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nsw_caselaw:178fd5962177b5b782d5c74c:52 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 46. Hailee Williams and her mother returned to see Dr Stening on 3 December 2012. Meigan Williams said this:
“97. I recall taking Hailee to the rooms of Dr Stening on 3 December 2012. I do not precisely recall the time of that appointment. I recall being present during that consultation and again I did most of the talking. I vaguely recall a discussion to the following effect:
‘Dr Stening: How have you been getting on?
Hailee: The injection was okay and helped the hip pain for a couple of weeks. I have had trouble with the lifting at work.
Me: What options do we have?
Dr Stening: You could have another cortisone injection but as it did not provide lasting relief the first time, you are unlikely to get any benefit from a second treatment.
Me: If a cortisone injection was not a viable option, what can be done to help Hailee’s pain, as it was getting worse and it was affecting her life and work? | 52 |
nsw_caselaw:178fd5962177b5b782d5c74c:53 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | Dr Stening: The X-rays did not show any abnormalities and Hailee’s problems are likely to be her growth plates. This will resolve as she matures. Time will resolve the issue but in the interim Hailee should avoid, as much is possible, bending and lifting activities. Her job was not helping her.’
98. To the best of my recollection now, at no time, during that consultation did Dr Stening inspect and/or examine Hailee’s hips, pelvis or back. To my recollection, she was not directed onto the examination table. It is my strong recollection she remained seated, with me, in front of Dr Stening’s desk.
99. I recall again asking Dr Stening many questions about what else we could do for Hailee, what other options she had. I was looking for answers and asking a lot of questions. I felt I was not getting answers to my questions.
‘Dr Stening: Physiotherapy could help, and I will refer you. We will get an MRI done and see what that shows up just to be sure’.” | 53 |
nsw_caselaw:178fd5962177b5b782d5c74c:54 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 47. In about mid-December 2012, Meigan Williams contacted Dr Stening’s rooms regarding Hailee’s MRI results. Dr Stening called back later. She described the conversation as follows:
“107. A conversation to the following effect (after exchanging pleasantries):
‘Dr Stening: I’ve looked at the MR scan and there are no abnormalities revealed. So there is nothing structurally wrong and Hailee just has to wait for symptoms to resolve as she matures.’
108. I recall being surprised at the news. I was sure he would have found something wrong that would explain Hailee’s symptoms. We went on:
‘Me: Are you really sure there’s nothing there? It doesn’t make sense. Hailee is in real pain and it seems to be getting worse.
Dr Stening: Yes. The MRI is normal. So is the X-ray. Her pain is likely caused by the growth plates, which is very common. It will sort itself out. Sometimes it takes longer than other times, but we’ll just have to wait’.” | 54 |
nsw_caselaw:178fd5962177b5b782d5c74c:55 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 48. Meigan Williams said that Dr Stening gave her no further advice about Hailee’s condition or signs of deterioration. Meigan Williams did not see Dr Stening again in December 2012 and had no further contact with him until February 2013.
49. Meigan Williams said that on 13 June 2013, Dr Cree told her that Hailee’s condition was “really a medical emergency” and that she could be rendered a paraplegic “within a matter of weeks” if she were not operated upon soon. Hailee was shortly thereafter taken to theatre for a lumbar spinal fusion and bone graft. | 55 |
nsw_caselaw:178fd5962177b5b782d5c74c:56 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | Cross-examination of Meigan Williams
50. Meigan Williams was asked about her daughter’s consultation with Dr Mutasim. She was not prepared to accept the possibility that when she saw him with Hailee initially and described why they were there that she mentioned only hip pain but not back pain. Nor was she prepared to accept the possibility that in that consultation on 21 May 2012, back pain only came up for discussion at the end of the consultation after the examination of Hailee had been performed. She had it firmly in her mind at that time that Hailee had problems in her hips as well as her back. | 56 |
nsw_caselaw:178fd5962177b5b782d5c74c:57 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 51. With reference to the consultation with Dr Stening on 20 June 2012, Meigan Williams disagreed with the proposition that she did not describe to Dr Stening that Hailee was having any back pain. She reaffirmed the version of what occurred as described by her in paragraph 69 of her statement. She also disagreed that Dr Stening said that it looked like her daughter had suffered a recurrence of the condition that she had back in 2009. Meigan Williams recalled discussion about a cortisone injection but “absolutely disagreed” with the suggestion that Dr Stening said that getting up and down from the squatting position and lifting kids was likely to aggravate Hailee’s problem or for the time being she should try to avoid those activities. | 57 |
nsw_caselaw:178fd5962177b5b782d5c74c:58 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 52. Meigan Williams also disagreed that during the second half of 2012 her daughter’s main problem was her hip. Her hip pain was a constant problem and her back pain was intermittent. She said, “Hailee had good and bad days during that period of time, with both her hip and her back pain.” She disagreed that Hailee’s back was not a significant problem for her in the second half of 2012.
53. Paragraph 64 of her statement is in the following terms:
“64. I recall on 24 May 2012 I took Hailee to Castlereagh Imaging in Penrith for her X-rays. I always read the X-ray referral and I have little doubt that I read it on this occasion. I gave the referral to the receptionist on arrival.”
54. Meigan Williams was taken to that paragraph in cross-examination. Her evidence was as follows:
“Q. Do you see in that you say in the second sentence, I always read the X-ray referral and I have little doubt that I read it on this occasion?
A. Yes. | 58 |
nsw_caselaw:178fd5962177b5b782d5c74c:59 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | Q. That's a reference to the X-ray that Hailee was sent for in May 2012 by Dr Mutasim?
A. Yes.
Q. In the same way, did you read the referral when she was sent for the MRI in December 2012?
A. I don't recall doing that.
Q. It's your practice to do it isn't it?
A. It is my practice to read the reports that are put in the MRIs and in the X- rays, that is my definite practice.
Q. Paragraph 64 doesn't refer to X-ray or radiology reports, it refers to referrals, do you agree with that?
A. Yes.
Q. If that's correct what's stated there, or did you intend in paragraph 64 to refer to the X-ray reports?
A. I was referring to the X-ray reports.
Q. We should correct the reference to referral to indicate that you meant X-ray reports?
A. Yes.
Q. You don't have a practice of reading referrals for imaging?
A. No. | 59 |
nsw_caselaw:178fd5962177b5b782d5c74c:60 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | Q. In this case though, had you, by the time you spoke to Dr Stening in December, had you actually received the report or not?
A. Which report are you referring to?
Q. Sorry, that was unclear. The report I'm referring is the MRI scan report for Hailee?
A. The MRI report from my recollection was around 17 December when I had a phone call with Dr Stening.
Q. By the time you had the discussion with him where he told you about the results, did you actually have the report?
A. No, I don't believe I had the report.
HIS HONOUR: Could I just interrupt?
Q. At paragraph 64 of your first statement in the second sentence, you say I always read the X-ray referral and you go onto say, I gave the referral to the receptionist on arrival. Do I understand that following some questions from a few moments ago, that in the second sentence you want to change that to I always read the X-ray report? | 60 |
nsw_caselaw:178fd5962177b5b782d5c74c:61 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | A. May I just clarify that paragraph 64 refers to 24 May 2012? I thought we were discussing December 2012.
Q. All I wanted to know was, at paragraph 64, I agree you've isolated it in time in May 2012, I may have misunderstood but I thought from questions from Mr Downing you wanted to change the word referral in the second sentence to report? Did I understand that correctly?
A. Yes.
Q. Perhaps not a matter for me at this stage, but that doesn't seem to make any sense because you were on your way to the Castle Ray Imaging and would not at that stage have had a report, but merely a referral would you not?
A. Yes, in that context that's correct.
Q. When you say in that context, the change of the word referral to report, I have to indicate to the parties at paragraph 64 has led me to be confused, but I'm not running the evidence in this case and I'll simply note that that has confused me.” | 61 |
nsw_caselaw:178fd5962177b5b782d5c74c:62 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 55. The fact that the referral dealt with Hailee Williams’ hips and not her back was then further explored:
“Q. You understood that was an MRI had been done confined to the left hip, correct?
A. Yes.
Q. Your concern at that point was that Hailee had significant problems not just in her left hip, but in her back?
A. Yes.
Q. That's your evidence isn't it?
A. Yes.
Q. Having been told now that the imaging that had been done of the left hip was clear, would you not have raised with Dr Stening your concern at the imaging of the back?
A. I relied on Dr Stening of his expertise and his direction in Hailee's medical treatment and he assured us that it was the growth plates and that it would heal in time.
Q. Do you think it's possible that in fact there was no discussion between you, Hailee and Dr Stening in December 2012 about the back?
A. No.”
56. Finally, on this topic, Meigan Williams gave this evidence: | 62 |
nsw_caselaw:178fd5962177b5b782d5c74c:63 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | “Q. According to what Hailee was telling you, by December 2012, was the back pain as big a problem as the hip pain?
A. Yes.
Q. Surely, if that were the case, that is, if the back pain had been there for some time, that it was getting more constant, more severe, and it was as big a problem as the hip pain, you would have raised with Dr Stening at this point, your desire that there be some investigation of the back.
