Annorah Joyce Ryan v Sandra Pollock [1993] ACTSC 62 (2 July 1993)

SUPREME COURT OF THE ACT

ANNORAH JOYCE RYAN v. SANDRA POLLOCK
No. SC284 of 1988
Number of pages - 11
Damges

COURT

IN THE SUPREME COURT OF THE AUSTRALIAN CAPITAL TERRITORY
Master Hogan(1)

CATCHWORDS

Damages - Assessment - Personal injury - Motor vehicle accident - Neck and back injury - Exacerbated by treatment - Chain of causation not broken - Cloward's procedure to neck - Fusion to lumbar joint - No issue of principle.

HEARING

CANBERRA, 24-25 March 1993
2:7:1993

Counsel for the Plaintiff: B. Salmon QC/C McKeown

Instructing Solicitors: Brian Martin and Sons

Counsel for the Defendant: C. Whitelaw

Instructing Solicitors: Crossin Barker Gosling

ORDER

THE COURT ORDERS THAT:
1. I direct the entry of judgment for the plaintiff in the sum of $257,560.

2. I order the defendant to pay the plaintiff's costs.

DECISION

MASTER HOGAN This is the assessment of damages for personal injuries sustained by the plaintiff in a motor vehicle accident on 14 October 1985.

2. The plaintiff was driving her car home from work, and stopped at an intersection in obedience to an amber light. The defendant's vehicle collided with the rear of the plaintiff's car. There is no suggestion that the defendant was not at fault in doing so. What is very much in issue is whether most of the disabilities of which the plaintiff now complains resulted from that failure to take care.

3. The plaintiff is a married woman with three children. At the time of the accident she was aged almost 50, and was a permanent part time employee of Australia Post, working as a mail sorter and despatcher, in shifts that were usually of about 4 hours in the early morning. It was work that she found interesting and enjoyed. She had good general health, and enjoyed ten pin bowling, gardening and other activities.

4. On the day of the accident she was driving home from work at the Queen Victoria Terrace Post Office to Queanbeyan. She stopped in Canberra Avenue at the intersection with Newcastle Street. She was wearing a seat belt.

5. The impact forced her stationary car into the intersection and turned it to the right. She did not strike her head or lose consciousness, but was thrown about in the impact. She felt a sore neck, but was able to drive home after the police had finished their investigations at the scene.

6. She rang her husband, who came home, and then took her to the Casualty Department at the Woden Valley Hospital. The Hospital notes include the following:
"Examination showed her to be tender over C6/7 and T1/2. Her neck

extension and lateral flexion was limited by pain. Reflexes, power and
sensation in the limbs were quite normal. She had an x-ray of her neck
which showed no abnormality. X-ray of her thoracic spine showed no
recent abnormality but some minor degenerative changes which have been
long standing. She was given a cervical collar to wear for two weeks
and some pain relief and advised to be reviewed by her local doctor for
possibly physiotherapy if she was not recovering well in two weeks
time. She was given a work certificate for two days."

7. She did not go to work on the following two days, and on 16 October consulted Dr Madew, her general practitioner. He found limitation of neck movement in all directions. He prescribed pain relief and a collar, and gave her a further certificate to be off work till 27 October.

8. On 26 October 1985 he noted that the neck was much improved, with good movement, and allowed her to return to work on 4 November 1985.

9. When she went back to work she found that the activity involved in lifting sacks of mail and distributing parcels made her neck painful, and then caused severe headaches.

10. She returned to see Dr Madew, who prescribed physiotherapy, gave her another certificate for work, and referred her to Dr Vance for specialist advice. On 30 December 1985 Dr Madew reported that she was still unfit for work, but that he expected recovery in about 3 months.

11. The physiotherapist she consulted was Susan Tuisk. She found marked limitation of movement and acute muscle tenderness in the neck and shoulders. She directed her efforts at relieving the headaches.

12. The plaintiff took her holidays from mid December to mid January 1986. On 15 January 1986 Dr Vance saw her. The ache in the neck was no longer constant, and did not occur every day. Sometimes it extended into her left upper arm and behind her right shoulder. He found a full range of movement, with some discomfort at the extremes and tenderness in the lower cervical area. X-rays that had been taken in December did not disclose any abnormality. He suggested that she could return to work, which she did on 16 January 1986.

