_id
stringlengths 38
41
| version_id
stringlengths 36
36
| type
stringclasses 1
value | jurisdiction
stringclasses 1
value | source
stringclasses 1
value | mime
stringclasses 2
values | date
stringlengths 19
19
| citation
stringlengths 21
1.02k
| url
stringlengths 61
64
| when_scraped
stringlengths 32
32
| text
stringlengths 1
1.02k
| chunk_index
int64 0
3.72k
|
|---|---|---|---|---|---|---|---|---|---|---|---|
nsw_caselaw:178fd5962177b5b782d5c74c:252 | 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 | “DOWNING: But it's correct, isn't it, that nowhere in your answer to question 9, which specifically directed you to the assumption that she would be having conservative management, did you qualify your answer, as set out in 9.1, to suggest that conservative management would have halted the progression and avoided surgery?
WITNESS SEKEL: Well, it wasn't discussed.
DOWNING: You understood what you were answering in 9.1, didn't you?
WITNESS SEKEL: It wasn't discussed.
DOWNING: But Dr Sekel, you understood that - you had read the questions, I take it?
WITNESS SEKEL: Yes, of course I did.
DOWNING: And you understood - read the question now, that what it was asking was--
WITNESS SEKEL: ‘Is it likely she would have come to surgery?’ | 252 |
nsw_caselaw:178fd5962177b5b782d5c74c:253 | 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 | DOWNING: No, start at the beginning, please, at question 9. That is, ‘In your view, if she had been diagnosed with the spondylolisthesis in June or December 2012, and treated for it as per 7(a) and 7(b)’, that is, the conservative management that I've already taken you to?
WITNESS SEKEL: Right. Yes.
DOWNING: ‘Is it likely she would have come to surgery, and if so, what sort’, and your unqualified answer to question 9.1 was, ‘Yes, it is likely that the plaintiff would still have come to surgery in any event, that is, on the assumption she was conservatively managed’?
WITNESS SEKEL: Yes, because that - I would have taken into consideration what happened to her next, not just on that one point in time. | 253 |
nsw_caselaw:178fd5962177b5b782d5c74c:254 | 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 | DOWNING: Dr Sekel, that - the question didn't direct you to that, did it? It directed you to specifically assume she was conservatively managed, as you've specified in the answer to question 7 she would have been, and to express a view as to whether she would still have come to surgery, and your unqualified response, along with all of the other experts was that, ‘Yes, she would still have come to surgery’?
WITNESS SEKEL: Yes.
DOWNING: You've changed tack from then to now, haven't you?
WITNESS SEKEL: I don't - I don't see where. I might be a bit thick.
DOWNING: You now say that if, in fact, she had been diagnosed at those times, and she'd been conservatively managed, you take the view that she would have avoided surgery?
WITNESS SEKEL: Statistically, yes.
DOWNING: You say statistically, that is, by reference to the body of literature about the different forms of spondylolisthesis?
WITNESS SEKEL: For dysplastic spondylolisthesis. Yes. | 254 |
nsw_caselaw:178fd5962177b5b782d5c74c:255 | 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 | DOWNING: What I'm suggesting to you is that the view you expressed then, with the knowledge of a type of spondylolisthesis she had, that conservative management was unlikely to prevent her ultimately coming to surgery?
WITNESS SEKEL: (No verbal reply)
HIS HONOUR: You'll need to respond, Dr Sekel.
WITNESS SEKEL: I'm sorry. You're asking me to answer that?
DOWNING: Yes?
WITNESS SEKEL: What was the question again, sorry?
DOWNING: What I'm suggesting is that you have changed your position from then to now.
WITNESS SEKEL: Yes.
DOWNING: And you say--
WITNESS SEKEL: From just - from just - well, the answer's yes.
DOWNING: And you say that the justification for that is the statistics in respect of dysplastic spondylolisthesis?
WITNESS SEKEL: Yes.
DOWNING: They were statistics that were known to you then, weren't they?
WITNESS SEKEL: Yes.” | 255 |
nsw_caselaw:178fd5962177b5b782d5c74c:256 | 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 | 202. Dr Fraser contended that Dr Sekel’s reliance upon statistics was an inferior substitute for specific reference to Hailee Williams’ clinical presentation and circumstances. Moreover, Dr Fraser submitted that Dr Sekel’s change of position on what is a critical issue in these proceedings “does him no credit”. Dr Fraser submitted that I could have “very little confidence” in Dr Sekel’s views that conservative management would have averted surgery in this case. | 256 |
nsw_caselaw:178fd5962177b5b782d5c74c:257 | 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 | 203. Dr Drnda was similarly challenged. In his report dated 7 November 2019, he said that a reasonable practitioner who was aware of Hailee Williams’ lumbosacral spinal problem in June 2012 would have advised her to avoid work that involved repetitive bending, twisting, lifting and carrying heavy items and to avoid contact sports like netball, basketball, martial arts or anything that involved running and jumping. He then expressed the view that, on the balance of probabilities, if that advice had been heeded, there “would be a significant possibility that [she] would stabilise at a certain level of back discomfort and avoid progression of her listhesis”. [Emphasis added]
204. Dr Drnda was cross-examined about that view:
“DOWNING: You have your report now.
WITNESS DRNDA: Yes.
DOWNING: Page 11 of 19, right at the top. | 257 |
nsw_caselaw:178fd5962177b5b782d5c74c:258 | 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 | WITNESS DRNDA: Okay. Had advice been given in C above and the plaintiff had followed that advice, then on the balance of probabilities, what was the likely cause of the plaintiff’s condition? Yes, I understand the significant possibility the plaintiff would stabilise a certain level of back discomfort and avoid progression of her listhesis.
DOWNING: And you read the question carefully.
WITNESS DRNDA: Yes.
DOWNING: And you chose your words in answering the question carefully.
WITNESS DRNDA: Yes. Yes, what was the question?
DOWNING: That was the question.” [Emphasis added]
205. Dr Drnda had earlier given the following response to questions from Mr Morris about the same issue: | 258 |
nsw_caselaw:178fd5962177b5b782d5c74c:259 | 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 | “WITNESS DRNDA: I agree partially with everyone. But I believe that Hailee Williams in June 2012 was probably grade two, not high grade and if conservative management, as it was outlined was instituted, she would have very good chance to remain in the same level and not to deteriorate in February. When she had MRI scan May - I think May, so a year later roughly. Scans showed depending how you measure it, how precise you are, it was borderline between two or three you can - instead late two early three. But not more than that. So, I cannot accept that she was in June 2012 grade three. She must have been grade two. And because there was no treatment - appropriate treatment instituted, she deteriorated over eight months. So, February 13 when she developed signs of, developed symptoms of irritation to nerve root. So, conservative management in my opinion, including avoidance of physical strain that she had at work, so basically leaving work, looking for alternative work, looking alternative sport | 259 |
nsw_caselaw:178fd5962177b5b782d5c74c:260 | 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 | activities, prefer swimming than anything else, would possibly lead or very likely, more likely than not, lead to stabilisation at the level that she was. And more likely than not she would avoid surgery. Because there was no treatment - appropriate treatment until February 2013, she deteriorated, she got worse and then she tipped over the point where she was then heading towards the surgery. [Emphasis added] | 260 |
nsw_caselaw:178fd5962177b5b782d5c74c:261 | 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 | 206. Dr Fraser’s submissions emphasised the italicised words, suggesting that there was an element of Dr Drnda checking himself when he used the language of possibility rather than probability, which Dr Fraser submitted was a matter of significance that Dr Drnda appreciated. He submitted that on Dr Drnda’s views, Hailee Williams could prove no more than that she lost a chance of avoiding surgery through conservative management, and failed therefore to satisfy the civil burden: see, for example, Tabet v Gett at [67] –[69] as follows:
“67 In this case, saying that a chance of a better medical outcome was lost presupposes that it was not demonstrated that the respondent's negligence had caused any difference in the appellant's state of health. That is, it was not demonstrated that the respondent's negligence was probably a cause of any part of the appellant's brain damage. | 261 |
nsw_caselaw:178fd5962177b5b782d5c74c:262 | 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 As Gummow ACJ explains, to accept that the appellant's loss of a chance of a better medical outcome was a form of actionable damage would shift the balance hitherto struck in the law of negligence between the competing interests of claimants and defendants. That step should not be taken. The respondent should not be held liable where what is said to have been lost was the possibility (as distinct from probability) that the brain damage suffered by the appellant would have been less severe than it was. | 262 |
nsw_caselaw:178fd5962177b5b782d5c74c:263 | 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 It may be that other cases in which it might be said that, as a result of medical negligence, a patient has lost ‘the chance of a better medical outcome’ (for example, a diminution in life expectancy) differ from the present case in significant respects. These are not matters that need be further examined in this case. It need only be observed that the language of loss of chance should not be permitted to obscure the need to identify whether a plaintiff has proved that the defendant's negligence was more probably than not a cause of damage (in the sense of detrimental difference). The language of possibilities (language that underlies the notion of loss of chance) should not be permitted to obscure the need to consider whether the possible adverse outcome has in fact come home, or will more probably than not do so.” | 263 |
nsw_caselaw:178fd5962177b5b782d5c74c:264 | 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 | 207. In that case, the injured plaintiff was unable to prove that it was probable that the brain damage that he sustained would have been avoided if treatment with corticosteroids had been undertaken earlier. The evidence was insufficient to be persuasive. Dr Fraser maintains in like fashion that Dr Sekel’s reliance upon statistics, associated with his change of opinion, and Dr Drnda’s initial reference only to a significant possibility, were not sufficient to establish that in this case Hailee Williams would have avoided surgery even if appropriately treated. | 264 |
nsw_caselaw:178fd5962177b5b782d5c74c:265 | 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 | 208. Secondly, Dr Fraser submitted that Hailee Williams had several idiosyncratic characteristics that put her at a significantly increased risk of suffering a slip progression in her spondylolisthesis and the consequent need for surgery to address it. These included the trapezoidal shape of her L5 vertebra and the dome shape of her sacrum, significant hypoplastic deficiencies in her facet joints which meant that forward slip of L5 on S1 was not adequately prevented and the fact that Hailee Williams was skeletally mature as at 24 May 2012.