A. As I said, I relied on Dr Stening to direct Hailee's medical treatment. When we raised the back pain with Dr Stening, we were told it was referred pain and that it was the hips and the growth plates. And that over time, they would heal.
Q. What I'm suggesting to you is that it was only in the early months of 2013 that the back pain became a significant problem for Hailee, do you agree or disagree with that?
A. I disagree with that.” | 63 |
nsw_caselaw:178fd5962177b5b782d5c74c:64 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | Dr Fraser
57. At the commencement of the hearing, Dr Fraser made certain admissions. These were described in detail in Mr Downing’s opening remarks. Some of what he said was to the following effect.
58. Even though the X-rays that Dr Fraser was asked to interpret and report on were not X-rays of Hailee Williams’ lumbosacral spine, but were X-rays of her hips and pelvis, he accepts serendipitously that they revealed a right sided pars defect that he failed to see or to report upon. Dr Fraser accepts that that amounts to a breach of duty: it should have been identified at the time and further X-rays of the lumbosacral spine should have been recommended. Dr Mutasim took a history from Hailee Williams on 21 May 2012 of hip pain as well as back pain but in his referral letter to Dr Fraser did not seek imaging of her lumbosacral spine. His request was limited to her hips and pelvis. Dr Fraser’s report to Dr Mutasim dated 24 May 2012 was as follows:
“PELVIS AND HIPS | 64 |
nsw_caselaw:178fd5962177b5b782d5c74c:65 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | Findings: No abnormality was seen in the bony pelvis. The geometry of both hip joints is normal with no evidence of an arthropathy or other bony abnormality. There is no periarticular calcification. The appearance of the symphysis is normal and the sacroiliac joints normal.”
59. Nor did Dr Mutasim make any reference at all to back pain in the letter that was sent to Dr Stening. There is no agreement about Hailee Williams’ precise presentation to Dr Mutasim or whether it was limited to her hips.
60. Dr Fraser also accepts, consistently with his admission, that if further specific X-ray imaging of the lumbosacral spine had been done, it would have led, in either June or December 2012, to a diagnosis of spondylolisthesis. There is considerable disagreement among the experts as to the precise grade of that spondylolisthesis, in part because there was no lumbosacral X-ray, CT scan or MRI performed at the time. | 65 |
nsw_caselaw:178fd5962177b5b782d5c74c:66 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 61. Dr Fraser’s concession was appropriately in line with his evidentiary statement dated 5 August 2019, portion of which was as follows:
“25 I am aware that in this matter, the plaintiff has served expert reports from Dr John Earwaker, radiologist, in which he reviewed the 24 May 2012 x-ray images of the pelvis and hips and reported on them. I am aware that Dr Earwaker identified a right-sided pars defect in the oblique projection of his right hip) and a hypoplastic bifid neural arch of what he took to be the fifth lumbar segment. Further, I am aware that Dr Earwaker has indicated his opinion that I departed from competent practice as expected by peer professionals in 2012 in not identifying and reporting the right-sided pars defect and the hypoplastic bifid neural arch. | 66 |
nsw_caselaw:178fd5962177b5b782d5c74c:67 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 26 As I have stated above, it is correct that when I reviewed the 24 May 2012 x-ray images, I did not identify the right-sided pars defect (which can be seen on the edge of the lateral/oblique projection of the right hip). As per my usual practice, if I had identified it, I would have mentioned it in my report.
27 While I can’t now recall my precise thought process in reviewing the images and preparing my report, as per my usual practice, I would have been aware of the clinical history of pain in both hips and the lower lumbar region. However, as I have stated above, I would also have been aware that notwithstanding that history, the referring GB, Dr Mutasim, sought imaging with ultrasound and x-rays of the hips and pelvis only, not of the lumbar spine. It seems likely to me that because Dr Mutasim only wanted imaging done of the hips and pelvis, that was my primary focus in assessing the x-ray films (with the process of assessing the films being two-staged, as I have described above. | 67 |
nsw_caselaw:178fd5962177b5b782d5c74c:68 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 28 If I had identified the right-sided pars defect on 24 May 2012 then, as per my usual practice, I would have made a recommendation for further x-ray imaging of the lumbar spine and possibly, a CT scan of the lumbar spine.”
62. It was in these circumstances that Dr Fraser’s cross-examination was limited to the matters that are now considered. | 68 |
nsw_caselaw:178fd5962177b5b782d5c74c:69 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | Cross-examination of Dr Fraser
63. Dr Fraser gave the following evidence:
“Q. Is it fair to say that you made a decision, although there'd been a clinical history of pain in the lower lumbar, you made a decision not to X-ray that part of the body?
A. There was no request to X-ray the lumbar spine.
Q. That might be so, but can you say today whether you turned your mind to the clinical history of pain in the lumbar spine?
A. I did not, as the request was for X-ray and ultrasound of the hips, that's what was done. The lower lumbar is second line and certainly would have been very much the second or third raised point to attend to. If I may say, had Dr Mutasim wanted the lumbar spine X-ray, he would have asked for it, he didn't
Q. Did you in your position as a radiologist have a view given as there was a history of pain in the lumbar spine, that it might be desirable to take an X-ray of the lumbar spine? | 69 |
nsw_caselaw:178fd5962177b5b782d5c74c:70 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | A. No, lumbar pain is a very common issue, it was not requested, it was not done.”
64. The cross-examination of Dr Fraser was necessarily limited having regard to his admission of breach of duty and his associated acceptance that if further specific X-ray imaging of the lumbosacral spine had been done, it would have led, in either June or December 2012, to a diagnosis of spondylolisthesis. | 70 |
nsw_caselaw:178fd5962177b5b782d5c74c:71 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | Conclusions concerning Dr Fraser’s liability
65. Dr Fraser’s failure to report the existence of a pars defect in his 24 May 2012 report misled Dr Stening. His evidence about this, effectively mirrored in interrogatories administered by Hailee Williams and answered by Dr Stening on 31 October 2016, is set forth at paragraph 139 of his evidentiary statement as follows:
“139. If any of the imaging of Ms Williams’ lumbo-sacral spine identified a grade I-III spondylolisthesis, then as per my usual practice, I would have taken the following steps:
(i) told Ms Williams that she would need to return for further review and clinical assessment in 3 months’ time and then at 3 monthly intervals;
(ii) told Ms Williams that she would need to have serial X-rays at 3 monthly intervals to look for evidence of any progression;
(iii) told Ms Williams that she should not engage in any high impact sports or activities; | 71 |
nsw_caselaw:178fd5962177b5b782d5c74c:72 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | (iv) told Ms Williams that she should return sooner than 3 monthly if she developed symptoms in the lower limbs like weakness, numbness, tingling or altered sensation, including urinary or faecal incontinence. Further, that it was extremely important that she come back as soon as possible in those circumstances because she might need urgent treatment;
(v) told Ms Williams that she needed to see a paediatric spinal sub-specialist for opinion and further management and provided her with a referral to a paediatric spinal sub-specialist.” | 72 |
nsw_caselaw:178fd5962177b5b782d5c74c:73 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 66. In this respect, Hailee Williams relies upon Dr Stening’s evidence in support of her case against Dr Fraser to establish that Dr Fraser’s admitted breach caused her loss as the result of the way that it misled her then treating orthopaedic specialist. Dr Stening was understandably not cross-examined to suggest that his evidence in this regard was subject to challenge. Indeed, as Hailee Williams’ submissions emphasise, Dr Stening went further in his evidence to indicate that he would also have recommended core strengthening exercises, a suggestion that accords with other expert evidence in these proceedings. | 73 |
nsw_caselaw:178fd5962177b5b782d5c74c:74 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 67. Dr Stening relied on the X-ray report from Dr Fraser and, although Dr Stening subsequently provided Hailee Williams with a medical certificate for restricted work duties, he did not immediately proceed to arrange for or offer alternative conservative, non-operative clinical management in the way that the experts agree would have been appropriate in mid-2012. Hailee Williams was thereafter left in a vulnerable position with an undiagnosed spondylosis or spondylolisthesis that exposed her to a risk of harm if left untreated. Her case against Dr Fraser is that if he had identified and reported on the pars defect in June 2012, that would have led to further inquiries which, in turn, would have revealed the state of Hailee Williams’ spondylolisthesis. | 74 |
nsw_caselaw:178fd5962177b5b782d5c74c:75 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 68. Dr Fraser denied that his alleged negligence was a necessary condition of the occurrence of Hailee Williams’ harm so that nothing he did or failed to do caused her loss as a matter of fact: s 5D(1)(a) of the Civil Liability Act 2002. Moreover, he denied pursuant to s 5D(1)(b) of the Act that it is appropriate for the scope of his liability to extend to the harm which Hailee Williams alleges she suffered.
69. Breach of duty having been admitted by Dr Fraser, it is convenient to defer consideration of the s 5D issues that relate to him, and the question of damages, if relevant, to later in these reasons. | 75 |
nsw_caselaw:178fd5962177b5b782d5c74c:76 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | Dr Stening
70. A significant contest between Hailee Williams and Dr Stening is the question of whether Dr Stening was ever provided with a history from Ms Williams’ general practitioner Dr Mutasim that included a reference to low back pain. An associated, and even more significant, contest concerns whether Hailee Williams or her mother ever complained of back pain to him or otherwise drew it to his attention during any consultations with him.