13. Again she found that her symptoms flared up at work, and after two weeks she returned to Susan Tuisk, who, on 17 February 1986 reported that her symptoms were similar to the previous ones, but of a milder nature, and that they subsided after a few treatments. Nevertheless she thought it possible that symptoms might recur.

14. On 14 April 1986 she saw Dr Vance again and told him that her neck was continuing to improve. To his observation neck movements were good. He expected her recovery to be complete and to leave no residual disability.

15. Her employment record shows that between 16 January and 19 May 1986 she lost only one day's work, on 6 May 1986.

16. It is also noteworthy that till this time there is no recorded complaint of any pain in the middle or lower back.

17. However, she was not convinced that the conservative treatment she had received was all that could be done, and she was still suffering some discomfort, so she went to consult Dr Ferguson, on the recommendation of her solicitors. He first saw her on 21 April 1986.

18. Dr Ferguson took a careful and detailed history. He noted her complaint of soreness at the back of the neck immediately after the accident, and that on the day after the accident she began to have headaches and upper back pain. He also elicited the information that a month or two later she developed sensory abnormalities in her right hand, and since 5-1/2 months after the accident she had pain in her left wrist and hand. The further detail that he obtained about upper back pain was that for 3 or 4 weeks from the day after the accident the plaintiff experienced daily pain in the upper part of her back on the right when her neck pain was worse.

19. It lasted for several hours at a time, but did not interfere with movements of her back.

20. X-rays showed some evidence of Scheuermann's Disease, especially in the dorsal and lumbar spine, but in his opinion this condition was asymptomatic before the accident, was not affected by it, and had played no part in causing her symptoms.

21. Among the x-rays that he ordered was one of the lower back. He did so because he elicited evidence of tenderness in that area. It disclosed a congenital fusing of the last lumbar vertebra with the first sacral vertebra. That condition also was not a cause of any symptoms.

22. He diagnosed subluxation of her cervical, dorsal and lumbar spine, instability of the cervical spine, and possible spinal disc injury associated with upper spinal nerve root compression.

23. He advised treatment and correction by manipulative treatment. She decided to accept his advice and undergo that treatment. In my opinion she acted reasonably in accepting that advice and undergoing the treatment.

24. Dr Ferguson gave evidence and was cross examined. During the cross examination the following questions and answers were recorded:

"MR WHITELAW So, therefore, would it be fair to say that as Mrs
Ryan presented to you in April 1986, there was no real need to
manipulate her lower back?
DR FERGUSON One could say there was no real need, but the trial of
treatment is the best way of determining if that defect exists and
there is no harm done by correcting it, so it's one of those things
which could be regarded as slightly negligent if a fault is present and
if it's opportune to fix it, one should, I believe, fix it.
MR WHITELAW But, doctor, I am suggesting to you that there was nothing
to fix in Mrs Ryan's lower back in April 1986?
DR FERGUSON There was a little bit of tenderness.
MR WHITELAW But nothing else?
DR FERGUSON No, it was very minor, I agree with that, but she was
tender in that region of the spine and one has to explain that and, in
fact, I don't recall whether it resolved following correction of the
displacement, but it was a very incidental part of the management.
MR WHITELAW I think you said, whatever the tenderness was, you did not
relate that to the accident, is that right?
DR FERGUSON Well, I couldn't be sure of that, because it was a very
minor part as for her total complaints and I didn't follow it through
in any great depth. I simply found she was tender there, I assumed
that was due to the same condition that affected the upper part of her
spine where her complaints were centred and it was worthwhile to
rectify at the same time.
MR WHITELAW Was that upper part of the spine being affected by
Scheurmann's Disease?
DR FERGUSON No, her neck was the main part of her spine that was
affected by the accident.
MR WHITELAW When I asked you a short time ago, whether you thought the
tenderness in her lower back was consistent with having suffered an
injury in the accident, didn't you say that was not the case, that you
did not relate the tenderness to any injury suffered in the accident?
DR FERGUSON I couldn't really relate it to the accident, because there
were no complaints related to her lower spinal tenderness that could
have or could not have come from the accident. I simply noted that she
was tender there."

25. On two occasions the manipulation aggravated the neck pain and headaches, and made her nauseous and giddy. He therefore decided to perform the manipulation under general anaesthesia, which he did on 3 June 1986. He carried out a number of further manipulations and prescribed a variety of anti inflammatory drugs. On 8 October 1986 he reported that her neck pain and headaches had been a lot better. He attributed her adverse reaction to exacerbation of the previously asymptomatic and underlying Scheuermann's Disease by the manipulation. He thought that result was unavoidable for as long as she required manipulative treatment to alleviate the subluxation caused by the accident, and prescribed the anti inflammatory drugs to alleviate it. The pain in the finger joints was not connected with the accident.