209. Dr Earwaker was also cross-examined about this area as follows:
“DOWNING: Just following up on what you've just said. When one looks at all of the different factors in respect of the plaintiff's spinal anatomy you identify one factor that would be protective against there being a problem with a slip but a number that suggests that there was a real risk of slip. Is that a fair summary?
WITNESS EARWAKER: Yeah, that's a fair summary. | 265 |
nsw_caselaw:178fd5962177b5b782d5c74c:266 | 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 | DOWNING: So that even if you'd identified this at an early age, you would have already been concerned that there may well be progress of slip and a need for surgery?
WITNESS EARWAKER: Yeah.”
210. Some things described by Dr Earwaker in his 27 February 2018 report should also be noted at this point. Dr Earwaker referred to the 11 June 2013 X-ray findings of Hailee Williams’ lumbosacral spine as follows:
“There is a Grade 3 Spondylolisthesis of L5 on S1.
The sacrum is dome-shaped and the L5 vertebral body has a trapezoidal configuration consistent with the presence of a high-grade slip. There is severe narrowing of the L5-S1 disc space consistent with secondary disc degeneration. The intervertebral foramina also appear to be compromised.
Impression:
Congenital/Dysplastic Grade 3 L5-S1 Spondylolisthesis…” | 266 |
nsw_caselaw:178fd5962177b5b782d5c74c:267 | 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 | 211. Dr Earwaker noted that Hailee Williams suffers from the congenital, otherwise known as dysplastic, form of spondylolisthesis: it has been present since birth. He then said this:
“In the case of [Hailee Williams] the L5 neural arch is severely dysplastic; the right side being more underdeveloped than the left side. There is a consequent congenital anomaly of the lumbosacral articulation with facet joints (particularly in this case) which do not buttress the forward slip of L5 on S1. The pars interarticularis is usually poorly developed. Invariably the malformed elements which constitute the laminae fail to fuse midline. Dysplastic spondylolisthesis is associated with lumbo-sacral spinal instability.” | 267 |
nsw_caselaw:178fd5962177b5b782d5c74c:268 | 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 | 212. Dr Fraser submitted that having regard to this and other material, the evidence strongly supported a finding that Hailee Williams’ degree of slip was very likely unchanged or only marginally changed, between 20 June 2012 when she saw Dr Stening and 13 June 2013, when she underwent surgery. Dr Fraser’s proposition is that Hailee Williams’ condition in June 2012 was such that she was at that time inevitably destined to come to surgery and that the delay in that occurring until June 2013 did not make any difference. The degree of her slip of L5 on S1 did not materially change during that time and conservative management of her condition would have made little, if indeed any, difference at all. | 268 |
nsw_caselaw:178fd5962177b5b782d5c74c:269 | 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 | 213. Thirdly, Dr Fraser submitted that the evidence given by Hailee Williams’ experts after considering her clinical circumstances in the critical period between June 2012 and June 2013 indicated that “there is even more reason to prefer the view of the defendants’ experts”. It was contended that Dr Sekel appears to have accepted that because of all of Hailee Williams’ predisposing congenital factors, the prospects of her avoiding surgery through conservative management “could be put at no higher than a chance”:
“DOWNING: Would you agree that in all - and again I'm directing this to you, Dr Sekel. Would you agree that in all of the plaintiff's circumstances she was congenitally one of the patients who was at significantly increased risk of slip progression?
WITNESS SEKEL: Yes.
DOWNING: That is even there had been a diagnosis of the slip earlier, that is in mid-2012 and you tried to conservatively manage her, she still faces that risk?
WITNESS SEKEL: Yes, it's a proportion. | 269 |
nsw_caselaw:178fd5962177b5b782d5c74c:270 | 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 | DOWNING: What I'm suggesting to you, and you can agree or disagree, is that while there was a chance you might have been able to prevent her progressing to surgery and in particular the progression of her radicular symptoms you could put it no better than that, being a chance?
WITNESS SEKEL: That's correct. But not inevitable.
HIS HONOUR: Sorry, I didn't quite follow. What's not inevitable?
WITNESS SEKEL: That she would end up progressing and having radicular symptoms needing surgery - progressing to the stage where she needed surgery and developed radicular symptoms, it was not inevitable.
DOWNING: Would you also agree that the spondylolisthesis in her case had been there and would have been affected by her day to day activity throughout her childhood?
WITNESS SEKEL: Yes.
DOWNING: Especially during the period of pubertal growth?
WITNESS SEKEL: Yes.” | 270 |
nsw_caselaw:178fd5962177b5b782d5c74c:271 | 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 | 214. Dr Fraser argued that when regard is had to Hailee Williams’ documented activities between April 2012 until May 2013, there was no more than a small chance she would have avoided surgery if her condition had been accurately diagnosed and she had been restricted in her activities through conservative management. Dr Sekel agreed with this:
“DOWNING: What I want to suggest is that if you accept that they were her actual activities, the proposition that by sending her to conservative management and her being managed in the way you’ve described. The proposition that that would have made all the difference for surgery is no more than a small chance.
WITNESS SEKEL: Yes, if that’s all she did.”
215. Dr Drnda agreed:
“DOWNING: And do you agree with his [Dr Sekel’s] answer, that if in fact she behaved in that way, you could put the prospect of avoiding surgery at no higher than a chance? | 271 |
nsw_caselaw:178fd5962177b5b782d5c74c:272 | 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 | WITNESS DRNDA: So, if I assume that she had reduced work in childcare with limited ability to - with limited lifting and the regular physiotherapy.
DOWNING: Yes.
WITNESS DRNDA: And still developed what she developed. Well then I would agree that chances would decrease for her to avoid surgery.”
216. Necessarily inherent in Hailee Williams’ approach is the assumed position that conservative management of her condition from June 2012 would have made a relevant difference to her progress. For abundant caution I note that my understanding of her case on this issue is that she could not by conservative management have been made better than she was on 20 June 2012, but that the avoidance of problematic work related and recreational physical activities, together with core strengthening exercises, could have maintained her condition as at that date and thereby avoided deterioration that would have led to surgery. | 272 |
nsw_caselaw:178fd5962177b5b782d5c74c:273 | 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 | 217. The defendants’ experts have argued that Hailee Williams was always a candidate for surgery, with or without conservative management. As Dr Tuffley said in his evidence:
“…we always say, avoid extension, because it tends to aggravate their symptoms, but in some cases it's important because you're trying to get the pars defect to heal when there's only a very slip [sic], or there's only spondylolisthesis, but in these cases it's - avoiding extension is not going to see the pars defect heal, but it might decrease the irritation”.