71. Dr Mutasim referred Hailee Williams to Dr Stening on 3 June 2012. His letter of that date to Dr Stening relevantly says this:
“Thank you for seeing Miss Hailee Williams aged 18 yrs for opinion and continuing management.
Presenting Problem: Pain in the left ASIS for last 2 months.
Has had similar pain in 2009.”
72. Following his consultation with Hailee Williams on 20 June 2012, Dr Stening wrote to Dr Mutasim as follows: | 76 |
nsw_caselaw:178fd5962177b5b782d5c74c:77 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | “Thank you for your referral. Hailee’s 18 years of age now. The last 6 months she has started working as a childcare worker and this has corresponded to developing recurrent pain around the anterior aspect of both hips, left worse than right.
Several years ago she consulted with me and had similar symptoms and a diagnosis of iliac apophysitis.
On examination she had pinpoint tenderness over the anterior superior iliac spine, left greater than right. There was also discomfort on hyperextension of the hip and on Ely test.
IMPRESSION
It looks as though she’s developed recurrence of this iliac apophysitis. I’ve recommended that she have injections of cortisone into the area and then a period of rest for at least 3 weeks afterwards, abstaining from sports etc. It also would be wise for her to move from her current duties to one where she doesn’t need to repetitively lift children as this may have contributed to the onset of her symptoms. | 77 |
nsw_caselaw:178fd5962177b5b782d5c74c:78 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | I’ll keep you informed of further developments as they transpire.”
73. The terms of that letter significantly framed Dr Stening’s evidence-in-chief. However, his cross-examination was largely informed by a different version of the facts upon which Hailee Williams relies.
74. Dr Stening administered a cortisone injection two days later. He reported to Dr Mutasim by letter dated 22 June 2012 as follows:
“I injected Hailee’s anterior superior iliac spine region with two ampules of Celestone Chronodose and local anaesthetic under sterile technique today.
Hopefully this will alleviate her symptoms satisfactorily over the next week or so.
I’ll see her to inject the other side if she gets a good response from this injection today.”
75. Dr Stening’s statements of evidence are dated 15 August 2019 and 29 July 2019. It becomes necessary, despite its length, to reproduce a large portion of his first statement, relevantly as follows:
“2009 | 78 |
nsw_caselaw:178fd5962177b5b782d5c74c:79 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 14 Hailee Williams was first referred to me by her general practitioner, Dr Amin Mutasim, via a letter dated 21 November 2009. That letter is located at page 45 of my patient records for Hailee Williams.
15 I first saw Hailee Williams on 21 December 2009. I can’t now recall if she attended alone or with her mother. At that time, as per the usual practice in my rooms, my receptionist would have given Hailee Williams and/or her mother a Patient Information Sheet to complete. A copy of the Patient Information Sheet for Hailee Williams is located at page 44 of my patient records for her. | 79 |
nsw_caselaw:178fd5962177b5b782d5c74c:80 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 16 As per my usual practice when seeing a new patient, when Hailee Williams first attended on me on 21 December 2009, I would have read the referral letter I had received from Dr Mutasim, taken a history from Ms Williams, conducted a physical examination and reviewed any imaging that was available to me. I may also have obtained some history from her mother if she was present. I would also, as per my usual practice, have concluded the consultation by discussing with Ms Williams (and her mother, if she was present) my views as to her diagnosis and my recommendations as to management and treatment. | 80 |
nsw_caselaw:178fd5962177b5b782d5c74c:81 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 17 My letter to Dr Mutasim dated 21 December 2009 (which is located at page 43 of my patient records for Hailee Williams) contains a summary of my interpretation of Dr Mutasim’s referral letter, the history I obtained in respect of Hailee Williams, the physical examination I conducted, my review of Hailee Williams’ imaging (which I assume she brought with her on 21 December 2009) and my views as to diagnosis and management/treatment.
18. Ms Williams’ presentation on 21 December 2009 was with pain in the left anterior superior iliac spine (ASIS), though it is evident from my letter of 21 December 2009 that the history I got on that day was that while the symptoms had developed about 6 months’ ago, just before Ms Williams ran in the City to Surf, they had completely resolved while Ms Williams was resting over the last 6 to 8 weeks.
19 In layman’s terms, the ASIS is the anterior superior iliac spine that is located at the anterior or front aspect of the hip. | 81 |
nsw_caselaw:178fd5962177b5b782d5c74c:82 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 20 Where a teenage patient presents with ASIS pain, I have a usual practice in terms of the examination I perform. I have no doubt that during the 21 December 2009 consultation with Ms Williams, I examined her as per my usual practice.
21 First, I would have observed Ms Williams walking informally, as she came into the consultation room, to see if I could identify any abnormality. On occasions, if I don’t think I get enough information through that informal observation, I ask the patient to walk around the room for me, so that I can formally observe the patient’s gait. I can’t now recall whether I requested that Ms Williams walk for me so that I could observe her gait during the 21 December 2009 consultation.
22 Secondly, where the presentation is of a teenage patient with ASIS pain, I initially have the patient lie supine on the examination bench and I palpate the pelvis by pressing over the iliac crests. That was where I understood Ms Williams had pain. | 82 |
nsw_caselaw:178fd5962177b5b782d5c74c:83 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 23 I then spring the pelvis, pressing down on the iliac crests and feel over the greater trochanters (where female teenage patients often have symptoms with hip pain).
24 I next move the hips around, flexing up and rotating in to look for any discomfort. I hold one leg up and then flop it out to the side while pressing down on the other leg in order to stress the sacroiliac joint.
25 Thirdly, I then turn the patient over prone in order to stretch out the front of the hips and see whether it might aggravate the patient’s pain or discomfort coming from the iliac crest. I do that by hyperextending the hip. I next perform an Ely test by flexing the knee while the patient is lying prone. The Ely test assesses for rectus femoris spasticity/tightness. In layman’s terms, the idea is to stretch the muscles arising from the anterior superior/inferior iliac spine. | 83 |
nsw_caselaw:178fd5962177b5b782d5c74c:84 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 26 During the Ely test, if a patient’s bottom goes up while the knee is being bent, it indicates a tight rectus femoris muscle. It can also indicate that there is irritation at the origin of the inferior iliac spine, which can be a source of apophysitis.
27 It is evident from my letter of 21 December 2009 that I found nothing abnormal on examination, with no specific pain response. Further, it is evident from my letter of 21 December 2009 that I concluded that Ms Williams was suffering from a traction-type apophysitis of the ilio-tibial band/sartorius origin.
28 As per the letter of 21 December 2009, and my usual practice, I would have explained to Ms Williams, and her mother if present, my diagnosis in layman’s terms. While I can’t now recall the precise words I used, I would have said words to the following effect: - | 84 |
nsw_caselaw:178fd5962177b5b782d5c74c:85 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | ‘Hailee has pain arising from where the muscles arise from the anterior superior iliac spine, that is the bony prominence at the front of the hip. At her age there is a growth plate in this area that can become irritable. We call this apophysitis. Children generally grow out of this as the growth plate fuses.’
29 I did not arrange any follow up with Ms Williams after 21 December 2009.
20 June 2012
30 By a letter dated 3 June 2012, Dr Mutasim referred Ms Williams back to me for further opinion and management. A copy of Dr Mutasim’s 3 June 2012 letter is located at page 40-41 of my patient records for Ms Williams.
31 Following on from the 3 June 2012 referral by Dr Mutasim, I first saw Ms Williams on 20 June 2012. A copy of my letter back to Dr Mutasim of that date, which stands as my clinical record of the consultation, is located at page 38 of my patient records for Ms Williams. | 85 |
nsw_caselaw:178fd5962177b5b782d5c74c:86 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 32 I can’t now recall whether Ms Williams attended alone or whether her mother attended with her on 20 June 2012. Ms Williams was 18 years of age by that time and many patients of that age still attend with their parents or guardians.
33 By 20 June 2012, it was roughly 2½ years since I had last seen Ms Williams. Given the time period involved and the fact that it was a new referral, I would have treated the 20 June 2012 appointment as an initial review and thus allocated 20 minutes for it. I can’t now recall precisely how long the appointment ran for.
34 As per my usual practice, when I saw Ms Williams on 20 June 2012, I would have read the referral letter of 3 June 2012 from Dr Mutasim. I would have seen from it that he described her presenting problem as pain in the left ASIS for the last 2 months and that it was similar pain to what she had presented within 2009. | 86 |
nsw_caselaw:178fd5962177b5b782d5c74c:87 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 35 On seeing that reference to Ms Williams’ 2009 presentation, as per my usual practice, I would have read through my letter of 21 December 2009, in order to refresh my memory as to the nature of Ms Williams’ presentation at that time.
36 As per my usual practice, I would have taken a history from Ms Williams on 20 June 2012. That is, having seen that the referral from Dr Mutasim was for pain in the left ASIS for the last 2 months, I would have asked her questions to the effect of the following:
‘What symptoms do you have? Is the pain radiating anywhere? What relieves it and what aggravates it?’
