Medical treatment and assessments
19As an aide to analysis, in the ensuing paragraphs, I have extracted a chronology of the plaintiff's medical and allied attendances that followed her fall.
20On the day of the accident, the plaintiff was taken by ambulance to Bathurst Base Hospital, where it was noted that she had a painful right after-foot, 2nd, 4th and 5th toes, a deformed 4th toe, an abrasion of the top of the foot, and difficulty weight bearing. A graze was seen on the dorsum of the foot with antero-superior swelling to the lateral malleolus. The injury was assessed as being an inversion injury with some slight displacement at the fractured base of the 5th metatarsal bone. A plaster-of-paris slab was applied to the plaintiff's lower right leg.
21On 23 February 2011, the plaintiff consulted her general practitioner, Dr Shahla Jamshidi, for the first time regarding her injuries. Dr Jamshidi reviewed the hospital discharge summary and arranged for follow-up x-rays of the plaintiff's foot after 6 weeks of immobilisation in a CAM boot and arranged for the plaintiff to commence physiotherapy. Dr Jamshidi also referred the plaintiff to Professor Peter Martin, am orthopaedic surgeon.
22On 3 March 2011, an x-ray of the plaintiff's right foot was interpreted to show fractures at the base of the 4th metatarsal, and a proximal fracture of the 5th toe, without displacement of fragments.
23On 18 March 2011, Mr Roger Cvitanich, the treating physiotherapist, described the treatment he gave to the plaintiff as comprising joint mobilisation, soft tissue releases and gradual conditioning.
24On 15 April 2011, Dr Jamshidi recommended to the plaintiff that she wear ankle/foot supports, and avoid wearing high heels or very flat shoes.
25On 2 June 2011, the plaintiff underwent MRI studies of her right foot, which revealed the presence of micro fracturing of the cuneiform base of the 2nd metatarsal, with swelling of some related soft tissues and bone bruising.
26On 30 June 2011, at the request of her solicitor, the plaintiff was examined by Dr George Kalnins, an orthopaedic surgeon, who observed the plaintiff to have residual swelling and slight deformity of the right 4th toe. He recorded a history that the plaintiff had some night pain after a long day of working. He noted that his examination took place approximately 4 months post-accident, and he expected continued recovery would take place over a further 3 months.
27On 4 July 2011, Dr Sherif Riskallah, an orthopaedic surgeon, reported on his consultation with the plaintiff. This was apparently at the request of the plaintiff's general practitioner. The plaintiff did not tender any reports from Dr Riskallah but parts of a report from that doctor were later cited by Dr Stephenson, the orthopaedic surgeon appointed to examine the plaintiff on behalf of the defendant.
28On 16 September 2011, at the request of her solicitor, the plaintiff was examined by Dr Neil Berry, a consultant surgeon. He predicted the plaintiff would, over the ensuing two years, experience further discomfort on prolonged standing, walking in high heels, and walking up and down stairs. He expressed a guarded prognosis as the plaintiff had remained symptomatic in her right foot.
29On 31 October 2011, the plaintiff saw Dr Peter Johnson, a rheumatologist whom she had previously seen concerning rheumatic disease of her right hand. On this occasion, Dr Johnson took a history of the plaintiff having left knee and right foot problems. Dr Johnson arranged for the plaintiff to have some blood tests and an MRI scan of her left knee.
30On 16 November 2011, the plaintiff consulted Dr Johnson again for her left knee problems, which he considered to be mechanical. He described an MRI study of the plaintiff's left knee as having identified a meniscal tear of that left knee, which he then injected. Dr Johnson reviewed the plaintiff's blood test results and he ruled out the presence of an inflammatory process.
31An issue emerged during the hearing as to whether the plaintiff's left knee problems were accident related. I will give consideration to that causation issue when stating my findings on the plaintiff's accident related disabilities.