26. Her employment records show that between 17 June 1986 and 17 March 1987 she was absent from work for 32 days, in July, August and September.

27. In assessing damages I do not think it matters very much to point out that the plaintiff might well have been better off had she not undergone the manipulations of her back by Dr Ferguson. She consulted him because of continuing symptoms that were undoubtedly caused by the accident. In the course of treating them he manipulated the lower back, which physically may or may not have been damaged in the accident. She acted reasonably in accepting his advice, and in undergoing treatment to the extent and in the parts that he advised. His treatment was an accepted form of therapy. It is not shown that Dr Ferguson was so negligent in carrying it out that his intervention broke the chain of causation between the accident and what followed. If and in so far as her subsequent condition, including her complaints in the lower back, resulted from the manipulations by Dr Ferguson, it resulted from the course of treatment that she reasonably underwent as the result of the accident, and was itself therefore a result of the accident.

28. Dr Ferguson referred the plaintiff to Dr Danta, consultant neurologist, who saw her on 9 October 1986. (His report is dated 1987, but I think it is clear from other evidence that 1986 was meant.) She was complaining of pain in the neck and left arm and headaches. On examination he found neck movements slightly restricted, and tenderness in the neck structures and muscles. A CT of the cervical spine was normal. She also had x-rays of the lumbar spine with her, which Dr Ferguson had ordered. They also were unremarkable. He thought she had suffered a typical whiplash injury to the neck, which had aggravated and rendered symptomatic pre-existing cervical spondylosis. He advised conservative treatment, but thought it likely that she would continue with some pain for a number of years.

29. On 24 September 1986 Dr Ferguson referred the plaintiff to Dr Robson, neurosurgeon, who saw her late in December 1986. He thought her symptoms of pain in the neck and left arm with paraesthesia in the left arm indicated disc damage, and nerve root compression, but he was not able on the signs and investigations then available to decide on the exact site of the problems. He advised the plaintiff to undergo a myelogram, which she underwent, with the usual severe discomfort, on 31 December 1986. All he could detect on the pictures was a small nerve root involvement at C4/5, and perhaps a small midline bulge at C5/6.

30. He therefore sought more information with discograms. On 18 March 1987 he investigated the discs at C4/5, C5/6 and C6/7. He found both 4/5 and 5/6 ruptured. He advised fusion. She reluctantly accepted his advice.

31. On 2 July 1987 at Calvary Hospital he performed anterior interbody grafts at 4/5 and 5/6, and extensive neurolysis at 5/6.

32. Meanwhile, as early as June 1987, he had noted that she had been complaining of low back pain since the myelogram in December 1986, worse on the right than on the left, and that sometimes the big toe became numb.

33. Dr Robson was called to give evidence. During his evidence in chief he said:

"On 9 June I had written to Dr Ferguson saying, 'I reviewed Annorha
Ryan today and of course we are going to go ahead and fix her neck
soon. Today she came in to say that she is having pain in the leg and
she dates the onset of this to the myelogram last year. I am very
interested in this because there is intrinsically nothing whatever in a
myelogram that can give anyone lasting pain in the leg, except that I
have now seen it happen on two previous occasions with people with neck
trouble and this has been followed later by pain in the leg and lower
back bringing to light a previously unsuspected disc trouble. This is
exactly the situation here as she had no previous story of back or leg
pain.' I think that's incorrect, she had a somewhat trivial story of
back leg - back before. 'She says that this is not settling in way, so
I have started off getting some plain x-rays of the lumbar spine. I
will see what I can see in those as the first move to sorting it
out.'"

