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You are here: BAILII >> Databases >> England and Wales Court of Appeal (Civil Division) Decisions >> Watt v Tucker [2005] EWCA Civ 1420 (23 November 2005) URL: http://www.bailii.org/ew/cases/EWCA/Civ/2005/1420.html Cite as: [2005] EWCA Civ 1420 |
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COURT OF APPEAL (CIVIL DIVISION)
ON APPEAL FROM The High Court of Justice
Queens Bench Division, Bristol District Registry
His Honour Judge Darlow
4B550123
Strand, London, WC2A 2LL |
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B e f o r e :
LORD JUSTICE TUCKEY
and
LORD JUSTICE NEUBERGER
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Rebecca Watt |
Respondent |
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- and - |
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Richard Tucker |
Appellant |
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Smith Bernal Wordwave Limited, 190 Fleet Street
London EC4A 2AG
Tel No: 020 7404 1400, Fax No: 020 7831 8838
Official Shorthand Writers to the Court)
Adam Chippindall (instructed by Guys, Solicitors) for the Appellant
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Crown Copyright ©
Waller LJ:
Introduction
History leading up to trial
"11.1 This lady was involved in a road traffic accident on the stated date, 27 January 2000. As a consequence of accidents of this type one sees forces generated. These forces transmitted into the axial skeleton produce damage to the soft tissue structures in the upper thoracic and cervical regions by allowing excess movement in flexion, extension to stretch these tissues past their normal elastic limit. The damage produces a Whiplash Associated Disorder.
11.2 The natural history of a Whiplash Associated Disorder is to see a resolution of all symptoms within the cervical spine within a period of one year in the majority. A minority have symptoms after one year. Twelve to twenty percent of people who suffer the injury have symptoms at two years and if this be so those symptoms will tend to continue in the long-term but will improve until four years from injury at which time a plateau state is reached.
11.3 In this lady's case it is now two years from accident. I saw no evidence of inappropriate response to clinical examination or symptomatic exaggeration. There are two particular poor prognostic features. The first is that the claimant is of the female gender and secondly there is evidence of what I consider a depressive state previous to the index accident. These are poor prognostic features and tend to be a factor in prolonged and protracted recovery from whiplash associated disorders."
"Occupational activities: Ms Stone was away from her work for the period of several weeks immediately after the accident and this is compatible with the accident. What is unusual is the history we see from then that in September she reduced her working period having worked for eight months up until that point in time, reducing again in October and then again the following year; this is not the pattern we see in normal circumstances. One would expect the converse, one would expect a return to work in a light capacity and gradually increase the capacity as the years go by. We must therefore look to a causation in this matter and I believe a significant factor is the underlying psychological state."
"4.1 on page 3. Clarifying my current working regime: Due to the ongoing symptoms which are at their worst for conventional optometry, I now only do this type of work for one day per week. I work as an optometrist for a laser surgery company two days per week which aggravates the back symptoms to a lesser extent. I work in total three days per week though am considering stopping conventional optometry altogether. I am experiencing a loss of earnings as the laser job is not as well paid as conventional optometry."
"11.5 on page 8. I felt I should explain why I have gradually decreased my workload which Mr Mackay highlighted. Immediately following the period during which I was signed off work I returned to my prearranged commitments. I experienced worsening symptoms which made me more and more uncomfortable at work over the following six months. I reduced my workload to what I could cope with but still found the symptoms aggravated by practicing conventional optometry and reduced the hours again. I sought careers advice regarding my hours to only one day of normal practice and now do two days per week of work for a laser company which involves less leaning. I am considering discontinuing normal optometric practice if the unacceptable aggravation of symptoms does not resolve. This may not be the usual pattern seen in whiplash injuries but may be explained by me soldiering on in order to honour work and financial commitments in the early stages."
" Page 3 paragraph 4.1: I am happy to accept the views expressed by Mrs Watt that her altered occupation was as a consequence of the symptoms which were described.
