Facts
4 The respondent was born in 1940 in Belgrade. She is a university graduate and she emigrated to Australia with her husband in 1967.
5 In 1991 the respondent's son broke his nose and was referred to the appellant for corrective surgery. Surgery was performed in 1991 and 1995 and there were attendances by the respondent in company with her son on occasions between those dates.
6 On 19 April 1995 the respondent's general practitioner gave her a referral to the appellant "for cosmetic surgery". She saw the appellant on 9 May 1995 and decided to have a facelift in light of the discussion. The appellant reported to the general practitioner the following day:
This patient (sic) request for a facelift is justifiable in view of the improvements that can be achieved. This patient's face lift operation will improve her significantly in terms of improving her cheek and upper neck area. We are making arrangements for this to be carried out in the middle of July and I will keep you informed on progress.
7 A deal of evidence was tendered to the effect that the respondent was anxious to improve her appearance through surgery and was, to that extent, in a dependant and vulnerable position. This material was used as the springboard for a variety of submissions by each side.
8 It was found that the appellant told the respondent on 9 May that he would make her look 20 years younger; she would feel a different person; and the operation would not leave her looking like a mummy. At one stage in the judgment these were referred to as "unfulfilled promises" (RB 41), but the action did not proceed as one based upon contract. In the course of the consultation, the appellant also told the respondent that it was his mission on earth to make people beautiful and that facelifting was his specialty. The latter two "blandishments" (the word was the trial judge's) were not found to be untrue, but they were obviously part of the context in which the respondent decided to undergo the treatment.
9 The surgery was initially scheduled for July, subject to a second fuller consultation and payment of the $5000 fee that the appellant had quoted. However, it was on 29 August 1995 that the respondent returned and paid the fee. On this visit the appellant discussed a number of post-operative complications that would or might occur. The primary judge held that many of the risks were disclosed (RB 18-20, 31, 37-8). The surgery performed did not involve trespass (RB 44).
10 Nevertheless, applying Rogers v Whitaker (1992) 175 CLR 479, the learned trial judge found that the appellant was negligent in not informing the respondent of the full range of risks capable of attending the procedure, in particular the risks of facial asymmetry, nerve damage and dimpling of the lips. Unfortunately these risks came home, despite the exercise of due care in the surgical procedure. It was held that the respondent would not have undergone the procedure had all these risks been brought home to her by the appellant.
11 The surgery was done on 11 September 1995. It consisted of a superficial musculo-aponeurotic system (SMAS) procedure together with liposuction.
12 From the outset the respondent complained about the outcome. She was unhappy about tightness, asymmetry and lines on her lips. There were visits to the appellant at his surgery on 12 September, 23 September, 12 October and 21 November 1995 and 30 January, 29 February, 19 March, 21 May, 30 May and 6 June 1996. The appellant told the respondent that the facial surgery could not be reversed and, on 12 October 1995, he refused to carry out any further surgical procedures. The respondent persisted in her complaints. The appellant suggested that the asymmetry existed before the operation. In addition to the visits recorded above, there were attempts to telephone the appellant which were taken by his nurse/receptionist but not transferred through to him. Throughout much of this period the respondent expressed dissatisfaction over the result of the surgery and she asked for alleviation of her plight.
13 Sometime in 1995, probably during the October visit, the appellant raised the possibility of laser surgery to the lips. Initially a fee of $1500 was quoted. Later the appellant through his receptionist offered to do the procedure at a discount on condition that the respondent permitted the operation to be filmed for use in the promotion of the appellant's practice. The respondent accepted this offer and the laser surgery was done on 30 January 1996 and funded by Medicare.
14 On 19 March 1996 the appellant carried out revision surgery on the respondent's lip. On 21 May 1996 and 30 May 1996 there was minor excision surgery and scar revision.
15 On 29 August 1996, the respondent told the appellant that she had received a second opinion and that she claimed to be deformed. She demanded further surgery, but the appellant told her he was unable to offer it. This was the final consultation between the parties.
16 In the upshot, the respondent was left angry and very depressed by the results of the surgery. She was very self-conscious about her "new" appearance. Friends enquired of her whether she had had a stroke. The tightness affected her facial expression, particularly on the left side. She became reclusive, even avoiding going out to do shopping as much as possible. Her self-consciousness was such that she felt unable to travel abroad to see her dying mother.
17 The following findings were made in relation to post-operative treatment:
The next aspect of the doctor-patient relationship, which has to be evaluated, is the post-surgery portion. In this area, I do not accept the accuracy of the self-serving statements contained in the correspondence from the defendant to the referring general practitioner Dr Khong. There is no expert evidence in the case to guide the court about what steps the surgeon should take when he becomes aware that his surgical patient is postoperatively disillusioned and complaining about the result. Commonsense would seem to indicate that a policy of ignoring the patient, whilst it might be comfortable and convenient for the surgeon, is contraindicated. The ordinary person in the community would expect the surgeon to make himself available for discussion with the patient to seek to explain - if he could - how the results of the surgery, whatever that might be, are just as he forecast before obtaining the patient's consent to the surgery being conducted. The ordinary person would also expect that the surgeon, if requested and if appropriate arrangements for payment could be made, would embark upon remedial surgery promptly, or at least arrange for a second opinion to be provided. In the event that the surgeon considered remedial surgery to be inappropriate, then, in this day and age, the ordinary person would expect the surgeon to make appropriate recommendations for his dissatisfied and distressed patient to be appropriately counselled. A letter to the referring general practitioner would be the very least that could be done.
In the present case, the defendant did not embark upon any remedial surgery for an unacceptably long period of time, viz until 30 May 1996, and then only after an inordinately long period of repeated refusals to speak to the plaintiff. Nor did he make any acceptable recommendations or arrangements for the plaintiff to be counselled.