Later he continued:

"MR SALMON The myelogram was a procedure that was indicated as a
result of her complaints of neck pain?
DR ROBSON Correct.
MR SALMON And you carried out the myelogram in accordance with the
ordinary procedure?
DR ROBSON Standard.
MR SALMON Now the onset of pain in the back of a much more serious
kind, which you eventually note down in June, I think you indicated was
something that you had observed on other occasions after a myelogram?
DR ROBSON I'd seen it twice before then in my own notes, and I've
probably seen it since again. I do not know what causes it. It only
happens if you have a bad back; it doesn't happen if it's a totally
normal back, and even then it's obviously very uncommon, but I have
seen it though - I refer there to persistent pain.
MR SALMON Yes. And do you, in the light of your experience, regard it
as being connected with the myelogram having taken place?
DR ROBSON Yes, I feel I really must. I feel I really must make that
connection, even though I'm sorry I can't give you scientific chapter
and verse as to why this should be.
MR SALMON Well, thereafter you not only treated the neck, but
subsequently treated the back as well?
DR ROBSON Yes, I tried to get around the back without meeting it headon
so to speak. We gave her an injection in the lower back and various
tablets and pills. It just didn't really go away.
MR SALMON And ultimately an operation was performed in June 1989?
DR ROBSON We did, in fact, repeat the myelogram.
MR SALMON Do you have that there?
DR ROBSON Yes.
MR SALMON And further?
DR ROBSON She had the repeat of myelogram on October 1988 and I could
see that one of the nerves didn't fill properly and that's the basis of
the underlying problem brought to light by the myelogram.
MR SALMON I suppose I have to ask you this question, but are you able
to make any assessment as to whether this problem would have arisen had
there not been the need to conduct the myelogram?
DR ROBSON Well, I can't really. I think she - one of the problems, Mr
Salmon, is that we can all have trouble with discs in our back without
it being painful, and then some event occurs, perhaps trip over the
cat, have a myelogram, whatever it may be and then in this instance the
myelogram, itself, was sufficient to trip her over from being
comfortable into being uncomfortable. I'm sure it has to do with the
osmotic properties of the dyes that are introduced, but I don't know
beyond that.
MR SALMON Well?
DR ROBSON I think that she may never have had trouble; equally she may
have had trouble though, I am not able to - I just don't like the way
it just came straight along. She's a very sensible person. She just
produced this directly after the myelogram, continually from then
on."

34. After the operation on her neck in July 1987 the plaintiff spent about a week in hospital, and then went to stay with her daughter to recuperate. As she did so, after about a month, she felt that her neck was better, though she still got occasional pain extending into the arm, which is still the condition of her neck. The headaches were, and have continued to be, much better. There was the usual discomfort in the iliac crest from where the bone was taken for the fusion.

35. Her back however continued to trouble her. She returned to work, but worked in pain. As Dr Robson said, she was given a cortisone injection and various tablets and pills, but the pain did not go away. In October 1988 he carried out the further myelogram. She did not want to have the further operation. Eventually the pain persuaded her. There was also a delay while Dr Robson arranged for special prostheses to be obtained from the United States.

36. On 1 June 1989 Dr Robson carried out a fusion of the joint at L5/S1. The bulge in the disc which was affecting the S1 and L5 nerve roots was confirmed on operation.

37. She spent a week in hospital and then went to her daughter's home again to recuperate. She then returned to work. She continued to suffer pain in her back extending into her leg.

38. There are some unexplained anomalies in the schedule of absences from work supplied by Australia Post which forms part of Exhibit "D". For example, it does not show any absence in July 1987, and the number of days of absence in March to June 1987 does not match the dates. If that record is correct, she did not return to work after the June 1989 operation till 5 July 1990, and then managed to stay at work only for two weeks. She was then absent again from 19 July 1990 till 15 Arpil 1991.

39. In the absence of Dr Robson overseas, she was seen by Dr Newcombe, neurosurgeon, first on 4 October 1989. She was experiencing prominent right lower limb pain and numbness in the right foot. X-rays of the fused part of the back were satisfactory. The leg pain settled to some extent, but the back still troubled her.

40. On 19 December 1990 Dr Newcombe saw her again, in order to give a report to her employer. The low back pain was continuing, but fluctuating in severity. There was some right leg pain on the outside of the leg sometimes extending to the ankle, which varied in intensity. There was tenderness over the right iliac crest.

41. Dr Newcombe noted the strenuous efforts Dr Robson had made to get her fit for work, and a recommendation by the Commonwealth Medical Officer that she be retired on the grounds of incapacity. There is no report in evidence from the Commonwealth Medical Officer.