Page 8 paragraph 11.5: I have addressed this matter, I believe, already in reply to paragraph 4.1. The problem of backache can affect one's ability to carry on working at a particular type of work and I accept it can be necessary to alter one's working practices to avoid aggravating factors; it was proper for me to draw to the attention of the Courts the matters of my paragraph 11.5."
". . her vocational capacity at the date of our examination had not been significantly impaired by psychiatric symptoms due to the accident (in January 2003 and November 2003) and we do not believe significant impairment due to the accident will arise in the future. We defer to the opinions of the orthopaedic surgeons about the impact of her physical symptoms upon her vocational capacity."
"44. Having said the above she has symptoms in the upper thoracic spine, which I believe are genuine consequent upon the index accident and would not be suffered should she not have had the index accident. This young lady has complied with all the advice given.
45. She will not develop post-traumatic arthrosis in the neck or thoracic region as a consequence of the index accident.
46. Mrs Watt I believe is capable of a gainful occupation. Taking into account the aforesaid paragraphs, I believe reasonably that she has readjusted her work style and I believe that she would be capable of returning to the hours she was doing prior to the index accident in laser optometry but if she gets discomfort to take analgesics to allow her to continue the 32 hour week. I believe she is capable of doing so but appreciate there may well be aggravation of symptoms.
47. Of course the final judge of this is the patient and she must decide how much she is able to cope in terms of discomfort.
48. I believe that from a purely orthopaedic point of view she is capable of a 32-hour week.
49. The lady should be advised that she should continue to be active despite getting discomfort and I believe she is capable of the activities she was doing prior to the index accident, albeit on a limited capacity. Again it is for the patient to decide and this is a sensible patient, well motivated now I believe of how much she can do and how much discomfort she is prepared to accept."
"1. From your perspective as the Court's medico-legal witness, did you find Mrs Watt in any way to be an unreliable patient, either in the reporting of her medical history, reported symptoms, their resulting disabling effect on her or in any other way? If you answer is 'yes', please accompany the answer with a full explanation.
2. Has the material mentioned given you a more useful insight into the postural requirements of an optometrist to that which you had when you prepared your report in December?
3. In response to your observation about taking analgesics to control the pain Mrs Watt says that her problems are at their most acute when she is adopting the posture of leaning forward with her arms held out. The intense exacerbation of her underlying symptoms this posture provokes is resistant to analgesics. The level of pain suffered whilst waiting for clients to make a selection between 2 lenses held out in front of their eyes (for example) can bring tears of pain to Mrs Watts' eyes. Is it your orthopaedic view that the Court can rely on the veracity of these observations from Mrs Watt?
4. Mrs Watt's position is that she can earn more working 3 days per week as an optometrist working for Ultralase and resting her vulnerable spine in the days in between that she could earn working 5 days a week in an alternative sedentary job. Taking into account all the new material brought to your attention in these Questions and their exhibits, would you consider, form an orthopaedic viewpoint, that she is acting unreasonably by restricting her working week to 3 days of laser optometry spread out over each working week?"
"I have seen videos WDA1 and WDA3. It was not my view that I saw anything within the two videos which would be contra-indicated in this lady's case. I am not convinced on any of the activities seen that they would be contra-indicated in t his case; indeed, my report will address the matter of rehabilitation and the fact that people should continue working despite discomfort, being reassured that discomfort does not produce deterioration.
I am not convinced from an orthopaedic point of view that she was orthopaedically incapable of working at her job as an Optometrist – either laser or standard. I have made the point in my report that there are factors which are non-orthopaedic which are not for me to comment upon – significantly, the psychological response. Of course, it must be appreciated that people's conception and perception of disability can be significantly altered by any psychological upsets and, whilst from a purely orthopaedic point of view one knows that it is proper to advise to continue with any activity, and that by doing such an activity even though there is discomfort it does not mean there is a deterioration – indeed the converse is so – it can be the psychological factor that is significant in altering people's conception of what they can or cannot do."