37 The history I obtained is as set out in the first paragraph of my letter of 20 June 2012. I can’t now recall whether that came from Ms Williams or her mother, if she was present. | 87 |
nsw_caselaw:178fd5962177b5b782d5c74c:88 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 38 Specifically, the history I obtained was that over the last 6 months, after Ms Williams had begun working as a child care worker, she had developed recurrent pain around the front of both hips, with the pain on the left worse than the right.
39 I am aware that in her statement, Ms Williams says certain things about what occurred at the 20 June 2012 consultation. At paragraphs 84-85 of Ms Williams’ statement, she says that her mother was present on 20 June 2012 and that her mother did most of the talking to me. Ms Williams says that she recalls not speaking a lot to me.
40 As I have stated above, I can’t now recall whether Ms Williams’ mother was present on 20 June 2012. She may well have been. I also can’t now recall how much Ms Williams’ mother provided the history to me, as opposed to it coming from Ms Williams directly. | 88 |
nsw_caselaw:178fd5962177b5b782d5c74c:89 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 41 On 20 June 2012, because Ms Williams was presenting with pain at the front of the hips (bilateral ASIS pain) I would have examined her, as per my usual practice, as I have described it at paragraphs 20-26 above.
42 As per my 20 June 2012 letter, when I examined Ms Williams in 2012, I found that she had pinpoint tenderness over the bilateral ASIS, with the tenderness greater on the left than the right. That indicates that when I palpated over the ASIS, she reported pain on both sides, though the pain was worse on the left than the right.
43 Further, my 20 June 2012 letter indicates that when I examined Ms Williams prone, she described discomfort both when I hyperextended her hip and when I performed the Ely test. That discomfort is suggestive that the sartorious or quadriceps muscle is being stretched (and thus seemed to be the cause of Ms Williams’ pain). | 89 |
nsw_caselaw:178fd5962177b5b782d5c74c:90 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 44 I am aware that in her statement, Ms Williams says certain things about the examination I performed on 20 June 2012. In paragraph 91, Ms Williams describes me examining her while she was lying supine. As I have indicated above, I would have examined her lying supine as part of my usual practice. However, Ms Williams further states that she recalls lying on her back and me raising her legs up and down while they were straight. | 90 |
nsw_caselaw:178fd5962177b5b782d5c74c:91 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 45 I don’t now recall the fine details of the examination I performed on 20 June 2012, but doing straight leg raising is not part of my usual practice when it comes to examining a teenage patient presenting with ASIS pain. However, it is possible I had Ms Williams, while lying supine, lift her legs up while I pushed down against them. I sometimes do that with patients presenting with ASIS pain when I am concerned about hip pathology. If there is pain on straight leg raising while I push down, it can indicate that the pain is emanating from the hip joint or anterior to it. | 91 |
nsw_caselaw:178fd5962177b5b782d5c74c:92 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 46 I am also aware that in paragraph 92, Ms Williams says she has no picture in her mind of lying on her front (prone) during the appointment. As I have indicated above, it is my usual practice to examine the patient lying prone where a teenage patient presents with ASIS pain and my 20 June 2012 letter to Dr Mutasim confirms that I did so with Ms Williams, in that I describe hyperextension of the hip and performing the Ely test.
47 Ms Williams also says in paragraph 92 of her statement that she doesn’t have any recollection of me asking her to adjust her clothes or of removing her clothes or shoes. Ms Williams was a female patient of 18 years of age as at 20 June 2012. With such patients, I try to be conscious of their sensitivities about disrobing and I often don’t ask them to totally disrobe or even partially disrobe, unless I feel it is necessary. | 92 |
nsw_caselaw:178fd5962177b5b782d5c74c:93 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 48 Where I examine a patient as I have described examining Ms Williams above, I would not need to see the skin, so I may well not have asked her to remove her clothes or adjust her clothes.
49 I am aware that Ms Williams’ mother Meigan Williams says in her statement, at paragraph 71, that her recollection is that I did not perform a physical examination of Hailee on 20 June 2012. That is incorrect. I examined Ms Williams as I have described above and I referred to that examination in my letter to Dr Mutasim of 20 June 2012.
50 On the basis of my review of Dr Mutasim’s 3 June 2012 referral letter, my review of my earlier 21 December 2009 letter to Dr Mutasim about Ms Williams, the history I obtained from Ms Williams or about her on 20 June 2012 and my examination of her, my working diagnosis on 20 June 2012 was a recurrence of Ms Williams’ iliac apophysitis. In accordance with my usual practice, my next step on 20 June 2012 was to review Ms Williams’ imaging. | 93 |
nsw_caselaw:178fd5962177b5b782d5c74c:94 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 51 I can’t now recall specifying reviewing Ms Williams’ imaging on 20 June 2012. Further, my letter of 20 June 2012 does not specifically refer to the imaging. However, I am aware that Ms Williams (at paragraph 87 of her statement) says that she has a mental picture of handing me a large envelope from the radiologist, which contained x-ray films and what she understood to be an x-ray report. While I don’t have a specific recollection of Ms Williams handing me the imaging, patients do normally bring their imaging to consultations with me. | 94 |
nsw_caselaw:178fd5962177b5b782d5c74c:95 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 52 I am also aware that contained within my patient records for Ms Williams are copies of Dr Fraser’s report on the x-ray of the pelvis and hips dated 24 May 2012 (at page 42 of my patient records for Ms Williams) and a version of Dr Mutasim’s referral letter of 3 June 2012 which includes as part of it Dr Fraser’s report on the x-ray of the pelvis and hips of 24 May 2012 and his report on the ultrasound of both hips of 31 May 2012 (located at pages 40-41 of the patient records for Ms Williams). | 95 |
nsw_caselaw:178fd5962177b5b782d5c74c:96 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 53 That version of the referral letter from Dr Mutasim, containing Dr Fraser’s reports, has a fax header indicating that it was faxed from the Richmond Marketplace Medical Centre at 12.26pm on 20 June 2012. While I can’t now recall the specific circumstances of the fax coming in, it seems very likely that I had the imaging reports from Dr Fraser when I saw Ms Williams on 20 June 2012. As per my usual practice, I think it likely I reviewed the x-ray images of Ms Williams’ 24 May 2012 x-rays of the pelvis and hips and also read the report from Dr Fraser in respect of those x-rays and also the 31 May 2012 ultrasound of the hips.
54 I would not, as per my usual practice, have reviewed the ultrasound films of Ms Williams’ hips. My practice has always been that I don’t look at ultrasound imaging, and instead rely on the radiologist’s report, because my view is that to be clinically meaningful, you need to review the ultrasound in real time, rather than looking at static images. | 96 |
nsw_caselaw:178fd5962177b5b782d5c74c:97 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 55 While I can’t now recall my specific thought process on reviewing the x-ray films and Dr Fraser’s report on the x-ray films and ultrasound films, it is evident from my 20 June 2012 letter that I did not see anything that altered my working diagnosis of bilateral iliac apophysitis. If I had seen some particular abnormality on the x-ray images, particularly something that suggested a different diagnosis, I would have referred to it in my letter to Dr Mutasim of 20 June 2012.
56 More particularly, I did not identify a pars defect or any other defect of the spine on my review of the x-ray images. | 97 |
nsw_caselaw:178fd5962177b5b782d5c74c:98 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 57 I cannot now recall whether I identified a spina bifida occulta on reviewing the x-ray films on 20 June 2012. While my letter to Dr Mutasim of 20 June 2012 does not refer to a spina bifida occulta, it is unlikely I would have referred to the spina bifida occulta in the letter even if I saw it on my review of the x-rays. That is because my usual practice at the time, in reporting to a referring doctor regarding a patient presenting as Ms Williams did, was to regard a spina bifida occulta as an incidental finding.
58 I am aware that Ms Williams (at paragraph 87 of her statement) says that she has a recollection of me reviewing what she understood to be the x-ray report on 20 June 2012, though she has no recollection of me looking at the x-ray films on a light box. On the other hand, Meigan Williams, say that she recalls me looking at the x-rays on a light box (at paragraph 73 of her statement). | 98 |
nsw_caselaw:178fd5962177b5b782d5c74c:99 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 59 I have a light box in each of my consultation rooms. My usual practice is that wherever x-ray films are available, I review them on the light box. Consequently, on the assumption that Ms Williams on the assumption that Ms Williams or her mother gave me the x-ray images on 20 June 2012, I would, as per my usual practice, have reviewed them. That would have meant putting them on a light box and looking at them. I cannot think of any reason why I would not have looked at the x-ray images in Ms Williams’ case. | 99 |
nsw_caselaw:178fd5962177b5b782d5c74c:100 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 60 I am also aware that Ms Williams says she recalls me writing on a sheet of paper on my desk during the 20 June 2012 consultation (paragraph 87 of her statement). I refer to paragraphs 11-12 above where I have described my usual practice when it comes to dictating letters to referring doctors. I can’t now recall whether I wrote some brief handwritten notes on a blank piece of paper during the 20 June 2012 consultation. It is possible, though most often, I don’t make any handwritten notes as I dictate the letter to the referring doctor as soon as I finish the consultation. If I did make some brief handwritten notes, I would have used them as a memory aid when I dictated the letter to Dr Mutasim later on 20 June 2012 or on the following day and I would have disposed of the notes immediately after dictating the letter. | 100 |
nsw_caselaw:178fd5962177b5b782d5c74c:101 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 61 As per my letter of 20 June 2012, my conclusion on 20 June 2012 was that Ms Williams had developed a recurrence of iliac apophysitis, with it being bilateral in June 2012, whereas it had been left sided only in December 2009. Further, by June 2012, the iliac apophysitis was worse on the left than on the right.