218. During the concurrent evidence of the experts, the following discussion also occurred: | 273 |
nsw_caselaw:178fd5962177b5b782d5c74c:274 | 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 | “WITNESS BIGGS: Thank you. A few things. The numbers that Ron has said, 4% relates to those who progress in terms of their slippage. That’s not the number who end up having surgery. The 32% for the dysplastic ones are the ones who progress in terms of their slippage, not the number who need surgery. Secondly, we - the fact that two thirds or whatever we say improve with conservative management, that is referring to grade one or two spondylolisthesis. With the grade three, the article by Cadderlia reports only a 10% improvement with conservative management. And most of the literature would support operating on high grade spondylolisthesis if they’re symptomatic. And personally, I believe this lady had a grade three in June ’12. So therefore, I don’t think conservative management would have helped her.
MORRIS: Well you’ve seen the - we’ll deal with that.
WITNESS DAN: Your Honour.
HIS HONOUR: Yes.
WITNESS DAN: Can I just say that.
HIS HONOUR: Professor Dan. | 274 |
nsw_caselaw:178fd5962177b5b782d5c74c:275 | 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 | WITNESS DAN: I completely agree with what Dr Biggs has said and I think that it was inevitable that this particular young woman was going to come to surgery.
WITNESS SEKEL: Ron Sekel. I agree also but from a particular date and not from the 2012 dates.
MORRIS: So, when do you say, Dr Sekel? | 275 |
nsw_caselaw:178fd5962177b5b782d5c74c:276 | 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 | WITNESS SEKEL: I’m going on the clinical changes that occurred in mid-February, going through her notes she was cruising with a level of discomfort, gradually, slowly increasing in the back. But then the hamstring sign became strongly positive in mid-February. And she started developing diffuse neurological type symptoms into the lower limb after that or at that time. And so, from reading that clinically as best we can without back up radiology, to me she became a surgical problem round about the middle of February 2013 and not before. I would have treated her conservatively, with a conservative attitude until mid-February and then a month or two afterwards, if conservative measures were implemented and she remained with her symptoms that would have precipitated discussions about getting on with surgery. I believe she became a surgical candidate after that time. And leaving her longer just left her in pain with all the problems that followed.
MORRIS: Dr Drnda. | 276 |
nsw_caselaw:178fd5962177b5b782d5c74c:277 | 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 | WITNESS DRNDA: I agree partially with everyone. But I believe that Hailee Williams in June 2012 was probably grade two, not high grade and if conservative management, as it was outlined was instituted, she would have very good chance to remain in the same level and not to deteriorate in February. When she had MRI scan May - I think May, so a year later roughly. Scans showed depending how you measure it, how precise you are, it was borderline between two or three you can - instead late two early three. But not more than that. So, I cannot accept that she was in June 2012 grade three. She must have been grade two. And because there was no treatment - appropriate treatment instituted, she deteriorated over eight months. So, February 13 when she developed signs of, developed symptoms of irritation to nerve root. So, conservative management in my opinion, including avoidance of physical strain that she had at work, so basically leaving work, looking for alternative work, looking alternative sport | 277 |
nsw_caselaw:178fd5962177b5b782d5c74c:278 | 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 | activities, prefer swimming than anything else, would possibly lead or very likely, more likely than not, lead to stabilisation at the level that she was. And more likely than not she would avoid surgery. Because there was no treatment - appropriate treatment until February 2013, she deteriorated, she got worse and then she tipped over the point where she was then heading towards the surgery. | 278 |
nsw_caselaw:178fd5962177b5b782d5c74c:279 | 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 | MORRIS: Thank you.
WITNESS BIGGS: If I may. Michael Biggs again. I don’t actually agree, I’m afraid. I don’t think she was a grade two in June 12. If we accept that that’s when her symptoms occurred, in June 12, then we can call that her date of her diagnosis, assuming she’d had x-rays, let’s call that the date of diagnosis. All the literature would suggest that increase slippage from the date of diagnosis occurs in under 4% of patients, so on the balance of probabilities, she hasn't changed her slip from the date of her diagnosis until the date of her surgery.” [Emphasis added]
219. Dr Tuffley’s evidence was to the following, similar effect: | 279 |
nsw_caselaw:178fd5962177b5b782d5c74c:280 | 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 | “WITNESS TUFFLEY: I think the - whether or not there was pre-existing trauma is irrelevant in this case. I think what we're seeing is the natural history of a condition which has been there for a long time, and it's just that as it progresses, various elements change the symptoms. I think, on the x-ray that was eventually taken in mid-2013, there's such a gross degree of disc degeneration that it indicates the condition has certainly been there for a long time. I think we're getting a bit hung up between grade 2 and grade 3. I mean, a grade 2 can be a 49% slip and a grade 3 a 51% slip, so I think it's - I think we're all agreed she had a significant slip around about the 50% mark, for some time, and I just think we're seeing the natural history, and I think when she's presented, she's fully mature, and a lot of conditions have a natural history where they get worse through adolescence, particularly in children, such as, say, scoliosis, for example, and then once their skeletally matured, it | 280 |
nsw_caselaw:178fd5962177b5b782d5c74c:281 | 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 | stabilises in terms of the degree of deformity. I don't agree with Dr Sekel, that conservative treatment would have resulted in the restoration of a more cuboid L5. I think those secondary changes in the doming of the sacrum and the doming of the underside of the L5 and the trapezoidal shape, they're all part of the natural history of her particular condition.” [Emphasis added] | 281 |
nsw_caselaw:178fd5962177b5b782d5c74c:282 | 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 | 220. In response to Hailee Williams’ so-called alternative case, that she would have fared better from surgery if it had been performed earlier, Dr Fraser submitted that, with the sole exception of Dr Sekel, all experts agreed that it would not be appropriate to operate before there was the manifestation of some neurological deficit. That was first observed by Dr Cree on 13 June 2013 and surgery followed immediately thereafter. In short, Dr Fraser submitted that I should conclude that even if Hailee Williams had been diagnosed earlier and she had been conservatively managed under expert orthopaedic and spinal care, she would not have come to surgery any earlier than she did in fact. | 282 |
nsw_caselaw:178fd5962177b5b782d5c74c:283 | 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 | 221. The burden of Dr Fraser’s response to this question is that if, contrary to my conclusion, his breach of duty caused loss and damage to Hailee Williams that necessitated surgery, her current medical problems were entirely caused by that surgery and that its clinical inevitability means that he can successfully invoke the protection of s 5I of the Act. In other words, the development of Hailee Williams’ current pain syndrome was an inherent risk of that surgery, to which it is exclusively referable, and that the risk could not have been avoided by the exercise of reasonable care and skill. | 283 |
nsw_caselaw:178fd5962177b5b782d5c74c:284 | 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 | 222. Although as will shortly appear, because of the view I have taken concerning the issue of whether conservative management could have avoided surgery, the issue does not arise, I do not consider that the development of Hailee Williams’ pain syndrome on the evidence in this case has been shown to be separate and distinct from her antecedent medical condition that prompted the surgery that Dr Fraser contends carried the alleged inherent and unavoidable risk. | 284 |
nsw_caselaw:178fd5962177b5b782d5c74c:285 | 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 | Consideration and conclusions
223. In my opinion, if Dr Fraser had correctly diagnosed Hailee Williams’ anatomical spinal problem or condition on 24 May 2012, she would still have developed her current pain syndrome and associated problems even if her condition had been conservatively managed. The evidence about the likely ineffectiveness of conservative management is, in my view, quite compelling. Dr Fraser’s breach did not cause her loss. That is because conservative management of her pre-operative pain syndrome would not have been enough to stem or stall the natural progression of a serious congenital anatomical spinal condition that led to it. Hailee Williams would also inevitably have come to surgery at some point after 20 June 2012 whether Dr Fraser had breached his duty or not. His breach did not cause the need for surgery or the consequences of the surgery if, contrary to my view, they were different to or more significant than her pre-surgical difficulties. | 285 |
nsw_caselaw:178fd5962177b5b782d5c74c:286 | 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 | 224. Moreover, in considering the competing evidence about this I have necessarily had regard to the onus of proof that Hailee Williams bears. I accept unconditionally that the evidence establishes that if her condition had been detected earlier, specifically when Dr Fraser reported on her condition to Dr Mutasim, she would in the first instance have been conservatively managed in the ways detailed by the experts. However, I am unable to accept that Hailee Williams had any more than a chance that this approach would have obviated the deterioration of her condition in the way that has occurred. In accordance with authority, such as Tabet v Gett cited earlier, Hailee Williams is required to establish that it is probable that conservative management would have avoided her current problems. The uncontroversial proposition that she had a chance of doing so, and that she has established the existence of that chance, does not suffice to prove that Dr Fraser is liable to her for his breach of duty. | 286 |
nsw_caselaw:178fd5962177b5b782d5c74c:287 | 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 | 225. It is important in this context to take note of the experts’ views at which they arrived in conclave and which are recorded in the Joint Report of Experts re Causation dated 26 May 2020. Because Dr Sekel and Dr Drnda were members of that conclave, and because on one view their evidence in court was at odds with the opinions they expressed in the Joint Report, it is necessary to set out the terms of Question 10 in that report and the answers provided by the doctors concerned:
“Question 10
If the plaintiff had been provided conservative management/treatment, including advice as to limiting physical activities in day to day life and in employment, at the times set out in question 9 above and she had limited her activities consistent with the advice she had received, then please provide your view as to her likely clinical course and in particular:
10.1. Whether her spondylolisthesis would have stabilised or progressed; and | 287 |
nsw_caselaw:178fd5962177b5b782d5c74c:288 | 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 | 10.2. Whether she would have come to some form of surgery notwithstanding the conservative management/treatment.