"Having reviewed these videos and seen the work of an optometrist, of course I was not aware of the precise activities which are undertaken by an Optometrist and I assume that we are dealing here with the work which would have been undertaken by Mrs Watt at the time of the index accident, as an Optometrist working 32 hours a week. I was not convinced on reviewing these two videos allowed to me that the type of work undertaken, or the positions undertaken, which are not held for any prolonged period of time, were such that they would have been a significant factor in the development of neck pain to the point which would prevent her working in that condition. That which I saw was that there are many different positions held by the neck and in between which movement was allowed; this differs significantly from the type of work which is done by a typist or a person doing VDU work when the neck is held in one position, in which situation discomfort is felt, but when mobility is allowed one can continue working.
I was therefore not convinced on seeing these videos and it would not be clear to me how a change of direction to laser optometry could be any different from the type of work she is doing, or would have been doing, seen on the two videos.
Certainly, from an orthopaedic point of view I do not see any reason why she should not have continued undertaking the work she was doing at the time of the index accident, accepting that she will get occasional discomfort in the neck, but this, of course, will happen in the population as a whole during their lifetime with not unusual symptoms."
"2. Attached to this statement and marked MG1 is a letter from my firm to Fennemores detailing my concern about the nature of the Claimant's questions to Mr McKay.
. . . . . .
6. On the day of Mr McKay's departure and following a prompt from me to his secretary, he produced the letter dated 21st July and another document of the same date entitled "video review" Self-evidently Mr McKay cannot now be asked to clarify his opinion any further before the Trial as he is away on holiday. It is my submission that whether or not he has specifically answered the questions put by the Claimant, he has dealt with the substantive point which is whether from an orthopaedic point of view the Claimant can undertake the type of work demonstrated in the two types of eye test shown in the videos provided to him.
. . . . . .
9. As to the first point of the Claimant's Application therefore the Defendant's view is that, subject to any further explanations from Mr McKay's secretary, Mr McKay has dealt with the outstanding questions, particularly in respect of the predominant purpose of his further opinion being sought, namely to comment from a clinical point of view on the capability of the Claimant to undertake standard optometric eye tests. It is my submission that it is for the Trial Judge to consider whether the Claimant is "genuine" and whether her decision to change her work was "reasonable", not the orthopaedic expert."
" an Orthopaedic Surgeon has carried out an examination and found little by way of physical signs, it is not appropriate for him/her to express opinions about the genuineness of a patient. Questions of reliability which relate to credibility and reasonableness are questions for the Judge having heard all of the evidence. We must therefore object to the questions 1, 3 and 4 because the premise upon which these questions have been put relies entirely upon the self-reporting evidence and expression of symptoms of the claimant which are unverifiable by objective analysis or testing by any expert."
"Questions 1 and 4 are inappropriate questions. The second question adds nothing. The third question is most important but may be trespassing into the function of the trial judge. The real question is whether the Claimant herself is telling the truth."
The Trial
The Judge's Judgment
The Appeal
Conclusion
"All depends upon the circumstances of the particular case. For example, the joint expert may be the only witness on a particular topic, as for instance where the facts on which he expresses an opinion are agreed. In such circumstances it is difficult to envisage a case in which it would be appropriate to decide this case on the basis that the expert's opinion was wrong. More often, however, the expert's opinion will only be part of the evidence in the case. For example, the assumptions upon which the expert gave his opinion may prove to be incorrect by the time the judge has heard all the evidence of fact. In that event the opinion of the expert may no longer be relevant, although it is to be hoped that all relevant assumptions of fact will be put to the expert because the court will or may otherwise be left without expert evidence on what may be a significant question in the case. However, at the end of the trial the duty of the court is to apply the burden of proof and to find the facts having regard to all the evidence in the case, which will or may include both evidence of fact and evidence of opinion which may interrelate."
Lord Justice Tuckey :
Lord Justice Neuberger :