Dr Parmegiani
356 As discussed in Dasreef at [37], when a specialist medical practitioner expresses a diagnostic opinion in his or her relevant field of specialisation it will not be difficult to discern that specialised knowledge is applied, once the witness has described his or her qualifications and experience, and has identified the subject matter about which the opinion is proffered. In this case it is apparent that both Dr Parmigiana and Dr Lee are eminently qualified to give opinions based on their specialised knowledge about capacity, including where there is a diagnosed mental condition. However, as made clear in Guthrie v Spence, it is for the judge to decide the issue of capacity having regard to the totality of the evidence.
357 Dr Parmegiani provided five reports. In his first, dated 21 October 2020, he referred to a 2.5 hour assessment session that he conducted with Ms Rossi by Zoom. He provided supplementary reports dated 27 October 2020, 4 November 2020, 22 February 2021 (responding to Dr Lee's report) and 26 February 2021.
358 In his first report, Dr Parmegiani relevantly concluded:
In 2008 Ms Rossi entered a deed of release settling a workers' compensation claim, after being pressured to do so by her legal representatives. I believe that in 2008 she was still suffering from moderate to severe symptoms of depression, and that therefore at the time she was a 'handicapped person' within the meaning of the then Order 15 of the then Country County Court Rules of Procedure in Civil Proceedings 1999 (Vic). It is my opinion that in signing the deed she was unable to clearly understand the implications of doing so, or to argue her case effectively in opposition to the pressure exerted upon her to sign the deed by her then legal representatives.
…
With regards to your question (e) page 7 of your letter of instructions [see (E) extracted below], assuming that the matters set out in Ms Rossi's affidavit are true and correct, it is my opinion that as of 29 October 2008, Ms Rossi was suffering from symptoms of a Major Depressive Disorder that made it very difficult for her to understand, absorb, retain information and rationally process advice provided by her lawyers in relation to the deed. While her ability to appreciate or recall relevant factors may have been preserved to some extent, I believe that her ability to appreciate the consequences of her agreement to sign the deed and to reason and make rational decisions was impaired by her psychiatric condition. I believe that she would have been able to understand the general nature and effect of the deed, but that she felt under duress to comply with the instructions.
In summary, I believe that Ms Rossi had some limited ability to understand the nature and the consequences of the deed, but lacked the clear focus and fortitude required in such circumstances to adequately instruct her lawyers, to discuss the possible consequences of the deed, and to assertively put forward her objections.
359 In his second report, Dr Parmegiani provided further answers to the questions asked of him by Ms Rossi's solicitors. The extract below is regrettably lengthy, but it is important in that it reveals the assumptions made by Dr Parmegiani in forming his opinion and because Dr Parmegiani considered that at least 'in general terms Ms Rossi was able to understand the general nature and the effect of the deed' (see emphasised passages). The further questions were asked and answered as follows:
Assuming the matters set out in Ms Rossi's affidavit are true and correct, your opinion as to how and to what extent, if at all, Ms Rossi's disabilities impacted on her ability to participate in the decision to settle her workers' compensation claim as at 29 October 2008 including but not limited to her capacity:
(A) To understand, absorb, retain information and rationally process advice provided by her lawyers in relation to the deed.
The contemporary information, including the medicolegal reports of two psychiatrists, indicate that Ms Rossi at the time was suffering from a diagnosis of Major Depressive Disorder or Adjustment Disorder with Depressed Mood. I also take into consideration the reports of her then treating psychologist Ms Amanda Allan, and the affidavits of Ms Rossi, as well as the information I gathered at my own clinical assessment. It is my opinion that, in view of her psychiatric diagnosis, Ms Rossi was experiencing a severe disorder of mood, which in my experience can significantly impact adversely the person's ability to reason clearly, to retain information, and to process what information is retained, including the advice provided by her lawyers in relation to the deed. It is therefore my opinion, that at the time her capacity to do so was significantly impaired.
(B) To appreciate or recall relevant facts and understand available alternatives to executing the deed.
For the same reasons above, given the severe disturbance of mood and its adverse impact on Ms Rossi's cognitive abilities, including attention, concentration, memory and lucid thinking, I believe that she was not in a reasonable position to appreciate or recall the relevant facts and to understand the available alternatives to executing the deed.
(C) To appreciate consequences, including balancing risks and needs, in relation to entering into the deed.