42. Dr Newcombe thought her condition was stable, and unlikely to improve significantly. His conclusions about her ability to work were as follows:

"1. Mrs Ryan suffers from the residual effects of the motor vehicle
accident of 1985 and the necessary investigations and treatment thereby
incurred. These residual effects do not include any significant neck
problems, but do include residual low back pain and right lower limb
pain.
2. Mrs Ryan is not totally incapacitated for work in terms of the state
of her neck or lumbar spine from the organic and post operative
viewpoint.
3. Mrs Ryan is probably unfit for full time work in any capacity. It
is reasonable to consider that she could resume part time work of four
hours or so per day as previously, but in a limited and graduated
manner. It may not be reasonable to expect her to lift mail bags or to
lift heavy parcels. It would be reasonable for her to consider dealing
with standard letters and large letters for sorting and to seal mail
bags. Alternatively, she would probably be fit for clerical work
provided she could change position at will and not be confined to
sitting in one position at a desk."

43. He recommended further rehabilitation and a graduated return to part time work, and concluded:

"While I think that such a structured rehabilitation program should
be followed in the best interests of both Mrs Ryan and her employer, I
suspect that it will turn out that Mrs Ryan cannot do as efficiently
and without risk of further aggravation the unloading of the mail bags,
but she can do the sorting. Then, I suspect that Australia Post will
say that if she cannot do the unloading of mail bags then she cannot be
employed and, therefore, her retirement on medical grounds is the only
course available. However, as I am unable to answer the occupational
aspect fully, and in particular what level of tolerance Australia Post
is able to accept in an employee with regard to disability, I am unable
to fully determine her occupational capacity."

44. So far as the causation of the low back and leg pain was concerned, he commented:

"Dr Robson has indicated that it is unusual but it is known for
lumbar spinal problems to be initiated by myelography. I think it is
likely that there was pre-existing lumbar disc degeneration and
protrusion made worse by the manipulative positions implied with
myelography and possibly by the needle used for lumbar puncture. My
understanding of the history is that Mrs Ryan did have low back pain and
leg pain beforehand, though it was made worse by the myelogram. My
understanding of the history is that Mrs Ryan had such problems shortly
after the time of the accident, but they were aggravated by the
myelogram. If there was no pain at all until the time of myelography
then such an aggravation to cause symptoms would be unusual though not
unknown. I think it is clear that the myelogram in any case was
undertaken as an investigation as a consequence of the injury at work
on 14/10/85 and that it was properly performed."

45. Dr Newcombe gave evidence and was cross examined. He confirmed that in his experience lumbar spinal problems could be initiated by myelography. It would not be impossible for her to have suffered an injury to a disc in the lower back but not to have had significant symptoms for 12 to 18 months, although a period to onset of symptoms of 6 months was more likely. Given further details of the history he agreed that there was a strong suggestion that the lower back was not injured in the accident. He also agreed that vigorous manipulation of the spine could cause disc damage, and that risk would be increased by manipulation under general anaesthetic. He did not think that the lumbarisation at the lumbo sacral area was in any way significant.

46. On 11 October 1991 she was compulsorily retired from Australia Post on the grounds of her invalidity. She has not worked since 17 June 1991.

47. Dr Andrews, consultant neurologist, examined her for the defendant on 16 January 1990. The history he was given and his clinical observations were not markedly different from those reported by the other doctors. He noted that there was no history of back pain until after the myelogram, and doubted that her lower back problem was related to the accident.

48. Dr Andrews gave evidence and was cross examined. He expressed difficulty in understanding how there could be so much trouble resulting from a lumbar puncture. He also could not see evidence to persuade him that the manipulations by Dr Ferguson caused the lower back problems. He attributed those problems to a degenerative disc which just happened to become symptomatic after the myelogram, as the result of natural progression of degeneration.

49. A report was also tendered, on behalf of the plaintiff, from Dr Prakash, who examined her for the defendant on 23 November 1992. He had seen reports from Dr Robson. His opinion was as follows:

"Diagnosis - It is my opinion that this lady sustained soft tissue
injuries to her cervical spine and lumbar spine as the result of the
motor vehicle accident that she states she was involved in, on 14th
October 1985.
Discogram done in March 1987 which showed evidence of ruptured discs at
4-5 and 5-6 levels. As stated earlier in my report I have not seen any
of the x-rays, and I presume that this discogram was at the cervical
level, for which she underwent fusion and extensive neurolysis in the
cervical region on the 2nd July 1987. She continued to be troubled by
low back ache for which she underwent disc removal, internal fixation
and bone grafting to the lumbo-sacral area on the 1st June 1989.
It is just over seven years since her accident, and she continues to be
troubled by low back pain, and some neck pain."

50. Dr Prakash was not called to give evidence.

51. On reviewing the whole of the medical evidence, I think that it is possible, but unlikely, that significant damage was done to the plaintiff's lower back in the actual impact.

