The plaintiff's condition
3 The defendant submitted that the trial judge erred in finding that the plaintiff suffered from traumatic syringomyelia attributable to the accident. Syringomyelia is a condition in which the central canal of the spinal cord is enlarged and the spinal cord is affected. It can occur in the ordinary course as part of aging, but can also be caused by trauma or infection.
4 The plaintiff left school at 16, half way through year 10, and lacked writing skills. He obtained a trade as a printer, and worked at a number of printing firms. His printing skills were overtaken by new technologies, and on 7 August 1996 he took up employment as a plumber's labourer with Axis Plumbing Services. It was reasonably heavy work of a labouring nature. About three weeks before the accident the plaintiff suffered an injury to his finger, and he was not working and was receiving worker's compensation payments at the time of the accident and for a time thereafter.
5 The plaintiff said that in the accident "my neck felt like it had been chopped off", and that there was immediate pain. He drove to Milton Hospital. The hospital notes recorded "Painful neck - jarred" and referred to "Whiplash injury". An x-ray was taken, but no abnormality was visible. The plaintiff went home. He said that he was very uncomfortable and distressed by the pain, which remained.
6 The plaintiff returned to work with Axis Plumbing Services on about 19 November 1996. He said that he was on a light job and could cope. After a little while he was put on a new job where the work changed, and he found it harder. As a result, on 19 December 1996 he consulted a general practitioner, Dr Sivarajah, about his neck. Dr Sivarajah found that the flexion, extension and lateral movements of the neck were painful. Another x-ray was taken, which was reported as essentially normal. Dr Sivarajah sent the plaintiff for physiotherapy, and he had regular physiotherapy thereafter.
7 The plaintiff's condition did not improve, and on 5 March 1997 he saw a different general practitioner, Dr Sciacca. He complained of shoulder and neck pain, and on examination Dr Sciacca found tenderness with a good range of movement but tight quad testing to the left. Dr Sciacca referred him to Dr Manohar, a specialist in musculo-skeletal medicine and rehabilitation, who diagnosed musculo-ligamental strain and arranged for an MRI scan "to look for the probabilities of an annular tear to the cervical disc". The MRI scan was read by Dr Manohar as evidencing a C7/T1 annular tear with a small disc protrusion. The plaintiff was treated with analgesics and exercises.
8 Following the MRI scan Dr Manohar wrote a letter stating that the plaintiff was fit only for light duties. It was sent to Axis Plumbing Services. On 8 April 1997 Axis Plumbing Services told the plaintiff that it had no light duties for a plumber's labourer and that he should take leave until he was fit for full duties. His paid employment with Axis Plumbing Services ceased, although it seems that he did not formally resign until early 1998.
9 Dr Manohar referred the plaintiff to Dr Compton, a neurological surgeon. In a report dated 11 April 1997 Dr Compton noted the history of immediate pain in the accident and continued neck pain and stiffness, but continued -
"I could find nothing of significance in his past history and nothing of significance in his system review.
On examination I found him to be a fit man. He had a non-tender cervical spine and a reasonable range of cervical movement today.
His MR scan looked to me be [sic] a pretty high quality investigation and I could see no evidence of relevant abnormality.
I must confess that I don't believe that surgery would help this young man but I don't believe further tests are indicated at this stage."
10 The plaintiff continued to see Dr Manohar with neck and shoulder pain. He must have returned to Dr Sivarajah, since for a time after April 1997 Dr Manohar's reports were addressed to Dr Sivarajah. Over a long period Dr Manohar found restriction in cervical movements and discomfort, with varying language and detail in his reports. Physiotherapy was continued, and the C5/6 and C6/7 levels were infiltrated. There was no relief.
11 On 27 January 1998 the plaintiff began work on a part-time basis as an assistant in air conditioning businesses. He said that until April 1998 he worked first for one employer and then for another employer, on an average of three days a week for between four and eight hours a day: as will appear, it seems that he was in error and worked until 4 September 1998. He worked for the first employer only for a few weeks. The employment came about by word of mouth through friends. The work involved measuring and recording air-flow, and the change in employers was because the first job did but the second job did not require lifting a tool box. The plaintiff said that he could initially cope, but that when it became necessary to get into roofs or assemble air conditioning equipment he found it difficult. The employment ended when the second employer ceased his air conditioning business. The plaintiff did not work thereafter.
12 In January 1999 Dr Manohar arranged a further MRI scan. He read it as showing a syrinx, and referred the plaintiff to a consultant neurosurgeon, Dr Matheson.