62 Also, as per my 20 June 2012 letter to Dr Mutasim, I recommended to Ms Williams on that day that she undergo treatment in the form of injections of cortisone into the ASIS, followed by a period of at least 3 weeks’ rest.
63 I can’t now recall the precise words I used in discussing my diagnosis and recommendations as to treatment and management on 20 June 2012. Based on my usual practice in terms of how I speak to patients about pain related to iliac apophysitis and the contents of my letter, I would have said words to the following effect: | 101 |
nsw_caselaw:178fd5962177b5b782d5c74c:102 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | ‘It looks like you’ve suffered a recurrence of the condition you had back in 2009. That is, you are getting pain around the area of the pelvis where the muscles arise. I think we should try some cortisone injections and we’ll start with the left hip, where you have more pain, and see how you go after that. After the injection, you’ll need to have a minimum 3 weeks of rest, where you don’t do any strenuous activities like sports. I am hopeful that the pain will settle over time. If the pain becomes more constant, if the type of pain changes or if you experience pain at night, you should come back and see me.’
64 I am aware of what Ms Williams says I advised her on 20 June 2012. In relation to what she asserts in paragraph 93 of her statement, while I can’t recall the precise words I used, I may possibly have said words to that effect. | 102 |
nsw_caselaw:178fd5962177b5b782d5c74c:103 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 65 In relation to what Ms Williams says I discussed with her mother about cortisone injections in paragraph 94 of her statement, I can’t now recall the precise words used, but I may well have said words to the effect of those attributed to me.
66 I am aware that in her statement (at paragraph 100) Ms Williams says that I definitely did not say anything to her in June 2012 about not going to work or being on specific restricted duties and limited lifting tolerances. More particularly, I am aware that Ms Williams says that she has recently seen my letter to Dr Mutasim of 20 June 2012 and denies that I gave her advice about avoiding work or changing jobs, as per the last paragraph of the letter. | 103 |
nsw_caselaw:178fd5962177b5b782d5c74c:104 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 67 Based on the contents of my letter of 20 June 2012, the diagnosis I had arrived at of iliac apophysitis, the recommendation I made of cortisone injections and my usual practice in terms of how I speak to patients about pain related to iliac apophysitis, I think it very likely I said to Ms Williams words to the following effect:
‘Getting up and down from the squatting position and lifting kids is likely to aggravate your problem. For the time being, you should try to avoid those activities.’
68 I can’t now recall whether I said anything further specifically about changing positions or her work duties long term. Because my diagnosis as at 20 June 2012 was iliac apophysitis and I remained hopeful that it would resolve over time, I think it more likely I would have said something about avoiding particular activities for the time being, rather than about a long term change in position or work duties. | 104 |
nsw_caselaw:178fd5962177b5b782d5c74c:105 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 69 I am aware that Ms Williams alleges that by June 2012, she was experiencing pain in her back as well as pain in her hips (paragraph 77 of her statement) and further, she alleges that by June 2012, she was taking daily Voltaren and Panadol tablets at work for her back and hip pain (paragraph 83 of her statement). Further, I am aware that Ms Williams alleges that she demonstrated to me that she had pain across her lower back when she saw me on 20 June 2012 (paragraph 90 of her statement) and she also appears to raise as a possibility that she described back pain to me with words on 20 June 2012 (paragraph 90 of her statement). | 105 |
nsw_caselaw:178fd5962177b5b782d5c74c:106 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 70 Further, I am aware that Meigan Williams claims in her statement (at paragraph 69) that she said to me on 20 June 2012 words to the effect that Hailee had been suffering niggling hip and back pains off and on for a couple of years and that the hip and back pain was getting worse after she started working in childcare. She also claims (at paragraph 72 of her statement) that Hailee demonstrated to me where her back pain was. | 106 |
nsw_caselaw:178fd5962177b5b782d5c74c:107 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 71 While I can’t now recall what words Hailee Williams or Meigan Williams used on 20 June 2012 to describe Hailee’s symptoms or whether Hailee may have demonstrated the areas where she had symptoms in some manner, I am able to say what I would have done had Ms Williams or her mother described back pain or had Hailee demonstrated back pain on 20 June 2012. I had a usual practice in terms of what I would do where a teenage patient with ASIS pain complained of or demonstrated back pain, or where a parent reported back pain for the patient, which I would have followed in Ms Williams’ case. | 107 |
nsw_caselaw:178fd5962177b5b782d5c74c:108 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 72 First, if back pain was described or demonstrated to me, I would have referred to it in my letter back to her GP, Dr Mutasim, as the referring doctor. That is because back pain was a symptom that had not been referred to in the referral letter to me and I would thus have treated it as a new symptom. Further and significantly, back pain is a fairly unusual complaint in a teenage patient, and it can be indicative of a range of conditions, some benign and some serious. I would regard back pain in a patient presenting as Ms Williams did on 20 June 2012 as a matter of some significance and I would therefore have referred to it in the letter back to the referring doctor. | 108 |
nsw_caselaw:178fd5962177b5b782d5c74c:109 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 73 Secondly, if I’d received a complaint or demonstration of back pain on 20 June 2012, I would have conducted a specific examination of the whole spine. More specifically, I would have had Ms Williams stand, I would have had her adjust her clothing so that her spine was exposed, and I would have had her extend, laterally flex and rotate the lower back. I would have specifically observed her lower back looking for any evidence of muscle spasm.
74 Further, as per my usual practice, I would have palpated the lower back to see if there was a step and I would have looked at the sagittal profile of the pelvis. I would also have examined the legs looking for any evidence of tight hamstrings. | 109 |
nsw_caselaw:178fd5962177b5b782d5c74c:110 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 75 Further, as per my usual practice, I would have done a neurological examination of Ms Williams, in order to test the power and sensation in the legs. Depending on the results, I may have moved to do a more specialised neurological examination, checking her reflexes, performing a Babinski test and checking straight leg raising for any evidence of radiculopathy.
76 Finally, as per my usual practice, I would, as part of my examination, have checked Ms Williams’ abdominal reflexes in order to see if they were symmetrical (as asymmetrical reflexes can be a sign of occult intra-spinal pathology such as a syrinx). | 110 |
nsw_caselaw:178fd5962177b5b782d5c74c:111 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 77 Had Ms Williams complained of or demonstrated back pain on 20 June 2012 or had her mother described it, I would have referred in my letter back to Dr Mutasim not only to the fact of the complaint or demonstration of back pain, but to the results of my examination of her back. Even if Ms Williams’ examination of the lumber and thoracic spine was normal, I would at least have referred to the fact of the complaint of or demonstration back pain and of my examination revealing no abnormality. | 111 |
nsw_caselaw:178fd5962177b5b782d5c74c:112 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 78 Thirdly, if I’d received a complaint of or demonstration of back pain on 20 June 2012, I would have, as per my usual practice, sent Ms Williams for x-rays of the lumbo-sacral spine. In particular, I would have ordered AP/lateral/oblique views of the lumbo-sacral spine. As at 20 June 2012, I only had imaging of her hips and pelvis. In a teenage patient with back pain, I would have wanted to obtain specific imaging of the lumbo-sacral spine to see whether there may be some abnormality causing her symptoms.
79 My letter to Dr Mutasim of 20 June 2012 contains no reference to any complaint of or demonstration of back pain, no reference to any examination of the back and no reference to me referring Ms Williams off for further x-rays of the back. Because there are no such references, I say that Ms Williams did not complain of or demonstrate back pain to me on 20 June 2012 and nor did Meigan Williams describe Hailee as suffering from back pain.
22 June 2012 | 112 |
nsw_caselaw:178fd5962177b5b782d5c74c:113 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 80 I next saw Ms Williams on 22 June 2012, for the purposes of the cortisone injection into the left hip. Due to the passage of time, I can’t now recall whether Ms Williams attended on her own for this consultation or whether she also had her mother with her. I’m aware that in their statements, Ms Williams and Meigan Williams allege that Meigan Williams accompanied Ms Williams on 22 June 2012. I don’t dispute that this may be so.