32On 2 November 2012, at the request of the solicitor for the defendant, the plaintiff was examined by Dr Brian Stephenson, a consultant orthopaedic surgeon. In his report dated 12 November 2012, Dr Stephenson accepted that the plaintiff had injured her right foot and had sustained an undisplaced fracture of the proximal phalanx of the fourth toe. He also accepted that the plaintiff had consequential reduced agility of the right lower leg. He accepted the plaintiff's claimed disability in that regard.
33Dr Stephenson took a history of the plaintiff having fallen in the subject accident and of having landed on her knees. He examined both of the plaintiff's knees and he ascertained that her left knee was stable to examination although there was some reported pain in the anterolateral aspect and crepitus of that knee. In his initial report, Dr Stephenson provided no discussion about any disability of the plaintiff's left knee. This may have been because the solicitor who had retained him had asked him no questions about the left knee.
34On 6 March 2013, at the request of her solicitor, the plaintiff was examined by Dr Peter Conrad, a consultant surgeon. Dr Conrad considered that the ongoing pain and restriction of movement in the plaintiff's right foot was stable and permanent. He considered the plaintiff had lost 25 per cent loss of the efficient use of her right foot. He foreshadowed the possibility of the plaintiff developing some arthritis in her right foot in the region of her fractures. Dr Conrad's comments in the form of suggested restrictions to the plaintiff's work tasks will be analysed separately in connection with the plaintiff's claim for economic loss.
35On 10 April 2013, the plaintiff was examined by Dr Brian Martin an orthopaedic surgeon, at the request of Dr Jamshidi, for consideration of her right foot problems. Dr Martin saw the plaintiff again on 24 July 2013. He expressed a guarded prognosis but stated that he expected some improvement in the plaintiff's right foot. His rationale for that view was that at the time of his consideration, there was no sign of arthritis on the MRI scan.
36On 12 August 2013, at the request of her solicitor, the plaintiff was examined by Dr Conrad for a second time. On this occasion, in addition to examining the right foot, Dr Conrad examined the plaintiff's left knee, noting in his summary of the history taken from the plaintiff on that occasion, that the plaintiff had omitted to draw his attention to her left knee problems when she had consulted him on the previous occasion.
37Following that further examination, Dr Conrad reiterated his earlier opinion with regard to the stability and permanency of the plaintiff's right foot problems.
38Dr Conrad went on to describe the meniscal tear of the plaintiff's left knee as shown on an MRI scan, which he felt may well need an arthroscopy. In his oral evidence, Dr Conrad explained that his use of that expression was meant to convey that the arthroscopic meniscectomy procedure would more likely than not be required.
39Dr Conrad went on to state that the plaintiff should be able to continue working provided she was able to stand or sit at will, without a lot of standing, walking, and going up and down stairs.
40In addition to reiterating his earlier opinion on the plaintiff's loss of efficient use of her right foot at 25 per cent, Dr Conrad stated that the plaintiff had also lost 25 per cent efficient use of her left leg at or above the left knee.
41On 23 August 2013, at the request of the solicitor for the defendant, Dr Stephenson provided a letter in which he addressed some questions which had been directed at a consideration of the plaintiff's left knee problems. This request was in response to the service by the plaintiff's solicitor of the report of Dr Conrad dated 12 August 2013. This last report from Dr Stephenson comprised a commentary on the cause of the plaintiff's left knee meniscal injury. That commentary was based on an examination of the written materials provided to him, and was not based on any further examination of, or history taking from, the plaintiff.
42The plaintiff has remained under the intermittent care of her general practitioner, Dr Jamshidi, but no particular treatment was provided by that doctor. The report of Dr Jamshidi dated 26 March 2013 referred to consultation dates on 23 February 2011 and a physiotherapy consultation on 18 April 2022 (sic). Dr Jamshidi's progress notes referred to some additional consultations.
43The plaintiff has been referred to Dr RM Sorial, an orthopaedic surgeon. A report was requested by the plaintiff's solicitor on 26 July 2013 but no reply was available at the time of the hearing: Exhibit "F". Dr Sorial had however provided the plaintiff with a quotation for the cost of arthroscopic surgery, which suggests that such surgery might be imminent: Exhibit "G".