For the reasons outlined above, it is my opinion that given her then-current psychiatric condition Ms Rossi was unable to evaluate her alternatives appropriately, to appreciate the consequences of making the decisions recommended by her legal counsel, or to consider risks and consequences of entering into the deed.
(D) To reason and make rational decisions including about whether to enter into the deed.
While a Major Depressive Disorder's main effect is a severe disturbance of mood, the psychiatric condition also affects to considerable extent a person's ability to reason and to make rational decisions. Ultimately, she reported that her final acceptance of the instructions to sign the deed was based upon the impression conveyed to her by her legal counsel that if she were not to do so she would incur significant legal fees, which at the time she could not afford. It is my opinion that in such circumstances Ms Rossi felt overwhelmed by the situation, and was unable to reason and to make rational decisions.
(E) To understand the general nature and the effect of the deed.
Based on her recollection, and the contemporary reports, I believe that at least in general terms Ms Rossi was able to understand the general nature and the effect of the deed.
(F) To understand the advice given by her lawyers, regarding the nature of the deed, its purpose, its possible consequences (including not being able to bring any other claims), and the risks in terms of legal costs.
Ms Rossi was generally able to understand the advice given by her lawyers regarding the nature of the deed and its purpose, including its possible consequences and especially the risks in terms of legal costs. At my own clinical assessment in October 2020, she could clearly recall the details of her meeting with her legal counsel, and the matters that were discussed with her.
(G) To give instructions to her lawyers, including whether to agree or to disagree with settlement terms.
It is my opinion that, because of her then-current psychiatric condition of Major Depressive Disorder, her mood state and cognitive abilities were adversely affected to the point where she was unable to give clear instructions to her lawyers, specifically whether to agree or disagreement with the settlements terms.
(H) To understand what she was required to do as part of the settlement process, including the effect of signing the deed.
At a basic level, it is my opinion that Ms Rossi did understand what she was required to do as part of the settlement process including the effect of signing the deed.
(I) To understand, with the assistance of explanation from lawyers, of the issues in legal proceedings on which a consent or decision may be required.
I believe that at the time Ms Rossi signed the deed settling her workers' compensation claim in October 2008 she had some ability to understand, with the assistance of explanation from lawyers, the issues in legal proceedings on which her consent or decision may be required. It is however also my opinion, as outlined above, that her mood/emotional state at the time made it possible for her to be easily overwhelmed by the situation, and consequently to become unable to consider all matters at hand, unless she was given enough time and support to do so. Given her description of the situation as it unfolded, when she signed the deed, it is my opinion that this did not occur.
(J) To participate in this decision in the circumstances described in her affidavit, including but not limited to attending meetings and making decisions within the timeframes imposed.
It is my clinical opinion, based on review of the contemporary documents, subsequent reports and my own examination conducted in October 2020, that because of her mood disorder Ms Rossi would have had limited ability to participate in the decision, especially in the circumstances described in her affidavit. Ms Rossi clearly recalled feeling overwhelmed by the occasion, and having in her own mind no choice but to sign the deed when placed under pressure to do so. In many ways, she described a situation not dissimilar to her previous experiences at work, where she had felt belittled and harassed by people in position of power, and had been unable to assert herself.
360 In the report of 4 November 2020, Dr Parmegiani responded to a request by Ms Rossi's solicitors to further consider his answers having regard to particular paragraphs of Ms Rossi's affidavits. He said the following:
When commenting about Ms Rossi's ability to fully understand and appreciate the nature of the deed she was asked to sign in 2008, I stated in my report questions (E), (F), and (H), that Ms Rossi was, at a basic level, able to understand the matters that were presented to her. By stating that, I acknowledge that at that time Ms Rossi was alert and conscious, and was not affected by what is referred to in psychiatric terms as 'formal thought disorder,' which is an impairment of thinking usually found in psychotic conditions, such as Schizophrenia, Bipolar Disorder, or Major Depression with Psychotic Features. In that respect, I believe that at the time in question Ms Rossi was alert, conscious, and able to comprehend language. It is however my contention that because of the severe symptoms of mood disorder, which included depressed mood and overwhelming anxiety, Ms Rossi would not have been able to carefully consider the matters that were put before her, and to come to reasoned and logical conclusions of her own accord.
…
In summary, while I believe that Ms Rossi was conscious, alert and able to hear what was being proposed to her, it is my opinion that the severely disturbed emotional state, caused by her then psychiatric condition of Major Depressive Disorder, made it impossible for her to carefully consider the matters at hand or to make calm and well-reasoned judgements about them.