81 I sent a letter to Dr Mutasim on 22 June 2012 (which is located at page 37 of my patient records for Ms Williams). In the letter, I confirmed that I injected 2 ampoules of Celestone Chronodose and local anaesthetic into Ms Williams (left) ASIS. I further noted that I was hopeful this would alleviate her symptoms satisfactorily in the next week or so and that I planned to see Ms Williams to inject the other (right) ASIS if she got a good response from the injection. | 113 |
nsw_caselaw:178fd5962177b5b782d5c74c:114 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 82 At paragraph 97 of her statement, Ms Williams sets out her recollection of a discussion she says she heard between me and her mother on 22 June 2012. Further, at paragraph 99 of her statement, she sets out her recollection of advice she says I gave her at the time of the injection. At paragraph 88 of her statement, Meigan Williams claims that I said Hailee should come back in 6 months if her pain persisted. | 114 |
nsw_caselaw:178fd5962177b5b782d5c74c:115 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 83 While I can’t now recall the precise words I used in speaking to Ms Williams and/or her mother on 22 June 2012, I don’t dispute that I may have said words to the effect of those attributed to me by Ms Williams at paragraphs 97 and 99. I think it unlikely I would have said that if Hailee’s pain persisted, she should come back to see me in 6 months, as Meigan Williams claims. Rather, I think it likely, as per my usual practice, I would have said words to the effect of: ‘If you get a good result from this injection, I’ll do an injection on the other side. Please let me know how you go. If the pain becomes more constant, if the type of pain changes or if you experience pain at night, you should come back and see me’.
2 July 2012 | 115 |
nsw_caselaw:178fd5962177b5b782d5c74c:116 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 84 At page 36 of my patient records for Ms Williams, is a copy of my 22 June 2012 letter to Dr Mutasim on which there is a handwritten annotation added. On reviewing the handwritten annotation, I recognise it as a note made by my secretary. Further, it appears to be a note of a telephone call received from Ms Williams on 2 July 2012, some 10 days after I injected her left hip with 2 ampoules of Celestone Chronodose. The handwritten annotation reads as follows:
‘2/7
PT had no relief with inj
Pt requested a M/C for work to state no lifting – or restricted lifting (if so what are they) for six months.
I can write cert if you like.
(advised her to wait a little longer for result on injection)’ | 116 |
nsw_caselaw:178fd5962177b5b782d5c74c:117 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 85 Also within my patient records for Ms Williams, at page 35, is a Medical Certificate dated 2 July 2012 filled in in my handwriting and signed by me, which I assume was provided to Ms Williams. It certifies her as fit for light duties from 2 July 2012 to 2 October 2012 on the basis of ‘Tendonitis Hips’. It also indicates a restriction on her duties in the form of ‘no lifting or repetitive squatting and lift from this position’. | 117 |
nsw_caselaw:178fd5962177b5b782d5c74c:118 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 86 While I cannot now recall being informed by my secretary of a call being received from Ms Williams on 2 July 2012 or creating the medical certificate for her, it appears, based on my review of the documents and my knowledge of the usual practice we adopted in my rooms where a patient rang up asking for a medical certificate, that Ms Williams rang up my rooms and spoke to my secretary, indicating that she had received no relief from the injection to the left hip and requesting a medical certificate for work to either exempt her from lifting or to certify her as fit for restricted lifting only. | 118 |
nsw_caselaw:178fd5962177b5b782d5c74c:119 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 87 As per the usual practice that was adopted in my rooms, I have no doubt that my secretary informed me of the call from Ms Williams, informed me that she described having received no relief from the injection and informed me that Ms Williams wanted a medical certificate for work to either exempt her from lifting or to certify her as fit for restricted lifting only. It appears from the note made by my secretary that she was unsure as what restrictions, if any, might be placed on lifting for Ms Williams and wanted to obtain my view in that regard. | 119 |
nsw_caselaw:178fd5962177b5b782d5c74c:120 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 88 Further, on review of the annotated letter of 22 June 2012 and the Medical Certificate dated 2 July 2012, I have no doubt that I told my secretary that I would write up a Medical Certificate and that I subsequently gave it to her, with a request that it be provided to Ms Williams. It also appears from the handwritten annotation on the letter that I told my secretary to convey to Ms Williams that she should wait a little longer for a result from the injection to the left hip.
89. On review of the Medical Certificate I signed on 2 July 2012, it is evident that I certified Ms Williams as being unfit for lifting or repetitive squatting for a 3 month period from 2 July 2012 and that I also certified that she was to not lift from the squatting position. | 120 |
nsw_caselaw:178fd5962177b5b782d5c74c:121 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 90 It is also evident from the Medical Certificate that I was certifying Ms Williams as fit for restricted duties on the basis of her having tendonitis of the hips. If I had been provided any information to suggest that she had back pain through the communication I had with my secretary on 2 July 2012, I would have requested that Ms Williams come in for a further review and I would have specifically referred to the back pain in her Medical Certificate. As I have stated above, back pain is a fairly unusual complaint in a teenage patient and it can be indicative of a range of conditions, some benign and some serious.
3 December 2012
91 Ms Williams returned to see me on 3 December 2012. I can’t now recall whether she attended alone or in the company of her mother. I sent Dr Mutasim a letter dated 3 December 2012 in respect of my consultation with Ms Williams on that day. A copy of the letter is located at page 34 of my patient records for Ms Williams. | 121 |
nsw_caselaw:178fd5962177b5b782d5c74c:122 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 92. When I saw Ms Williams on 3 December 2012, as per my usual practice, I would have looked at my existing records for her (looking in particular at the June 2012 records). I would have reminded myself through reviewing the earlier records that Ms Williams had had an injection of cortisone into the left ASIS on 22 June 2012. As per my usual practice, I would have asked her on 3 December 2012 how she was going. I would have asked her questions with words to the effect of ‘how are your hips? Did you get any relief from the injection?’
93 It is evident from the contents of my 3 December 2012 letter that Ms Williams told me (or possibly her mother told me, if she was present) that her hip pain had not completely settled despite the injection of cortisone and further, that she had obtained about a month’s relief. | 122 |
nsw_caselaw:178fd5962177b5b782d5c74c:123 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 94 I am aware that Ms Williams alleges, at paragraph 117 of her statement, that she said to me words to the effect of ‘my pain has not gone away, it’s in the same places as before and it’s much worse’. Further, I am aware that in her statement, at paragraph 97, Meigan Williams sets out a conversation that she says she vaguely recalls occurring on 3 December 2012, in which she says she told me that Hailee’s pain was getting worse and affecting her life and work. | 123 |
nsw_caselaw:178fd5962177b5b782d5c74c:124 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 95 I can’t now recall Ms Williams using words to the effect she alleges in paragraph 117 of her statement or Meigan Williams using words to the effect she alleges in paragraph 97 of her statement. If I had been told that Ms Williams’ pain was much worse than it had been previously, or that it was getting worse and was affecting her life and work, then as per my usual practice, I would have recorded those matters in my letter to Dr Mutasim. Further, I would not have described Ms Williams’ pain as not having settled completely or her having obtained approximately a month’s relief from it in the letter to Dr Mutasim. In light of the contents of my letter to Dr Mutasim of 3 December 2012, I deny that Ms Williams or her mother used words to the effect of what they allege in their respective statements. | 124 |
nsw_caselaw:178fd5962177b5b782d5c74c:125 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 96 In the plaintiff’s statement, she does not specifically allege that she said to me on 3 December 2012 that she had back pain, though she seems to raise it as a possibility. She also says, in paragraph 119 of her statement, that she may have demonstrated to me where the pain was (including in the back) by using her hands.
97 If Ms Williams had described back pain to me or demonstrated it to me on 3 December 2012, then I would have taken certain steps, as per my usual practice, as described at paragraphs 71-78 above.
98 My letter to Dr Mutasim of 3 December 2012 contains no reference to any complaint of or demonstration of back pain, no reference to any examination of the back and no reference to me referring Ms Williams off for further x-rays of the back. Because there are no such references, I say that Ms Williams did not complain of or demonstrate back pain to me on 3 December 2012 and nor did Meigan Williams describe Hailee as suffering from back pain. | 125 |
nsw_caselaw:178fd5962177b5b782d5c74c:126 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 99 I can’t now recall whether I physically examined Ms Williams on 3 December 2012. While it is my usual practice to conduct a physical examination when a patient comes to see me, the 3 December 2012 consultation was a follow up after a specific mode of treatment I had employed when I last saw Ms Williams (on 22 June 2012). I was focused on how Ms Williams had done since I had performed the left hip injection and it is evident that Ms Williams informed me that she had only obtained limited relief. In circumstances where I was still unsure of the diagnosis and was considering further investigations (which I will refer to further below), I may not have conducted a physical examination on 3 December 2012. | 126 |
nsw_caselaw:178fd5962177b5b782d5c74c:127 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 100 As per my 3 December 2012 letter to Dr Mutasim, I recommended to Ms Williams that she have an MRI scan of the left hip. I was aware in December 2012 that teenage patients can have a number of conditions causing hip pain and Ms Williams’ hip symptoms had persisted for some time if she was suffering from iliac apophysitis. As per my usual practice, I would have organised the MRI scan to see if there was some evidence of a hip condition other than iliac apophysitis that might explain the pain.