The experts do not agree, with their respective answers and reasoning as follows:
1. Professor Dan Neurosurgeon and Dr Tuffley Orthopaedic Surgeon: The plaintiff’s spondylolisthesis would have still progressed because it is an inherent characteristic of the disorder. | 288 |
nsw_caselaw:178fd5962177b5b782d5c74c:289 | 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 | Yes, she would have come to some form of surgery notwithstanding the conservative management/treatment. The condition is one which progresses almost despite treatment rather than because of the treatment. Any effect of the physiotherapy treatment by Mr Seabury in this case was likely to exacerbate symptoms but not likely to alter the natural history of the condition. The main cause of the plaintiff’s gradually increasing symptoms was a loss of disc height due to degeneration, and that further ‘displacement’ if any would have only been a minor contributory cause of her increasing symptoms. In support of this contention I refer to the following literature:
(i) the article tabulated 73 in the Conclave material ‘The Natural History of Spondylolysis and Spondylolisthesis’ by Beutler et al;
(ii) to page 420 of Dr Sekel’s added document ‘Spondylolysis and Spondylolisthesis in Children and Adolescents’ by Cavalier et al, (Attachment 1 to this joint report); | 289 |
nsw_caselaw:178fd5962177b5b782d5c74c:290 | 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 | (iii) ‘Radiological Progression of Spondylolisthesis in Children and Adolescents’ by Danielson et al, (Attachment 2 to this joint report); and
(iv) ‘Progression of Spondylolisthesis in Children and Adolescents; a long-term follow-up of 272 patients’ by Seitsalo et al, (Attachment 3 to this joint report).
Dr Drnda Neurosurgeon and Dr Sekel Orthopaedic Surgeon are in agreement with each other, with their respective reasoning as follows:
2. Dr Sekel, Orthopaedic Surgeon: Statistically, she would have stayed static with conservative measures, but after the development of the reduced straight leg raising more likely than not would have progressed. In June and December 2012, I think she would have stabilised out statistically but by March 2013 she needed surgery, and she would have progressed from then on. | 290 |
nsw_caselaw:178fd5962177b5b782d5c74c:291 | 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 | That is, by 28 March 2013 and 1 May 2013 she was progressing and was no longer stabilised. The progression was because of the absence of appropriate conservative measures. After 15 February 2013 she was on a progressive course. Before that she had a chance statistically of stabilising out.
Further, I am of the opinion that the physiotherapy treatment by Mr Seabury did cause a progression of the plaintiff’s condition. The lack of adequate conservative care precipitated this, not just the physiotherapy, because she was doing other things as well. Her exercise program contributed. Physiotherapy was not the cause of her needing surgery, but it was a contributing factor. | 291 |
nsw_caselaw:178fd5962177b5b782d5c74c:292 | 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 | 3. Dr Drnda Neurosurgeon: There was a good chance for her to stabilise the condition and not to proceed to surgery, if investigations started in May 2012 to June 2013; if she had the diagnosis and instigated a proper spinal physiotherapist and did everything the spinal physiotherapist found beneficial. Specifically: if she had been advised to stop working in childcare, then she would have good chance to stabilise.
When in February/March 2013 her condition worsened, that was late, at that stage definitely she would progress to surgery. Prior to that there was no advice to stop working. There is evidence of athletes having grade II spondylolisthesis, athletes are fitter and stronger but they are also in high impact sports that with proper physiotherapy (and there are reports of them wearing a brace), they could improve and continue competing. | 292 |
nsw_caselaw:178fd5962177b5b782d5c74c:293 | 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 | The plaintiff did not need to go into competing sports, she just needed to adjust her lifestyle and vocational training. She needed to adjust all her life around her condition, so she would have had good chance to avoid surgery. With 6 or 8 months of a lack of conservative treatment, mismanagement when told not to quit her job, from June 2012 to February/March 2013, she lost that opportunity.” | 293 |
nsw_caselaw:178fd5962177b5b782d5c74c:294 | 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 | 226. With the best will in the world I am unable to be satisfied that opinions such as “she had a chance statistically of stabilising out”, “there was a good chance for her to stabilise the condition and not to proceed to surgery”, “she would have good chance to stabilise”, “the significant possibility the plaintiff would stabilise a certain level of back discomfort and avoid progression of her listhesis” or even Dr Sekel’s qualified response, “Yes, if that’s all she did” to the proposition that conservative management “would have made all the difference for surgery is no more than a small chance”, translate into evidence from these experts that it was more probable than not that Hailee Williams would have been successfully managed with timely conservative treatment. Moreover, beyond understandable attempts to explain these views away, they are at odds with other opinions of at least equal weight from Professor Dan and Dr Tuffley that Hailee Williams’ “spondylolisthesis would still have progressed because it | 294 |
nsw_caselaw:178fd5962177b5b782d5c74c:295 | 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 | is an inherent characteristic of the disorder” and that “she would have come to some form of surgery notwithstanding the conservative management/treatment” [Emphasis added]. The same doctors said that the “condition is one which progresses almost despite treatment rather than because of treatment”. Professor Dan and Dr Tuffley thought that the main cause of Hailee Williams’ gradually increasing symptoms “was a loss of disc height due to degeneration”, otherwise described as “the natural history of the condition”. | 295 |
nsw_caselaw:178fd5962177b5b782d5c74c:296 | 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 | 227. There is in any event a dispute among the relevant experts in this case about the precise grade or level of Hailee Williams’ spondylolisthesis. The evidence and the competing views about this simply do not enable me to conclude which opinion is correct. Dr Biggs believed Hailee Williams had a Grade III spondylolisthesis and that conservative management would not have helped her. He referred in his evidence (quoted above at [218]) to various statistics related to whether certain patients had a low-grade or a high-grade spondylolisthesis. An article attached to the Causation Report indicates that “non-surgical management of the symptomatic patient with high-grade spondylolisthesis is generally less successful than with low-grade spondylolisthesis”. However, Dr Drnda gave evidence that he believed Hailee Williams in June 2012 “was probably grade two, not high grade”. Despite that, Dr Drnda was unable to say more than that “if conservative management, as it was outlined was instituted, she would have very | 296 |
nsw_caselaw:178fd5962177b5b782d5c74c:297 | 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 | good chance to remain in the same level and not to deteriorate in February” [emphasis added]. I raise these matters to emphasise that, accepting favourably to Hailee Williams for the purposes of the argument that Dr Drnda’s view about the seriousness of Hailee Williams’ condition is correct, he was even so unable to speak other than in terms of chances. His evidence in joint session that it was more likely than not that conservative management would have forestalled deterioration of her condition or the need for surgery is difficult to accept having regard to his other references to chance, his position taken in the conclave and the weight of competing expert opinions to the contrary. | 297 |
nsw_caselaw:178fd5962177b5b782d5c74c:298 | 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 | 228. Although it has already been referred to, Dr Drnda provided a report in support of Hailee Williams’ case on 7 November 2019, about which he was cross-examined. With specific reference to the agreed regime of suitable conservative management, Dr Drnda was asked, and answered, the following question:
“8(f) Had the advice been given in (c) above, and the plaintiff had followed that advice, then on the balance of probabilities, what was the likely course of the plaintiff’s condition?