361 In his final report, Dr Parmegiani said:
Overall, having considered my clinical findings, my own review of the documents concerned, my interview of Ms Rossi and further review of Dr Lee's report, I am not satisfied that Ms Rossi at the time of signing the deed fully understood the issues, registered and was able to articulate the consequences of not signing.
362 A number of important points came out of cross examination:
(1) Dr Parmegiani's diagnosis in 2020 was a current diagnosis, based on her presentation and guided by her history, and he accepted it is most accurate as a current assessment.
(2) His reports were based 'in good part' on his clinical assessment and what Ms Rossi told him.
(3) He considered the assessment that he had undertaken with Ms Rossi was important because it had been a long consultation taking into account 'her emotional [lability] and tendency to lose track of things', and he found that instrumental in forming his opinion (Dr Parmegiani refers in his 22 February 2021 report to emotional lability/arousal). He considered that clinically she would 'not have been too dissimilar' at the time of the events, having regard to her ongoing, untreated major depressive disorder. He considered the diagnosis of persistent depressive disorder had remained stable for the last 13 years at least, although there may have been fluctuations, 'as is not uncommonly the case in depression'. He found her to be anxious with him despite him being sympathetic, and assumed that she would have been more distressed in a situation that was more confrontational.
(4) Dr Parmegiani also took into account the documents provided to him, which included Ms Rossi's affidavits, medical and psychiatric reports. He took into account the factual matters that Ms Rossi told him about what she did, observed or felt. He did not see any evidence from others who participated in the conferences.
(5) Dr Parmegiani assumed that the circumstances in which the Deed were signed included that Ms Rossi felt overwhelmed and paralysed (as her affidavit said that); that the solicitors had told her she was lying; that the reports were against her; and that if she didn't sign the Deed she would be up for several hundred thousand dollars, at a time when she was receiving the disability pension.
(6) He proffered that one of the reasons he concluded (at (G) in the second report) that Ms Rossi was unable to give clear instructions was based on Ms Rossi reporting that when she tried to speak to her lawyers her words came out 'all jumbled and they couldn't understand her', and he said that jumbled meant 'to the point of gibberish, when nothing makes sense', and that this would give rise to quite serious questions about one's cognitive ability.
(7) The passage of time (13 years) was relevant. Any test carried out at the time (29 October 2008) would have been much more conclusive, but in this case it was necessary to rely on reconstruction based on clinical assessment and a review of the documents.
(8) The diagnosis and symptoms could affect Ms Rossi's capacity - and he 'could even stick [his] neck out and say they most probably did'.
363 Dr Parmegiani agreed that he could not give conclusive evidence as to Ms Rossi's state of mind on the day of signing the Deed, and said that nobody would with absolute certainty unless they were there and assessed it at the time.
364 He maintained under cross examination the view that in general terms Ms Rossi was able to understand the general nature and effect of the Deed, and that she was generally able to understand any advice given by her lawyers regarding the nature of the Deed and its purpose, including its possible consequences and especially the risks in terms of legal costs. When taken to his conclusion in the supplementary report of 4 November 2020 (see [360] above), he agreed that he was not saying it was impossible for Ms Rossi to consider the matters at hand, it was just impossible for her to carefully consider the matters at hand; and that he was not saying it was impossible for Ms Rossi to make judgements about the matters at hand, but, rather, to make reasoned ones.
365 Dr Parmegiani acknowledged that a 'good part of that opinion' in his first report to the effect that Ms Rossi felt 'under duress to comply with instructions' (see [358] above) was based on the circumstances of signing as told to him by Ms Rossi.
366 When taken to the final report and the extract above (at [361]), Dr Parmegiani confirmed that the reference to Ms Rossi not being able to articulate the consequences was a reference to the report that Ms Rossi herself had given to him; that the reference to 'fully understood the reasons' meant everything that could have been relevant to her reasons; that he remained of the view that Ms Rossi was able to understand the general nature and effect of the Deed and was able to understand the advice given by her lawyers regarding the nature of the Deed, its purpose and the consequence and risks; and that it was not that she could not understand the Deed, but that her emotional state was such that she believed that she didn't have an alternative but to do so.
367 I accept, having regard to Dr Parmegiani's diagnosis and his assessment of the other medical evidence provided to him, that Ms Rossi had at the relevant time and continues to suffer from symptoms of a major depressive disorder (this does not mean that I accept that the symptoms or effects of the disorder have been consistent or constant since pre-2008 up to and including the time of his assessment in 2020, and I will return to this).
