the result of some pre-existing condition or that incapacity, either total or partial, would in any event, have resulted from a pre-existing condition, rests upon the defendant"; Purkess v Crittenden (1965) 114 CLR 164 at 168 per Barwick CJ, Kitto and Taylor JJ. That onus was not discharged.
10 That onus might have been discharged had the respondent successfully cross-examined the key expert medical witnesses of the appellant or his treating doctor. There was however no such cross-examination, indeed by either side. The appellant's medical witnesses included, first and foremost, the appellant's own doctor Dr Premarajah. He was his long-term treating doctor, well familiar with any pre-existing condition. Then there was Dr Matheson, the neurosurgeon who, so far as matters relevant to his examination as a neurosurgeon were concerned, was sufficiently familiar with so much of his critical condition as was relevant to his back and neck pain and its ramifications. Thus Dr Matheson observed that (AB, 119) "there are minor degenerative changes at C5/6 and C6/7". But then, importantly (AB, 121) "as far as his other disabilities are concerned, the neck lesion was present prior to the accident but his symptoms represent a material aggravation of this underlying disc lesion which will be permanent and not merely temporary" and "as far as the lumbsacral disc lesion is concerned this is probably directly due to the accident as we have no other history to give him" [emphasis added]. Then (at (10)) he concludes (AB 122) "As far as his back pain is concerned, I believe there is a direct link between it and the motor vehicle accident".
11 Dr Premarajah was totally familiar with his pre-existing conditions as his long-time treating physician although he did not set these out comprehensively in his report. He could readily have been cross-examined as to what condition pre-existed and what conditions were attributable to the accident, or aggravated by it. Dr Premarajah's conclusions as he expressed them in his report did follow a detailed statement of the MRI scans that the appellant had undergone. He records the appellant's stated symptoms, the range of analgesics and other medication that he took after the accident and his work cover certificates for being unfit for work after the accident. These are his conclusions (AB, 138):
"With restrictions of:-
(a) No lifting greater than 5kg
(b) No repetitive movements using right shoulder
(c) No excessive neck movements
Mr Peter Ram's prognosis of his neck and back condition are both extremely poor. The injuries are definitely consistent with the motor vehicle accident on 27.7.98.
The report of Dr Matheson, the neurosurgeon in August 1999 indicates that surgery in his neck is essential but Mr Ram's recent demise of one of his sons prevents him from seeking such treatment. Whether there will be total improvement after surgery and the problems of such treatment is probably better obtained from Dr Matheson.
Mr Ram is unlikely to be able to continue his work as a mechanic and will definitely have to be trained for another sedentary job. The fact that he has tried on several occasions as outlined to do suitable duties indicated his eagerness to return to his job but is unable to do so.
The percentage permanent impairment of the neck is about 35 percent. The percentage permanent loss of Mr Ram right arm above elbow is about 30 percent and below about 35 percent.
His percentage permanent loss of the left arm above elbow is about 25 percent and below elbow 20 percent.
The extent of his pain and suffering can be quantitated [sic] by the large number and changes of medication that he has had to undergo including injections by Dr Sundaraj, and the mood change and affectation of his family life. In my opinion the pain and suffering is excessive and in spite of presently being on auronix 300mg twice daily, panadeine forte when necessary, Valium 2mg twice daily, Tazac 150mg (for stomach acid problems) twice daily, he still continues to have pain daily which unfortunately cannot be removed completely due to the multiple cervical disc protrusions and cervical radiculopathy.
His lower back pain though noted later has definitely been caused partially initially by the accident and aggravated by his cervical lesions and changes in posture."
12 Significantly, the trial judge himself found that "it may well be that he was incapacitated from work from 27 July 1998 until 18 October 1998 because of the accident aggravating pre-existing conditions …"; judgment Red, 22-3.