There would be a significant possibility that the plaintiff would stabilise at a certain level of back discomfort and avoid progression of her listhesis.”
229. I have set out the precise terms of the question and the answer to make it clear that Dr Drnda was specifically referred to the balance of probabilities but only answered in terms of possibilities. | 298 |
nsw_caselaw:178fd5962177b5b782d5c74c:299 | 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 | 230. I am in the circumstances unable to be satisfied on the balance of probabilities that earlier conservative intervention or management would have altered the course of Hailee Williams’ progress. I am not satisfied that Dr Fraser’s negligence was a necessary condition of the occurrence of the harm that she suffered. It follows that I cannot be satisfied that her loss and damage were caused by Dr Fraser’s breach of duty in failing to diagnose her condition. I reiterate that I accept that conservative management and treatment would have been instituted in mid-2012 but for that breach of duty. Although it is not presently relevant to the determination of factual causation to consider what Hailee Williams would have done if Dr Fraser had not been negligent, I am satisfied that Hailee Williams would have followed advice if it had been given to her in accordance with the experts’ opinions of what conservative management would have involved. | 299 |
nsw_caselaw:178fd5962177b5b782d5c74c:300 | 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 | Conclusion
231. In these circumstances there should be judgment for Dr Fraser.
Damages
232. It remains nevertheless to consider the quantum of the damages to which Hailee Williams would, but for my conclusions, otherwise have become entitled. | 300 |
nsw_caselaw:178fd5962177b5b782d5c74c:301 | 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 | Non-economic loss
233. Hailee Williams made the following submissions.
234. Hailee Williams is 27 years of age. At the time of the alleged negligence in 2012, she was approximately 18½ years of age.
235. She had successfully completed her higher school education and was enrolled in university to study Primary School Education. Her expectation was to become a primary school teacher and ultimately move into student counselling.
236. She deferred from university in 2012 and entered childcare so she could gain experience in managing children. Her rationale was to see whether she would enjoy working with children given her proposed career path. As a result of her medical condition, primary school teaching is no longer possible. | 301 |
nsw_caselaw:178fd5962177b5b782d5c74c:302 | 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 | 237. Hailee Williams is now significantly disabled by her pain condition. The defendants accept this. She has developed a chronic and entrenched pain syndrome which is a combination of nociceptive and neuropathic pain radiating from her lumbar spine to her lower limbs and feet. This has been of longstanding duration.
238. Ms Williams' chronic nociceptive and neuropathic pain syndrome has adversely affected her psychological state resulting in a chronic adjustment disorder with depressed and anxious mood within the context of chronic physical disabilities and pain disorder.
239. She suffered a severe emotional shock when she was told she required urgent surgery in order to avoid becoming a paraplegic. Following surgery, she has suffered ongoing pain. She has never been without pain. | 302 |
nsw_caselaw:178fd5962177b5b782d5c74c:303 | 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 | 240. The severity of Ms Williams' symptoms of anxiety and depression are predominantly driven by her intractable response to the pain complaint. Her psychiatric prognosis depends largely upon the resolution of her chronic pain syndrome and the severity of the physical symptoms.
241. The pain management experts consider her prognosis to be guarded. There are significant negative prognostic factors that may have an impact upon future treatment.
242. It is accepted that Ms Williams' nociceptive and neuropathic pain condition has affected her activities of daily living, mobility, mood, social functioning, and quality of life. Dr Fisher clearly pointed out her invidious cycle of pain and suffering. | 303 |
nsw_caselaw:178fd5962177b5b782d5c74c:304 | 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 | 243. She has functioned better during some periods than at other times. While she has attempted to maintain employment, which is to the defendants' benefit as it reduces her economic loss, her engagement in employment has been associated with pain and fatigue. She has worked despite her pain. She wanted to contribute to the family and enjoy a sense of meaning and contribution. Her inability to re-engage in the workforce will have a negative effect on her self-esteem and emotional wellbeing. If she can work in the future, she will be suffering pain.
244. Ms Williams always wanted to have children. Her ability to have a normal family life with children for whom she could care is substantially compromised and is essentially unavailable to her. | 304 |
nsw_caselaw:178fd5962177b5b782d5c74c:305 | 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 | 245. Andrew Rae provided unchallenged evidence as to the nature and extent of the care Ms Williams requires due to her significant pain syndrome and related issues. She has effectively lost her independence. Mr Rae describes her increased use of walking sticks or Canadian crutches when ambulating in and outside her home. He has witnessed her having "collapsing attacks". He does not know what causes these. He described, in detail, the progression of symptoms from numbness in her thigh which progresses to her dragging her foot before ultimately collapsing into an apparent state of unconsciousness.
246. Andrew Rae also described her difficulties with respect to domestic tasks, her pain issues and an array of problems he has witnessed including her difficulty sleeping, nightmares, pain management, activities of daily living, and social interaction. None of these observations was challenged. | 305 |
nsw_caselaw:178fd5962177b5b782d5c74c:306 | 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 | 247. He also detailed the plaintiff's worsening physical, emotional and psychiatric state. He described her living conditions and decreased mobility, the deterioration in her mental health and treatment, her financial, emotional and self-perception, her employment, and what he does to assist her activities of daily living. His evidence was not challenged.
248. Similarly, the evidence of Ronald Rae was unchallenged about what he observed and the care he provided to Ms Williams, including domestic and personal care.
249. It has been suggested that Ms Williams may respond to a targeted multidisciplinary and supportive pain management program that in conjunction with spinal cord stimulators. This would assist her to manage her pain but would not remove it completely. Notwithstanding her motivation to reduce her pain, there are significant negative prognostic factors, not the least of which is the fact that there have been seven years of post-surgery without adequate pain management or treatment. | 306 |
nsw_caselaw:178fd5962177b5b782d5c74c:307 | 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 | 250. The efficacy of a permanent spinal-cord stimulator can only be determined by her response to the 10-day temporary simulator trial. If she does not achieve a minimum pain reduction of at least 50 per cent, then the permanent stimulator will not be implanted. Moreover, there are inherent risks with spinal-cord stimulators: between 10 and 15 per cent of electrodes migrate and there is a requirement for repeat surgery to replace batteries. It is an invasive procedure and would need to be the subject of advice.
251. The defendants made the following submissions. | 307 |
nsw_caselaw:178fd5962177b5b782d5c74c:308 | 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 | 252. While there can be no guarantees of success and there are some negative prognostic factors, not the least of which is that almost eight years have passed since Hailee Williams’ initial surgery, there are nonetheless several fairly significant positive indications. Ms Williams is still young, clearly motivated to receive treatment and improve her level of function and has expressed a preparedness to commit to appropriate pain management. Provided her medication regime is modified, including weaning off opioids and medicinal marijuana, and providing a multi-disciplinary and supportive treatment plan, possibly utilising a spinal cord stimulator, the defendants submitted that there are good prospects of a fairly significant reduction in her pain and improvement in her level of function. The defendants emphasised Associate Professor Boesel’s opinion as to the evidence base for high frequency spinal cord stimulation and its efficacy in bringing about pain reduction. | 308 |
nsw_caselaw:178fd5962177b5b782d5c74c:309 | 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 | 253. While the evidence also indicates that Ms Williams suffers from an adjustment disorder, the defendants submitted that it seems primarily to be driven by her experience of pain. In addition, she had an entrenched adjustment disorder prior to the events in respect of which she sues. There is thus a likelihood on the evidence that even but for the alleged negligence, Ms Williams would have continued to experience at least some level of depressive symptoms as part of that disorder.