52. But there was probably a degree of weakness there. It may have been slightly damaged in the accident, further damaged by the manipulation, and finally made significantly painful by the myelogram. There was sufficient tenderness in the area to persuade Dr Ferguson to x-ray and manipulate it.

53. But it is not necessary that I should be able to point to the exact mechanism by which the final state of the disc was brought about on which Dr Robson operated. It was certainly defective then.

54. I agree with Dr Andrews that the lesion on which Dr Robson operated has not been demonstrated to have been directly caused by the motor car accident. But that does not conclude the legal question.

55. The plaintiff reasonably underwent, first, the manipulation, and then the myelogram. On the balance of probabilities the final state of her lower back was brought about by some combination of some or all three incidents. Although it is possible, as Dr Robson said, that some other incident might have damaged her lower back, it was in fact that sequence of events, which were consequences of the accident, that did damage it. I therefore attribute the whole of her disability to the accident.

56. In summary, she sustained a whiplash type of injury to the neck, which was resolving, but was probably exacerbated by Dr Ferguson's manipulation, and for which she underwent a fusion operation. She is left with restricted neck movement and some residual discomfort, scars on the neck and iliac crest, and pain at the donor site.

57. The course of treatment also made symptomatic an underlying condition of the lower spine, leading to an operation for fusion at L5/S1, with a minor operation subsequently. She had a number of uncomfortable investigations. There is the operation scar on the back. She continues to suffer pain in the back and restriction of movement and activities.

58. She has been deprived of her ability to work at a job she enjoyed. Although she would be capable of part time light work there is none that is available for her experience and abilities, despite attempts at rehabilitation that were arranged by her employer. She has been compulsorily retired from public service because of her disabilities. She can no longer indulge in the leisure activities that she enjoyed. She is 57 years of age.

59. For her pain and suffering and loss of amenity I award $45,000, of which about $12,000 relates to the future.

60. For interest on the past component I award $5,000.

61. On the basis of the findings I have made the past out of pocket expenses are not contested at $26,544.

62. Exhibit "D" contains the relevant information for calculation of past wage loss. From 15 October 1985 to 13 October 1988 she lost a total of $1,100.60 in penalty payments. Otherwise she received in compensation until her retirement on 11 October 1991 what would have been her normal weekly wage.

63. The result is a net loss of $36,118.41, and a Fox v Wood figure of $5,628.30 to the date of retirement.

64. From that date to 30 December 1992 actual net earnings of a comparable worker were $16,982.37. Over that period she in fact received compensation totalling $15,307.82, on which tax was paid totalling $1,757. The rate thereafter for normal pay and penalty rates is $245.26 a week net. From 1 January 1993 to the date of judgment that is a total of $6,736.76. She would have received compensation of $251.23 a week, on which tax was paid at the rate of $30.50 a week.

65. The total net wage loss is therefore $59,838.

66. The total Fox v Wood figure is $8,178.

67. In assessing the value of the loss of future income earning capacity I take into account that she enjoyed her job, and may well have intended to work to age 65. However, she did have a degenerative condition in her back, and her work involved considerable lifting. She also had some problem with the condition of her heart, about which there is no medical evidence, but it was obviously not connected with the accident.

68. The present value of $245.26 a week for 7 years at 3 percent is $80,898. I allow $60,000 for loss of future income earning capacity.

69. The plaintiff's daughter and her husband have been required to provide her with assistance in her daily activities, and also in doing many of the things that she would have done. That assistance will continue into the future. At some time in the future it might have become necessary in any event. It is not a matter for exact calculation. As a matter of judgment I award a sum of $50,000 for the value of past and future voluntary services.

70. She will need to spend money on medicine at a rate of between $3.00 and $4.00 a week for the rest of her life, which on the actuarial tables is a period of 24.55 years. The present value of a loss of $4.00 a week for 25 years at 3 percent is $3,687. I award $3,000 for the future cost of medicine.

71. The total award is therefore made up as follows:

Pain and suffering $ 45,000
Interest 5,000
Past out of pocket expenses 26,544
Past wage loss 59,838
Fox v Wood 8,178
Future income 60,000
Griffiths v Kerkemeyer 50,000
Future medicines 3,000
TOTAL $257,560

72. As a global figure that sum seems appropriate to me.

73. I direct the entry of judgment for the plaintiff in the sum of $257,560.

74. I order the defendant to pay the plaintiff's costs.