13 The respondent in argument attempted to escape the implications of that finding, that of some damage resulting from the accident, by treating it as a statement of mere possibility. But the expression "may well" used by the trial judge hardly sits with the idea of mere possibility. The remainder of what the trial judge says does, with respect, bespeak error, namely that "the plaintiff's difficulty is being able to meaningfully separate out the effect of such aggravation from his pre-existing condition and determining for how long and to what extent the aggravation continued so as to have been a cause of the plaintiff's being unable to work at all"; judgment Red, 23 [emphasis added]. If there be difficulty it becomes the defendant's difficulty. The trial judge's error was to fail to recognise that once damage from the accident was established, even at a prima facie level, the evidentiary onus passed to the defendant of "adducing evidence that his incapacity is wholly or partly the result of some pre-existing condition or that incapacity, either total or partial, would in any event, have resulted from a pre-existing condition …". (Purkess v Crittenden (supra)).
14 The appellant attempted to argue that as Purkess v Crittenden had not been argued before the trial judge, it could not be relied upon now to establish this error, if error it were. But this is a matter of such basal principle that the trial judge should have been aware of the shifting of evidentiary onus following his earlier finding. As Windeyer J said in Purkess v Crittenden, at 170:
"but a plaintiff, tortiously injured, who suffers thereafter in a way in which he had not previously suffered, may in the absence of any countervailing evidence rely upon the prima facie conclusion that for his disabilities and sufferings the defendant is responsible. … A tortfeasor gets no allowance because of the frailty of his victim."
15 Nor do other passages in the judgment negate what appears to be a finding, albeit qualified, of incapacity by reason of the accident aggravating pre-existing conditions. Indeed two statements are consistent with that finding, namely: "it seems reasonably probable that the plaintiff's current radiological evidence of disc problems in the cervical spine can be related to the accident …"; judgment Red, 21P. That is, however, confusingly followed by:
"But I still do not know whether or not that changed radiological picture is productive of any change symptomatology and, if it is, for how long such changes may have continued. Unless a disc protrusion impinges in some way on the nerve root, it will not necessarily be productive of any pain. There are no neurological or radiological signs of nerve root involvement in any of the plaintiff's evidence."
16 Even that last statement, understood by way of qualification, is factually wrong when the actual evidence is considered. Nor is any medical foundation given for the earlier proposition about impingement on the nerve root. Thus one need look no further than Dr Adler's report. Dr Adler is a specialist in rehabilitation medicine according to his letterhead, and who (AB 147) has this to say under "Diagnosis":
"Mr Ram has suffered a very large left cervical C4-5 disc herniation with MRI demonstrating some pressure on the spinal cord and left C5 nerve root. Surgical decompression has been recommended to Mr Ram by Dr Matheson Neurosurgeon. A disc protrusion is causing discogenic neck pain with radiation of pain and paraesthesias into the arms. Examination demonstrates signs of right C6-C7 radiculopathy , this being nerve root injury causing elbow, wrist and hand weakness, as well as hand numbness. This gives rise to a clumsiness of the right hand …". [underlining in the original report]