254. The defendants submitted that, in all the circumstances, after having regard to the objective seriousness of her injuries and disabilities and their subjective effect on her, the appropriate allowance for non-economic loss should be assessed as 55% of a most extreme case. | 309 |
nsw_caselaw:178fd5962177b5b782d5c74c:310 | 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 | 255. In my view, Hailee Williams is significantly and functionally debilitated and has effectively lost her independence in most facets of her life. The prospect of any successful resolution of her pain syndrome is small. Hailee Williams appeared to me to be destined for a life of significant incapacity, with her currently entrenched disabilities unlikely on one view to resolve at all and certainly unlikely to improve in the short term. It is difficult to see how even the best medical care and attention will produce a satisfactory resolution of her cycle of pain. She was also an active and energetic young woman, participating in regular sport and recreational activities which are now lost to her. It is difficult to imagine the level of frustration and distress that this loss will have caused. | 310 |
nsw_caselaw:178fd5962177b5b782d5c74c:311 | 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 | 256. I am not able to accept the defendants’ assessment of her condition as only 55% of a most extreme case. In my opinion, Hailee Williams is entitled to damages assessed upon the basis that she is 82% of a most extreme case. | 311 |
nsw_caselaw:178fd5962177b5b782d5c74c:312 | 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 | Past out-of-pocket expenses
257. The parties have reached agreement on the following out of pocket expenses for the period 13 June 2013 to 15 June 2020:
Medicare $21,507.40
HCF (Private Health) $43,630.25
GAP Medical Expenses $21,202.05
Medication Expenses $13,250.00
Miscellaneous Expenses $10,665.00
TOTAL $110,254.70
258. Ms Williams has asked that any out of pocket expenses payable from 15 June 2020 to the date of judgment be reserved. | 312 |
nsw_caselaw:178fd5962177b5b782d5c74c:313 | 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 | Future Out of Pocket Expenses
259. Hailee Williams made detailed submissions with respect to her likely future treatment requirements. Her submissions were as follows.
260. Dr Rutkowski and Dr Dalton held vastly different opinions about Hailee Williams’ future treatment expenses based on her estimated long-term appropriate pain management. Dr Rutkowski considered the future to be bleak having regard the chronicity of her nociceptive and neuropathic pain condition, psychiatric disorder, emotional and social regression and physical care requirements. In contrast, Dr Dalton considered the solution to her pain disorder and disabilities lay in the implementation of core strengthening techniques in combination with appropriate pain management treatment. Dr Dalton has not entertained the probability that pain management may be unsuccessful. | 313 |
nsw_caselaw:178fd5962177b5b782d5c74c:314 | 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 | 261. The pain management experts acknowledge that a program involving the insertion of a permanent spinal simulator does not remove pain but enhances capabilities. Ms Williams submitted that they are far more circumspect in their opinions than Dr Dalton and that their experience and expertise are superior. As such, Dr Dalton’s opinion on the likely response to further pain management should be given little or no weight.
262. The pain management experts conceded that Hailee Williams would require ongoing and regular multidisciplinary treatments for the remainder of her life, including further surgical procedures to replace things such as batteries and migrating electrodes. They conceded that even with that intervention, she would still require care and assistance. Moreover, there is a significant rate of relapse to opioid medications for the treatment of nociceptive and neuropathic pains following the successful completion of pain management programs. | 314 |
nsw_caselaw:178fd5962177b5b782d5c74c:315 | 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 | 263. Having regard to these qualifications, Hailee Williams maintained that provision should be made for the following:
Equipment expenses total $67,546.00
Hi-Lo Bed, replacement every ten years $2,000.00*
Canadian crutches, replacement every ten years $95.00
Walker, replacement every ten years $125.00
Provision of replacement of handrails every ten years
Over toilet seat, replacement every ten years $150.00 | 315 |
nsw_caselaw:178fd5962177b5b782d5c74c:316 | 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 | Treadmill replacement, every ten years $2,000.00*
Cross trainer replacement every ten years $4,000.00*
Galileo vibration plate purchase, at the one-off cost of $11,000.00*
Continence pads per year ($3.55 for 10) $130.00
Mattress protectors, with replacement every year $100.00
Wheelchair, from age 60 years to 80 years, with replacement every five years $2,500.00 | 316 |
nsw_caselaw:178fd5962177b5b782d5c74c:317 | 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 | Jason recliner chair with lift option, replacement every ten years $5,000.00*
Installation of side by side drawer dishwasher at waist height, including cabinetry costs, one-off $5,000.00*
Replacement cost of drawer dishwasher, every ten years $2,000.00*
Heat packs x 2, replacement every four years $60.00
Shower chair, replacement every five years $100.00
Medical treatments total $220,065.00
Annual recurring: | 317 |
nsw_caselaw:178fd5962177b5b782d5c74c:318 | 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 | GP level B – 4 times $316.00
GP home visit annually $136.00
GP script – 6 times $71.00
GP multi-disciplinary care plan $265.00
Rehabilitation physician consultations $330.00
Sport and exercise medicine $330.00 | 318 |
nsw_caselaw:178fd5962177b5b782d5c74c:319 | 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 | Pain management consultations $555.00
Consultant psychiatry consultations $750.00
Psychological consultations ($250 every 6 months) $500.00
Physiotherapy consultations (6 per year) $780.00
Hydrotherapy (monthly) $780.00
OT review ($720 every 2 years) $360.00 | 319 |
nsw_caselaw:178fd5962177b5b782d5c74c:320 | 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 | Multidisciplinary team review ($1,500 every 5 years) $300.00
Spinal surgeon/orthopaedic review ($265 avg each 3 years) $88.00
Respiratory physician consultations ($330 every 5 years) $66.00
Physician case conference ($555 every 5 years) $111.00
Specialist urologist ($267 every 4 years) $66.75
ADAPT team reviews biannually ($700) $1,400.00 | 320 |
nsw_caselaw:178fd5962177b5b782d5c74c:321 | 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 | Subtotal $7,204.75
Average weekly amount $138.55
One-off
ADAPT Intensive Pain Management Program and transport $18,421.60
Spinal cord stimulation (including trial and placement) with a deferral for ten-year pending weaning from opioid medications (i.e. $61,400.00) $100,000.00
Investigations total $42,008.25
Blood tests, biochemical analysis and urine $200.00* | 321 |
nsw_caselaw:178fd5962177b5b782d5c74c:322 | 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 | Urinary tract ultrasound (every two years) $197.50*
X-ray and MRI spine ($1,825 every three years) $608.33*
CT spine ($765 every 5 years) $765.00*
Neuromuscular electrodiagnosis ($555 every 5 years) $111.00*
Chest or pelvic x-rays (av $122 every 6 years) $20.30*
Shoulder ultrasound ($395 every 7.5 years) $52.67* | 322 |
nsw_caselaw:178fd5962177b5b782d5c74c:323 | 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 | CT abdomen ($1,525 every 7.5 years) $203.30*
Subtotal $2,158.10
Average weekly amount $41.50
Medication costs total $115,185.00
Lyrica $513.00
Fluoxetine 20mg (20mg daily PBS $39.50 for 28 (13 treatments)) $513.00 | 323 |
nsw_caselaw:178fd5962177b5b782d5c74c:324 | 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 | Coloxyl (PBS $39.50 for 100 (1/2 treatment) for 12 months) $20.00
Noroxin/Alprin/Keflex (not regular PBS for $39.50 for 14) (1 treatment) $40.00
Panadol 500mg tds or Panadeine $306.00
Microlax/microlet enemas $20.00
Multivitamin $237.00
Endone $395.00 | 324 |
nsw_caselaw:178fd5962177b5b782d5c74c:325 | 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 | Nurofen $500.00
Volataren cream $158.00
Fish oil capsules $200.00
Magnesium $158.00
Temazepam $158.00
Melatonin (Circadin) $252.00 | 325 |
nsw_caselaw:178fd5962177b5b782d5c74c:326 | 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 | Cranberry $221.00
Clexane injection PRN $37.70
Norspan $1,696.76
Palexia ($41.00 per 28 tablets 1 per day) $492.00
Subtotal $5,917.46
Average weekly amount $113.80 | 326 |
nsw_caselaw:178fd5962177b5b782d5c74c:327 | 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 | 264. Hailee Williams has provided evidence regarding the benefits she has received whilst undertaking the medical marijuana trial in which she has been participating since July 2019. The current cost of her medical marijuana, whilst on the government trial, is $224.00 per week. The cost thereafter on a private basis is $448.00 per week ongoing.
265. These costs are claimed on the basis the trial will remain ongoing for a further six months and that beyond that, Hailee Williams wishes to avail herself of ongoing medical marijuana private scripts indefinitely.
266. The total cost of this medication, as outlined in Hailee Williams’ schedule of damages, is $467,040.
267. The defendants drew attention to the fact that this is an area where there is a significant difference between the views of Dr Dalton and Dr Rutkowski. Hailee Williams claims the total sum of $1,195,764. The defendants have conceded that only some (as indicated) of the following amounts are reasonable: | 327 |
nsw_caselaw:178fd5962177b5b782d5c74c:328 | 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 | 1. Equipment expenses totalling $5,224.80, including a suitable bed at $2,000 with replacement every 15 years, heat packs at $50, with replacement every 4 years, a shower chair at $250, with replacement every 5 years and a recumbent bike or spin bike at $1,000, with replacement every 10 years.