13 Dr Matheson saw the plaintiff in May 1999. His report of 4 June 1999 recorded the history -
"His problems began in August 1995 when he was in a vehicle which was rammed from behind by a truck. He had immediate neck pain and was taken to Middleton [sic] Hospital. He was x-rayed and sent home. He was offered a collar at the time but his neck was too uncomfortable to wear it and in my view he is probably better off without it anyway. He had some pain going to the left shoulder.
He was off work for about ten months and then did some air conditioning work on a casual basis but that did not last . He has also done some printing work. At the time of the accident he was working as a plumber's assistant. He has not been able to pursue physical work and is unemployed at the moment. He gets neck pain which is low in the neck and goes down to the interscapular region. He gets discomfort across his left shoulder." (emphasis added)
14 Dr Matheson read the MRI scans as showing a small syrinx extending from C4 to C7. He found stiffness and tenderness on examination and "subtle neurological changes". He diagnosed traumatic syringomyelia, saying -
"I do not think there is much doubt here that he has had a traumatic subluxation at the C5/6 level with a bump to his cord, giving him his residual symptoms. Certainly the disc at that level is abnormal and centered over the area of his small syrinx. We are not too sure of the natural history of his condition and I think most of these traumatic syrinxes do not progress but the occasional one does and therefore we will just have to sit and watch him. I have not recommended any specific treatment at the moment other than to re-train him into non-physical work. At this stage operating on his neck may produce no improvement. I would watch him from time to time and think he should have periodic MRI scans to make sure that the syrinx is not extending."
15 The plaintiff continued his regular consultations with Dr Manohar and occasional consultation with Dr Matheson, and continued with conservative treatment under the former's supervision. In his evidence he said that he had "pretty well constant" pain, at the time of the trial in April 2001 "absolute constant". He had problems in sleeping, with consequent feelings of exhaustion, and difficulty in driving for any period. He became irritable and depressed. He could not walk for more than half or three-quarters of an hour, and even sitting in the one spot for a period exacerbated the neck. None of exercises, acupuncture, hydrotherapy or analgesics provided significant relief.
16 The trial judge plainly accepted the substance of the plaintiff's complaints. It seems that at about the end of 1998 the plaintiff had returned to Dr Sciacca, whom he also saw regularly, and in a report to the plaintiff's solicitors dated 27 September 2000 Dr Sciacca said -
"He has been suffering from pain in the neck, shoulder, back of the head, and this year, all the above with symptoms of major depressive disorder with much anger and frustration especially at being unable to have a normal life with his young child. He is unable to participate in physical activity with him and he is unable to participate in personal activity with his wife.
Mr McDermott continues to have gros restrictions in movement in his neck and shoulder with tenderness in both sides of the base of the skull and in the low part of his neck, C5/6 and C6/7. He has no positive neurological signs.
These are a direct result of his motor vehicle accident on October 17 1996.
His prognosis is very poor. He is permanently unfit for any physical work (especially his pre-injury employment of labouring).
Future treatment will be based on anti-depressants and as needed physiotherapy to his neck. I am unable to estimate the cost of this and suggest you discuss this matter with his physiotherapist. All treatment to his present condition is directly related to the accident.
Ideally, employment for Mr McDermott would be of a self-employed nature, where he is able to work at his own pace, rest when the need arises, and where lifting and carrying, etc, would be at a minimum.
He is completely unfit for work as a labourer, especially for a plumber or builder.
Due to restriction in his arm movement and power, Mr McDermott would also be unsuitable for work as a printer.
He is permanently partially incapacitated to work and this is due solely to the motor vehicle accident of 1996.
He is having a great problem just interacting lightly with his child. Heavy home work such as mopping and vacuuming is out of the question for him."
17 The trial judge said that he considered that a general practitioner was often in a better position to assess a patient than a specialist, being generally closer to the patient. Apart from his particular reliance on Dr Sciacca, he later said -
"If I may digress, a matter to which I have not referred perhaps is that all the matters referred to in the doctors' reports which were given to them by way of the history were virtually confirmed by the plaintiff in the witness box and more importantly his wife gave evidence and she confirmed the problems which her husband was having. I think that that was strong corroborative evidence, if it was needed, of the problems that this man has had."
18 The trial judge accepted Dr Matheson's diagnosis of traumatic syringomyelia, saying "I think the probabilities are, firstly, that the plaintiff is suffering in the way in which he said he was suffering and that it is due to this syrinx involvement." Dr Manohar had adopted this diagnosis, although it is not clear whether he professed the same expertise as Dr Matheson. At a later point, after considering the other medical opinions, the trial judge said that -
" … the probabilities are in my view having regard to the reports which I have referred to emanating from the plaintiff's medical practitioners, that indeed he is suffering the problems he suffers and they can be explained in the way in which Dr Matheson explains them. And I think I have already said that it seems to me the probabilities are that this man's condition are due to the trauma and not to natural causes."