17 The trial judge makes no mention of this evidence whatsoever.
18 The trial judge then stated immediately after the earlier quoted passage that:
"Apart from the cervical spine, I am not satisfied that any of the plaintiff's other medical or psychological complaints can be attributed to the motor vehicle accident, except that the motor vehicle accident may have exacerbated those problems , but to what extent cannot meaningfully be quantified. The plaintiff has not proved on the balance of probabilities that, as a result of the defendant's admitted negligence, he has been significantly impaired for a continuous period of at least twelve months."; judgment Red, 21-2 . [emphasis added]
19 The part of this passage that I have emphasised can evidently be taken to be a reference to symptoms other than those from the cervical spine, namely pain in the jaw, pain in the neck insofar as not derived from the cervical spine but from the neck lesions and exacerbation in the appellant's depressed state. Accepting that all that is required for the evidentiary onus to shift from plaintiff to defendant is for the plaintiff to make out a prima facie case that the relevant incapacity resulted from the defendant's negligence, and not proof on the balance of probabilities, until such time as the respondent displaces that presumption, then that evidence on various aspects of his post-accident condition includes the following. In relation to the appellant's jaw the appellant reported, but only in August 2001, that "he had a sore jaw on the right side …". His symptoms were recounted to Dr MacGee, an oral surgeon who examined the appellant on 21 August 2001. The appellant reported amongst other injuries that following the accident eating was difficult as chewing caused pain at the angle of the jaw on the right side and within the right ear"; AB 156. Then he recounted to Dr MacGee that he was seen by Dr Au, dental surgeon, for the construction of an occlusal splint and then quotes the appellant as stating "… that since wearing the splint which has been constructed, his right sided ear and jaw pain have improved 50% to 60% and he further stated that now, he is able to eat 'reasonably well'. He states however, that he is still having major trouble with his neck"; AB 157. Importantly, at AB, 148 Dr MacGee concludes under "Personal Opinion":
"To me, as no direct trauma was sustained to the lower jaw which would have transmitted forces to the delicate jaw joint mechanism resulting in a temporamandibular joint dysfunction presenting it would appear that the cervical trauma sustained, namely, whiplash injury to his neck, has resulted in the jaw joint disturbance presenting post traumatically. Such a state is not uncommon as many patients who sustain whiplash injury do, in fact, develop a jaw joint disturbance to some degree or other."
20 There was no evidence given by either Dr Au, or any other source, of the appellant having difficulty or pain with his jaw prior to the accident.
21 In response, the respondent seeks to rely upon evidence in cross-examination of the appellant at AB 27U-W, 28D-E, 32R-S, 34J-K and 36A-B. A fair reading of that material is that it amounts to a denial that, prior to the motor vehicle accident, he ever had pain in his jaw but that he did have pain in the side of his face prior to the motor vehicle accident. He did not remember various referrals between 1994 and 1996 for x-rays and the like, no records of which are before this Court. They therefore can provide no refutation of the prima facie position established by the medical evidence to which I have earlier made reference concerning jaw pain. That is all the plaintiff is required to establish until such time as, to quote Windeyer J in Purkess v Crittenden at 171: "… the defendant had by evidence elicited in cross-examination or led, provided some material to overcome [the presumption] - either by proving the contrary or throwing the matter into doubt." Clearly, the respondent did neither.
22 Refutation of the appellant's medical complaint about headaches is attempted by referring to medical records constituting four entries between 1993 and 1996 from clinical notes (AB, 209-213) of Dr Premarajah. These on examination are quite inconclusive. They certainly do not of themselves point to a serious recurrent problem of headaches pre-existing the accident. That he might have had occasional headaches when engaged in a heavy occupation is hardly surprising.
23 As against that supposedly conclusive material against the appellant, Dr Premarajah in his report of 11 April 2000 refers to continued complaints of "dizziness, headaches and paraesthesia down the arm" for which the appellant was referred to Dr Keith Lachlan (probably Lethlean) of the Institute of Neurological Sciences; see AB 137.
24 Dr Matheson also refers to "severe neck pain which goes on to headaches and dizziness and pain going down to both medial elbows" AB 119.
25 In relation to the appellant's alleged psychological injuries, the appellant's expert Dr Murugesan, consultant psychiatrist, recounted the tragic death of his two sons which pre-dated the accident as well as "enormous financial problems" from the Home Fund collapse. He recorded that the "death of his second son made him depressed and he was already taking the anti-depressant medication, aurorix since February 1998". He added that "following the accident and the resultant problems enumerated above, he found the aurorix was not helping him as much as it did before" AB 129.
26 Later in the report, Dr Murugesan recorded his increasing of the anti-depressant aurorix from 150mg twice daily to 600mg daily and then to 750mg daily. He then stated as his opinion and prognosis that
"he suffers from major depression and chronic pain syndrome as a result of injury suffered from the motor vehicle accident on 27/7/98. As stated earlier he was already suffering from certain level of depression, probably reactive in origin resulting from his son's illness and his subsequent death. After the accident the depression has intensified and has become a major problem for him." AB 131.