2. Medical treatment totalling $139,133.43, including four GP visits per annum at $79 per visit, pain management at $18,421.60 initially and then two follow up visits per annum at $350 per visit, a spinal cord stimulator at $100,000, with deferral for 1 to 2 years pending weaning from medication (so that the deferred sum is $92,500), orthopaedic/spinal surgeon review every 3 years at $250 per visit and an additional psychiatric review once a year, at $350 per visit.
3. No medical investigation expenses.
4. No additional medical procedures, other than the spinal cord stimulator procedure, which has been allowed for separately. | 328 |
nsw_caselaw:178fd5962177b5b782d5c74c:329 | 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 | 5. No additional allied medical or adjunct therapies other than physiotherapy, which will be provided as part of the pain management program and has been allowed for separately.
6. Additional medication expenses of $4,472.66, including four years of Lyrica, Panadol or Panadeine and Duloxetine in the period during which weaning off medications will occur (which comes to $23.59 per week on the costings set out in the Statement of Particulars). Additionally, a buffer type allowance of a further $5,000 is made for occasional analgesics thereafter, in total amounting to $9,472.66.
268. I accept the defendants’ position with respect to medical investigation expenses. There is no suggestion that Hailee Williams’ orthopaedic condition will deteriorate other than at a rate commensurate with her age-related status as she matures. The need for the claimed suite of investigations does not appear to arise from the enduring pain state that is the main contributor to her current invalidity. | 329 |
nsw_caselaw:178fd5962177b5b782d5c74c:330 | 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 | 269. I consider that the cost of additional medical procedures, other than the spinal cord stimulator, are also not recoverable. Physiotherapy and the medical marijuana costs should be allowed upon the basis that they relieve the defendants of the consequences of what would be unrelieved or increased suffering if some amelioration of the enduring pain syndrome can be achieved in these ways.
270. The items marked with an asterisk in the preceding tables under this head of damage should not be allowed. | 330 |
nsw_caselaw:178fd5962177b5b782d5c74c:331 | 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 | Past economic loss
271. The defendants accept that but for her injury, Hailee Williams would likely have pursued a career as a primary school teacher. She would have studied full-time for approximately three years between 2012 and 2014, subject to possible deferral for travel so that she would have suffered no loss in 2015. Since then, the defendants accept that Hailee Williams would have earned approximately $53,600 net per annum.
272. The parties reached agreement on past economic loss as follows:
Past Loss of Income $174,459.00
Interest on Past Loss of Income $7,252.62
Past Loss of Superannuation $19,191.00
Interest on Past Loss of Superannuation $796.43
TOTAL $201,699.05
273. These agreed figures represent an acceptance of Ms Williams’ pleaded claim as outlined in her second further amended statement of particulars filed on 3 June 2020. | 331 |
nsw_caselaw:178fd5962177b5b782d5c74c:332 | 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 | Future economic loss
274. Hailee Williams and the defendants have agreed on the following matters:
1. But for her injuries and disabilities, Ms Williams would have achieved an academic result that would have allowed her to work as a NSW primary school teacher.
2. The applicable award setting out remuneration for a NSW primary school teacher is the Crown Employees (Teachers in Schools and Related Employees) Salaries and Conditions Award 2020.
3. Ms Williams would have worked to retirement at age 67 years.
4. A reduction for 15 percent for vicissitudes is required to be applied to Ms Williams’ future economic loss claim.
5. Ms Williams would have had a baby at age 31 and she would have taken one year of maternity leave (being paid 14 weeks full pay in accordance with the award) and returned thereafter to full time employment.
275. There is no further agreement with respect to future economic loss. Ms Williams made the following submissions. | 332 |
nsw_caselaw:178fd5962177b5b782d5c74c:333 | 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 | 276. Ms Williams was highly motivated and would have enjoyed the fruits of a full-time teachers’ salary to age 67 years. She has expressed an interest in returning to work provided her pain condition was under control. She could perform some administrative work. | 333 |
nsw_caselaw:178fd5962177b5b782d5c74c:334 | 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 | 277. Dr Rutkowski was pessimistic about Hailee Williams’ ability to return to any meaningful work for which she had been trained or had experience due to her chronic pain disorder. She expressed considerable doubt that she would return to employment notwithstanding completion of a pain management program. Her employment prospects were dependent upon her obtaining a sedentary position that allowed her to get up and move around periodically and a sympathetic employer who would allow her to modify her working environment and conditions. Dr Rutkowski expressed serious concerns having regard to Ms Williams’ significant physical and emotional condition since 2018. She restated her pessimism surrounding Ms Williams re-engaging in the open workforce, having passed the times where she could meaningfully re-educate vocationally due to her chronic pain syndrome. | 334 |
nsw_caselaw:178fd5962177b5b782d5c74c:335 | 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 | 278. Associate Professor Boesel stated that a pain management program with effective spinal cord stimulation would not resolve Ms Williams’ pain but would give her greater flexibility in work choices. However, he conceded there was no guarantee she would positively respond to temporary spinal cord stimulation and therefore a permanent spinal-cord stimulation would not be available. Accordingly, her nociceptive and neuropathic pain syndrome would persist. | 335 |
nsw_caselaw:178fd5962177b5b782d5c74c:336 | 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 | 279. Dr Girdler considered that her diminished functional hierarchy of self-care and other dysfunction would cause potential employers to look elsewhere rather than to employ someone with challenging attributes. Associate Professor Boesel, Dr Fisher and Dr Virgona agreed that Ms Williams would have difficulty in re-entering the labour market or retraining. The totality of the evidence, despite her desire to re-engage in employment, persuasively suggests that it is unlikely Ms Williams will return to full-time work even with successful pain management treatment.
280. Ms Williams therefore claims the loss of a primary school teacher’s wages (or in the alternative a school counsellor’s wage), and superannuation entitlements, until she turns 67. Based on the award, the present wage for a qualified primary school teacher or school counsellor is $112,163 gross per annum (being approximately $1,600 nett per week). | 336 |
nsw_caselaw:178fd5962177b5b782d5c74c:337 | 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 | 281. Ms Williams claims $1,600 net per week for 41 years based on the 5 per cent multiplier tables. This comes to $1,479,680. Applying a 15 percent discount for vicissitudes produces $1,257,728. Ms Williams also claims the loss of superannuation at 11 percent to the age of 67 years, in the sum of $138,350. Her total claim for future economic loss including superannuation is therefore $1,396,078.
282. Hailee Williams presented as an intelligent and resourceful woman. I can see no basis upon which to conclude that, but for her current disabling condition, she would not have embarked upon the posited career path or that her loss of income in the circumstances would not have been as she claims.
283. The defendants’ response was in the following terms. | 337 |
nsw_caselaw:178fd5962177b5b782d5c74c:338 | 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 | 284. Having accepted the premise that but for injury, Hailee Williams would have continued as a primary school teacher and progressed over time through various pay bands, a reasonable estimate for her likely earnings into the future is $70,000 net per annum ($1,346 net per week).
285. The defendants contend that the appropriate finding as to the future, based upon the assumption that Hailee Williams participates in a pain management program and probably has a spinal cord stimulator successfully implanted, is that while she will not earn anything for approximately the next two years, she will then be fit to return to roughly half the normal hours of work, either in an administrative position in the child care industry or possibly as a primary school teacher after retraining. Accordingly, the defendants allow $1,346 net per week as a loss for the next two years, then reduced to $673 net per week for the balance of her working life through to age 65. | 338 |
nsw_caselaw:178fd5962177b5b782d5c74c:339 | 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 | 286. The sum of $1,346 net per week over two years on the 5% table equates to $133,792. The sum of $673 net per week for 37 years, deferred for 2 years less 15% for vicissitudes equates to $463,644. Lost superannuation based on retirement in 37 years and consistently with the approach in Najdovski v Crnojlovic (2008) 72 NSWLR 728; [2008] NSWCA 175, amounts to $66,487, producing a total future economic loss, inclusive of superannuation, of $663,923.