101 As per my 3 December 2012 letter to Dr Mutasim, I planned to review Ms Williams once the MRI results were available in order to advise regarding further management. | 127 |
nsw_caselaw:178fd5962177b5b782d5c74c:128 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 102 I am aware that at paragraph 122 of her statement, Ms Williams claims that I said certain things to her at this appointment. While I can’t now recall the words I used in advising Ms Williams, I accept I may have said words to the effect of those set out in paragraphs 122(a) and (c). I deny that I said words to the effect of those set out in paragraph 122(b). That is because the growth plates in the hip would have fused when Ms Williams was younger and I would not have been suggesting to her that her symptoms as at 3 December 2012 reflected a problem with the growth plates in the hip. To my knowledge, the apophysis takes longer to fuse than the hip joint growth plates and I accept that I may possibly have said something about Ms Williams’ hip pain being due to the muscle attached to the apophysis (or growth plate) causing irritation. | 128 |
nsw_caselaw:178fd5962177b5b782d5c74c:129 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 103 In all of the circumstances and as per my usual practice, I think it is likely I said to Ms Williams words to the effect of ‘while I’m hoping you will grow out of your pain and it is due to apophysitis, I recommend you have a MRI scan of the left hip to see if there is something else going on to cause the pain’.
104 In paragraph 125 of her statement, Ms Williams sets out a conversation that she says occurred on 3 December 2012, leading to me suggesting that she try physiotherapy. I can’t now recall the specific discussions I had with Ms Williams and/or her mother or the specific circumstances that led to the referral to physiotherapy. It is possible I had a discussion to the effect of that attributed to me by Ms Williams. | 129 |
nsw_caselaw:178fd5962177b5b782d5c74c:130 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 105 It is not part of my usual practice to refer teenage patients with ASIS pain for physiotherapy where I am unsure of the diagnosis (as I was with Ms Williams on 3 December 2012). However, in her case, while I was unsure of her diagnosis, it is evident from my patient records for Ms Williams that I was not contemplating the diagnosis of any condition that would raise a risk of harm through Ms Williams undergoing physiotherapy. It is evident from my various letters and the investigations I undertook that as at 3 December 2012, I was still wondering whether her symptoms may be due to being tight in the hip flexors and hip abductors. On that basis, a stretching program may have provided her with some benefit. | 130 |
nsw_caselaw:178fd5962177b5b782d5c74c:131 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 106 At paragraph 128 of her statement, Ms Williams describes forming an impression at this consultation that I was going through things very quickly and wanted Ms Williams to hurry up. While I can’t recall the specific details of the 3 December 2012 consultation, my usual practice is to take as long with patients as is required given their clinical circumstances. I deny rushing the consultation and say that if the appointment on 3 December 2012 clinically required that I spend more time than the 10 minutes I would have allotted (for a follow up consultation), then I would have taken longer. | 131 |
nsw_caselaw:178fd5962177b5b782d5c74c:132 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 107 Also on 3 December 2012, I completed a referral to O’Neill Physiotherapy, signed it and gave it to Ms Williams. As at December 2012, I had a supply of physiotherapy referral forms for a small number of physiotherapists, including O’Neill Physiotherapy, in my rooms. While I did not retain a copy of the physiotherapy referral form for Ms Williams in my patient record for her, I have been informed by my solicitors that a copy is located in Mr Seabury’s records for Ms Williams and I have reviewed it. I recognise it as containing my writing and signature. A copy of the 3 December 2012 referral is annexed to this statement and marked with the letter ‘C’.” [Emphasis added at 55 and 56]
76. Dr Stening’s letter reporting to Dr Mutasim on 3 December 2012 is in these terms:
“Unfortunately, Hailee’s hip pain did not settle completely despite the injections of cortisone into the anterior superior iliac spine regions. She had approximately a month’s relief. | 132 |
nsw_caselaw:178fd5962177b5b782d5c74c:133 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | I’ve recommended she now proceed to an MRI scan of her left hip. The findings will be similar on the right side I’m sure.
I’ll review her with the results and advise regard [sic] further management.”
77. Hailee Williams underwent the MRI scan foreshadowed in that letter on 12 December 2012. Dr Stephen Morris reported the results to Dr Stening as follows:
“MRI LEFT HIP
Clinical history: Complains of anterior hip pain,? labral tear,? ASIS tendinosis.
Technique: Non-contrast MRI of the left hip.
Findings: The gluteus medius and minimus tendons are normal at the trochanteric attachment. No trochanteric bursitis. The hip flexors proximal hamstring and adductor origins are intact. No abnormality along the ASIS is seen. The rectus femoris is normal.
No joint effusion is seen. No fracture or osteonecrosis. No synovitis. Chondral thickness is maintained. No labral tear.
COMMENT | 133 |
nsw_caselaw:178fd5962177b5b782d5c74c:134 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | Normal study. There is no evidence of a labral tear. No tendinosis at the ASIS is seen.” | 134 |
nsw_caselaw:178fd5962177b5b782d5c74c:135 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | Cross-examination of Dr Stening
78. Dr Stening was asked about Hailee Williams’ later detected pars defect:
“Q. Now, you've said in your statement that had you been informed that there was a right sided pars defect, your treatment of this young woman would have been different; do you recall saying that?
A. Yes.
Q. And to that extent, had that been reported to you, that would have been critically important information for you, wouldn't it?
A. Yes. Yes, definitely.
Q. And is that because regardless of whether she complained of pain or not, you would be keen to determine whether she had either spondylosis or spondylolisthesis?
A. Yes, with a pars defect, aside from well, it needs to be monitored, essentially, or it needs to be identified and clarified as to the exact nature of the pars defect, yes.
Q. But it also helps inform you of your clinical decisions, doesn't it, and your clinical management?
A. Yes, yes. | 135 |
nsw_caselaw:178fd5962177b5b782d5c74c:136 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | Q. And it's one of those things that it helps you provide advice to the patient as to what activities he or she ought to engage in and what activities he or she should not engage in; do you accept that?
A. Yes. Yes, definitely.
Q. And if you had the pars defect reported to you, you would have told - and this is at this consultation on 20 June 2012 - can you suggest you would have done a number of things, and to that extent can I take you to page 51 of your report your statement.
A. Yep.
Q. The first thing is you would not have sent a report like that to Dr Mutasim, would you?
A. No.
Q. And what you would have done, just looking at that report, is you would have turned your mind to the clinical history contained in that report, specifically in the second sentence that over the last six months she has started working as a childcare worker; do you see that?
A. Yes. | 136 |
nsw_caselaw:178fd5962177b5b782d5c74c:137 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | Q. And that in that six-month period with the commencement of that work, that had corresponded to developing recurrent pain.
A. Yes. Yes.
Q. And that that pain was developing around the anterior aspect of both hips, left worse than the right; do you see that?
A. Yeah, yep.
Q. And you would have formed a view, can I suggest, that she might have been suffering from two conditions, that is spondylolisthesis symptoms or ASIS pain, or both?
A. Yes, I could have formed the view that, if I was aware that there was a pars defect, that the pain was referred from the back.”
79. That evidence was followed shortly after with these questions and answers:
“Q. Dr Stening, before lunch I was taking you to page 51 and we were saying, just by way of summary, that you'd agreed with me, I think that had you been told about the pars defect on the X-ray, you would have proffered a very different letter of advice to Dr Mutasim, is that correct?
A. That's correct. | 137 |
nsw_caselaw:178fd5962177b5b782d5c74c:138 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | Q. And one of the features, can I suggest, that would have struck you, is the history that you'd taken or recorded in your letter, that the plaintiff had started working in childcare and associated with that was the development of pain around both hips.
A. Yes. But in my letter, which I have in front of me, at that time I attributed it to her repetitively squatting and you know, getting up and down with her role as a childcare worker. And attributed that more to the ASIS.
Q. I understand. But one of the issues is that if she had the pars defect and she was engaged in heavy lifted and repeated lifting like this, she was at risk of experiencing lumbar pain, wasn't she?
A. It was more likely to aggravate lumbar pain, yes. | 138 |
nsw_caselaw:178fd5962177b5b782d5c74c:139 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | Q. And not only that, but if the spondylolisthesis was of a low grade, that is it hadn't yet slipped, if she engaged in heavy or repeated lifting or contact sports or that sort of thing, that sort of activity could give rise to the triggering of a slip, couldn't it?
A. I'm not exactly aware of what duties involved with childcare work. But generally, more vigorous activity, particularly as you mentioned with sports, are likely to aggravate a slip.
Q. And when we talk about vigorous activity, let's put aside the contact sports and so forth. Repeated lifting of items off the floor, or of objects or children off the floor would have been a significant matter that could have triggered a slip, wouldn't it?
A. Well, we're thinking activity where you're flexing and extending the lower spine. If there's a condition in the lower spine, then yes, it's likely to aggravate it. | 139 |
nsw_caselaw:178fd5962177b5b782d5c74c:140 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | Q. But not only when you say aggravating the condition, if it's spondylolisthesis, we're talking it could trigger a slip which hadn't previously been there, do you agree?
A. Spondylolisthesis refers to the slip itself as in you start to see a slip on the X-ray but if there's just an isolated pars defect without actual slippage having occurred, you will get pain in the lower back and that's the aggravation that
would occur. As to whether it triggers the slip to progress, I can't say for certain whether that would be the case.