368 Regardless of the diagnosis, his opinion with respect to Ms Rossi's capacity must be considered taking into account the findings of fact that I have made, and a number of other matters.
369 Relevantly, I have found that there were no outward signs of distress of a level which caused concern to Mr McCristal or Mr Hutchinson, an experienced solicitor and barrister respectively, on 27 October 2008 when a settlement offer was made. I have not been persuaded that Ms Rossi spoke in gibberish or could not be understood, a matter upon which Dr Parmegiani placed considerable weight. That is not to say there were no signs of emotion. Mr Hutchison said she was upset, but put it no higher than that. Nor were there outward signs of distress of a level which caused concern to an experienced solicitor and barrister on 29 October 2008 about Ms Rossi's understanding of the nature and effect of the terms of the settlement. Again, that is not to say there were no signs of emotion. Mr Hutchinson was able to say that Ms Rossi was disappointed.
370 Although Dr Parmegiani proceeded on the basis that Ms Rossi did not have the confidence to put forward her views on 29 October 2008, I have found that she was able to ask questions, pointed out a number of difficulties with the terms of the documents, recalled specific matters such as reference to a serious injury certificate and Medicare liabilities, and made it clear to Mr Hutchinson that she had different views about her case. I cannot properly infer in those circumstances that Ms Rossi was restricted in putting forward her views.
371 As to information discussed at the settlement, Mr Hutchison had told Ms Rossi she did not have a strong case. Mr McCristal read the various documents to Ms Rossi at the conference, and they were not particularly lengthy. The Deed expressly referred to the release provided by Ms Rossi extending to a release of all claims, actions, suits, costs or demand at law, in equity or under statute arising out of or relating to the course of Ms Rossi's employment at Qantas.
372 I have accepted that Mr McCristal also explained to Ms Rossi the mechanism by which the settlement was to work.
373 I have not found that there was conduct on the part of Mr McCristal or Mr Hutchinson that might constitute 'duress' or undue pressure to sign. The absence of objective evidence to support any such inference does not mean that Ms Rossi did not feel that she was under duress, but it sheds some light on the reliability of and credibility of that evidence. I have found that Ms Rossi's evidence as to events at the settlement conference was unreliable in part.
374 All of these matters have an effect on the weight I can properly accord to Dr Parmegiani's opinion, because he accepted and took into account what was reported to him by Ms Rossi about the settlement conference in 2008 in forming his opinion in 2020. In particular, his assumptions and acceptance of Ms Rossi's descriptions of her feelings and events (including speaking gibberish) formed the basis for his purported opinions as to her subjective state of mind at particular times, as did in large part his examination of her. Dr Parmegiani's opinions as to her subjective state of mind must be treated with considerable circumspection. I give those opinions no real weight.
375 Dr Parmegiani accepted that his examination of Ms Rossi was instrumental to his opinions, and that he assumed that her current mental state was reflective of her mental state in 2008. Other than referring to a consistent diagnosis over time, it was unclear why it was appropriate to assume that her symptoms, manner and emotional response to circumstances would be consistent and not fluctuate at any time. Furthermore, there was evidence of deterioration in Ms Rossi's mental state since 2008. Ms Allan suggested this (see [338] above). Ms Rossi also said in her October 2020 affidavit that she had 'ruminating thoughts, reliving distressing memories of the traumatic events I was subject to at both Qantas and Maurice Blackburn', suggesting that the experience in 2008 with Maurice Blackburn had added to her distress.
376 Regardless of those issues, I accept that Dr Parmegiani was qualified to say that in his opinion Ms Rossi suffered a major depressive disorder and that someone with her symptoms was or was not likely to be able to understand transactions of the nature of the Deed if explained to them. And indeed, whilst the iterations of his reports, following further questions from Ms Rossi's lawyers, tended to descend into a dissection of the purport of the transaction in a manner not contemplated in Gibbons v Wright or Hanna v Raoul, under cross examination Dr Parmegiani accepted that in general terms Ms Rossi was able to understand the general nature and effect of the Deed; and that she was generally able to understand any advice given by her lawyers regarding the nature of the Deed and its purpose, including its possible consequences and especially the risks in terms of legal costs. He accepted under cross examination that his opinion as contained in his first report had not been changed by his later reports. His opinion remained that Ms Rossi did have the capacity to understand the Deed.