287. In my opinion, the future loss of earnings claimed by Hailee Williams is reasonable having regard to the evidence of her current capacity and the prospect of improvement. It follows that her additional claim for an economic buffer should be disallowed, as the vicissitudes that are taken into account in discounting this part of her claim necessarily make allowance for a change in her circumstances. | 339 |
nsw_caselaw:178fd5962177b5b782d5c74c:340 | 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 | Past gratuitous care
288. Meigan Williams, Andrew Rae and Ronald Rae have given unchallenged evidence about the amount of care they have provided to Hailee Williams over the last seven years.
289. There was some disagreement between Dr Rutkowski and Dr Dalton regarding whether such care was necessary. Dr Dalton’s opinion with respect to Ms Williams’ injuries and disabilities is at odds with that of the pain management experts who consider that she suffers from a genuine and severe pain syndrome affecting all aspects of her life including her activities of daily living, domestic functions, social interaction and mood. The defendants’ submissions appear to have acknowledged that discrepancy. | 340 |
nsw_caselaw:178fd5962177b5b782d5c74c:341 | 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 | 290. Hailee Williams has submitted that the evidence of Dr Rutkowski should be preferred over that of Dr Dalton: Dr Rutkowski is a spinal rehabilitation physician and her curriculum vitae outlines her significant experience with patients who have suffered spinal cord injuries. Hailee Williams’ neuropathic pain has been caused by a spinal injury and as such Dr Rutkowski is better placed to make a prescription for appropriate care and treatment. Her assessment and recommendations are consistent with the largely unchallenged lay evidence.
291. Dr Rutkowski also undertook a thorough assessment of Ms Williams and attended her home on two occasions to assess her needs and future requirements. Dr Dalton, a sports rehabilitation physician, did not do so.
292. Hailee Williams claims the sum of $162,786 as particularised. | 341 |
nsw_caselaw:178fd5962177b5b782d5c74c:342 | 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 | 293. This claim is reasonable, is supported by the evidence and should be allowed. It has not been suggested, nor in my view could it have been, that those who spoke of the assistance provided to Ms Williams were giving other than truthful evidence. Moreover, the nature of the assistance given draws support from the opinions expressed by Dr Rutkowski concerning Hailee Williams’ current difficulties. | 342 |
nsw_caselaw:178fd5962177b5b782d5c74c:343 | 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 | Future gratuitous/paid care
294. Hailee Williams has given evidence that she can achieve very little by way of domestic tasks and often requires assistance with personal care. While she attempts some household tasks, the evidence suggests this is sporadic and her capacity to perform those tasks is unpredictable.
295. Ms Williams also provided evidence that if she were awarded damages, she intended to engage a paid care provider to assist with domestic tasks and personal care. In particular, she gave evidence that she desires to have a romantic relationship with her fiancé, rather than a carer/patient relationship.
296. Both Dr Fisher and Associate Professor Boesel gave evidence in joint session that her supportive relationship and close family were important prognostic factors. If those relationships unravel, she is at significant risk of psychological regression and consequent reduced capacity to adapt her life to pain. | 343 |
nsw_caselaw:178fd5962177b5b782d5c74c:344 | 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 | 297. Hailee Williams submitted that where she is not provided with commercial care and forced to rely on the ongoing assistance of her family members, unreasonable strain and pressure would be placed on her relationship with her fiancé and family. Given that these relationships are essential for her social and emotional wellbeing, and her capacity to cope with a significant pain condition, she submitted that she ought to be provided with commercial care.
298. Andrew Rae, Ronald Rae and Meigan Williams gave unchallenged evidence about the extent of the care which she requires as the result of her significant and severe nociceptive and neuropathic pain syndrome. That condition has adversely affected her activities of daily living, mobility, mood, social functioning, and quality of life. | 344 |
nsw_caselaw:178fd5962177b5b782d5c74c:345 | 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 | 299. Both Dr Rutkowski and Dr Dalton agreed that Hailee Williams currently requires assistance with activities of daily living including some aspects of meal preparation, cleaning, shopping, laundry, making the bed, gardening, handyman tasks and the like. The main difference of opinion is whether this is reasonable to be ongoing into the future and whether her care requirements would reduce if pain management strategies are introduced. This largely depends on whether such strategies are likely to be effective. Ms Williams has established a need for extensive care.
300. Hailee Williams submitted that on balance it is unlikely there will be a substantial or sustained positive response to pain management, spinal cord stimulation or any other technique. The efficacy of such treatment is speculative, and the defendants have failed to discharge their onus that it would result in significant improvement. | 345 |
nsw_caselaw:178fd5962177b5b782d5c74c:346 | 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 | 301. Dr Rutkowski stated considered that Hailee Williams’ future requirements were considerable. She considered that, on the assumption she was living alone and in a suburban house, Hailee Williams required three to four hours per week for household cleaning, two hours per week for meal preparation and other light activities related to cooking, one hour per week for laundry, including changing sheets and similar activities, two hours per fortnight for gardening and outdoor activities, and two hours per fortnight for handyman assistance. Dr Rutkowski considered that it would be reasonable for Ms Williams to have daily assistance with self-care (even if on a standby basis) and other activities of daily living. | 346 |
nsw_caselaw:178fd5962177b5b782d5c74c:347 | 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 | 302. Hailee Williams submitted that it would be reasonable for her to be provided with two hours of daily paid assistance for combined personal care (standby) and domestic assistance tasks. It would be reasonable for this care to be provided every morning to allow Ms Williams to shower safely and dress with standby assistance while her bed is made, heavier parts of daily meal preparation are performed, with more onerous aspects of daily kitchen cleaning and parts of the weekly laundry, household cleaning, and shopping undertaken later.
303. Ms Williams submitted that an average hourly rate of $55.00 is reasonable in the circumstances when considering where she currently resides. The rates are well within and below the National Disability Insurance Scheme guidelines and therefore most likely indicative of the relevant market rate. | 347 |
nsw_caselaw:178fd5962177b5b782d5c74c:348 | 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 | 304. With respect to her current and future transportation requirements, Dr Rutkowski considered that, having regard to her opioid medication regime, the pain management experts’ comments on negative prognostic factors and guarded prognosis and the known high relapse rates following pain management treatment, Hailee Williams required seven hours per week of transportation assistance for general outings and medical appointments. If she does not return to work, Ms Williams will likely require further transport assistance over and above that identified by Dr Rutkowski. According to Dr Rutkowski, Ms Williams will require an additional five hours per week of care from age 65 years.
305. Hailee Williams claims the sum of $1,355,144 as set out in the second further amended statement of particulars filed 3 June 2020. | 348 |
nsw_caselaw:178fd5962177b5b782d5c74c:349 | 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 | 306. As already noted, the significant difference of opinion between Dr Rutkowski and Dr Dalton concerns the question of whether Hailee Williams’ care needs will continue unabated permanently into the future or will abate progressively if anticipated pain management strategies are successful. Ms Williams’ position is that on balance it is unlikely that there will be a sustained or substantial positive response to pain management, spinal cord stimulation or any other technique, and that the efficacy of such treatment is speculative. | 349 |
nsw_caselaw:178fd5962177b5b782d5c74c:350 | 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 | 307. Clearly enough, assessments of such requirements can only be informed by expert opinion to a limited degree. That is for the obvious reason that even expert medical practitioners experienced in the field of rehabilitative medicine are only marginally better able to predict the future than me. I have already expressed a preference for Dr Rutkowski’s approach, as she been more closely involved with Hailee Williams and is objectively sympathetic to her predicament. Even so, the defendants are entitled to the benefit of the uncertainty that attends the suggestion that Hailee Williams’ condition will never improve, a proposition that cannot presently be tested or decided.
308. Doing the best I can, I would allow under this head of damages an amount of $900,000. | 350 |
nsw_caselaw:178fd5962177b5b782d5c74c:351 | 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 | Buffer for future care
309. Hailee Williams has a history of falls. Each of the lay witnesses has observed them. There is a record of a recent fall in Dr Chow’s notes where she injured her wrist. Hailee Williams has claimed a “buffer” for future care on the basis that any of the following complications may arise as a result of her neurological injuries, spinal injury, treatment requirements and spinal cord stimulator.
310. These complications could include spinal cord stimulator electrode migration, infection or arachnoiditis, further traumatically induced orthopaedic injuries due to falls and carpal tunnel syndrome due to reliance on crutches. Ordinary accidents that befall uninjured people will have a greater impact on her due to an already compromised level of functioning. | 351 |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.