Q. But that would be a possible risk, wouldn't it?
A. It's possible I guess, yes, or it could be a natural progression of the condition.”
80. Dr Stening agreed that if he had been told about the pars defect, it was the very information that he would have included in his letter to Dr Mutasim on 20 June 2012.
81. Dr Stening was then cross-examined on the following important topic: | 140 |
nsw_caselaw:178fd5962177b5b782d5c74c:141 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | “Q. The requirement for a three-month review and clinical assessment is in part reflective of one aspect and that is that young lady may still have had an immature skeletal process at that level, you agree?
A. It's primarily to be sure that the slip is not progressing rapidly.
Q. When you look at the X-rays at three monthly intervals to look for progression, this would be important to see, and I suggest a couple of things, one is to see whether there's any movement in the L5 process relative to S1?
A. Yeah, that's correct. That's sort of been one progression of the slip, yes.
Q. That may or may not be associated with any signs of symptoms?
A. Yes. That may be - well, it may not be associated with any symptoms such as nerve root irritation but there could be symptoms still of back pain for instance. | 141 |
nsw_caselaw:178fd5962177b5b782d5c74c:142 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | Q. But are there also circumstances in which you can have a progression of a slip with only mild or intermittent back pain which is due to muscular ligamentous strain?
A. I think so. Yes, possibly.
Q. So that slip may be, for all intents and purposes, asymptomatic or only partially symptomatic?
A. Yes, correct. It's possible.
Q. It may not give rise to any actual - I mean apart from directing or advising the patient to avoid contact sports or heavy lifting or repeated lifting and to try and obtain perhaps sedentary employment, they may still be able to engage in all their ordinary domestic and employment duties with very limited disability. Is that correct?
A. That's possible, yes.
Q. One of the other things you'd be able to determine on regular radiological view is any evidence of desiccation or intervertebral disc compression, correct? | 142 |
nsw_caselaw:178fd5962177b5b782d5c74c:143 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | A. On plain X-rays, if you're referring you know to regular radiological review, you wouldn't necessarily see any disc herniation. You may - I mean but you may see assistant or some narrowing of the disc space.
Q. That would those serial X-rays and so forth would be able to enable you to give further advice to the patient about any further exercise or core strengthening or physiotherapy they should be undertaking, correct?
A. The core strengthening is an important component of trying to minimise any back pain and potential progression but if the serial X-rays showed that there was suddenly starting to be a rapid slip well then you would be concerned that you would have to refer off to a spinal surgeon quite, you know very promptly.
Q. Yes, I understand. Because there's a risk…
A. Yes, that's right.
Q. … that it could progress quickly?
A. Exactly, yes. | 143 |
nsw_caselaw:178fd5962177b5b782d5c74c:144 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | Q. The other thing is if you've got a series of X-rays at three monthly intervals that would enable you to be able to give advice to the patient as to what was actually going on with the patient and provide them with the opportunity to make an informed decision about surgery. Correct?
A. I think so. If, yeah, if you were I mean bearing in mind I would not be doing the surgery and you know some specialist would have been giving that information about the risks of the surgical procedure, et cetera.
Q. And it's one of those things that surgery is really the last resort with back conditions isn't it?
A. Yes, surgery is the - is designed to stop the slip from progressing further and potentially reducing the slip although it's my understanding it's difficult. It's difficult surgery to reduce it accurately and yes, it's designed to minimise that risk of deterioration and neurological function. | 144 |
nsw_caselaw:178fd5962177b5b782d5c74c:145 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | Q. If the alternative is that the progressive X- rays demonstrate that there is no progression of the slip but the problem is compression on the intervertebral disc giving rise to radiculopathy then that might give rise to a very different surgical recommendation. Do you agree with that?
A. If yeah, I mean if the disc was causing pressure on the nerve root and that pain couldn't be resolved then, yes, it's possible that surgery would need to be performed to take pressure off the nerve root.
Q. But when it's talk about not being able to resolve it, the first course, even if you had radiculopathy would be to try and ensure that a program of conservative management would have taken place. Do you agree?
A. Yes.
Q. Non operative management?
A. Yes, definitely.
Q. Including avoiding any aggravating activity?
A. That's part of the way of minimising symptoms, yes, exactly.” | 145 |
nsw_caselaw:178fd5962177b5b782d5c74c:146 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 82. Dr Stening agreed with the following matters upon which Hailee Williams relies:
“Q. … It's the case though that either through your experience or through your knowledge, that non-operative measures such as refraining from repeating of loading of the spine through repeat of flexion and extension and also core strengthening can often give rise to a resolution of symptoms.
A. Yes, that's correct.
Q. And it can often mean that there's a sufficient resolution of symptoms, not to prove a disability in the ordinary activities of daily living for the patient, correct.
A. Yeah, that's correct.
Q. And it can even defer [sic, divert] a person away from surgery as a solution to their problem, do you agree with that?
A. It can. It can be the main stay of treatment. Yes.”
83. It was part of Hailee Williams’ case that she had demonstrated the location of her back pain for Dr Stening. He was asked about that: | 146 |
nsw_caselaw:178fd5962177b5b782d5c74c:147 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | “Q. Look, Hailee says that you asked her to describe where the pain was and she stood up and she showed you by pointing, and I would like to take you to page 53 and 54. Do you see those paragraphs?
A. Yep. Yes, I can see those.
Q. Now, what do you say to the suggestion that you asked her to show you where the pain was and she indicated with her hands in that manner, do you say that took place or it didn't?
A. I have no recollection of that taking place and with regard that, clearly she has her hands on her back as well as over her anterior superior iliac spine, the ASIS region, and that would indicate that she's pointing to the lower back, and that would have definitely been a red flag to me if she had have pointed in that you know, to that area. That would have concerned me.” | 147 |
nsw_caselaw:178fd5962177b5b782d5c74c:148 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 84. Dr Stening relied upon the fact that it would have concerned him as support for his total absence of any recollection of it occurring. He insisted that if Hailee Williams had complained of pain in her back, and given a demonstration of the type she described, he “would have undertaken a completely different medical assessment”.
85. Dr Stening not unreasonably had little, if any, recollection of the details of his first consultation with Hailee Williams and her mother to which they both referred in their evidence. It is apparent that Dr Stening was reliant upon the terms of Dr Mutasim’s referral for much of what he could recall. I sought to clarify that position by asking him the following question in those circumstances: | 148 |
nsw_caselaw:178fd5962177b5b782d5c74c:149 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | “Q. Just out of interest, Doctor, it may be quite reasonable in the circumstances but is it fair to say that your only accurate recollection of anything that took place at this consultation is what is reflected in your letter to the GP or do you have an independent recollection of anything that occurred at that time to which there's no specific reference either in terms or by implication?
A. I don't have any recollection of anything other than what is outlined in my letter to the GP.”
86. With further reference to the specifics of any possible physical examination he might have conducted, Dr Stening said this:
“Q. Let me put the question to you. Hailee Williams has indicated that she recalls you lifting her leg straight, each leg straight, one after the other as she was lying face up, right?
A. Yes.
Q. To that extent, given your usual practice, that could have been a result of you examining her because of a complaint of back pain, couldn't it? | 149 |
nsw_caselaw:178fd5962177b5b782d5c74c:150 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | A. If she complained of back pain and I was trying to elicit if there was any history of neurological problems, then yes, I could have done that.
Q. If that was about the usual practice in the event of a complaint of back pain, right, is it possible do you think, doctor, that in fact you did receive a complaint of back pain, performed the tests, did not find any satisfactory evidence of back pain and then did not include it in your letter?
A. No, I think that's unlikely. Because if I had examined a patient for a spinal exam or an exam for back pain I would have, even if I thought that all the findings were normal and I didn't elicit any you know signs of irritation or whatever that might indicate something was going on, I would have conveyed that as a positive finding in my medical records to exclude pathology. So I would have used that, I would have mentioned that in my letter because it is a although something is normal it is also a positive finding for excluding diagnoses.” | 150 |
nsw_caselaw:178fd5962177b5b782d5c74c:151 | nsw_caselaw:178fd5962177b5b782d5c74c | decision | new_south_wales | nsw_caselaw | text/html | 2021-05-20 00:00:00 | Williams v Fraser [2021] NSWSC 416 | https://www.caselaw.nsw.gov.au/decision/178fd5962177b5b782d5c74c | 2024-05-26T15:06:20.551301+10:00 | 87. Dr Stening agreed that if he had come to a view that Hailee Williams had no back pathology and he had been looking for it, it is improbable that he would not have referred to it. That is because it would have been an important positive finding upon which to report to the referring doctor.
88. Dr Stening agreed that there was an inconsistency between the restrictions placed upon Hailee Williams in the medical certificate for restricted duties that he later provided and the terms of his letter to Dr Mutasim:
“Q. Do you see any inconsistency between the medical certificate you gave on 2 July and the advice you were giving Dr Mutasim in that letter?
A. Yes. Well the inconsistency, it would be that - to move from her current duties.”
89. Dr Stening agreed that Hailee Williams needed to get away from repetitively lifting children. | 151 |
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