Prag v University of New South Wales [2004] ACTSC 51 (24 June 2004)

Last Updated: 19 October 2004

MARIA PRAG v THE UNIVERSITY OF NEW SOUTH WALES [2004] ACTSC 51

(24 June 2004)

NEGLIGENCE - requirement of repetitive work - complaint to employer of soreness in arm and hand - employer's knowledge of difficulty - no breach of duty to either provide assistance or not require work to be performed.

NEGLIGENCE - damage - whether change in employment duties requiring repetitive activity was causative of the onset of pain, rheumatoid arthritis and depression - no causal connection established between work trauma and onset of rheumatoid arthritis.

Makita (Australia) Pty Ltd v Sprowles [2001] NSWCA 305; (2001) 52 NSWLR 705

Ramsay v Watson [1961] HCA 65; (1961) 108 CLR 642

Adelaide Stevedoring Co Ltd v Forst [1940] HCA 45; (1940) 64 CLR 538

Tubemakers of Australia Ltd v Fernandez (1976) 50 ALRJ 720

No. SC 109 of 1999

Judge: Gray J

Supreme Court of the ACT

Date: 24 June 2004

IN THE SUPREME COURT OF THE )

) No. SC 109 of 1999

AUSTRALIAN CAPITAL TERRITORY )

BETWEEN: MARIA PRAG

Plaintiff

AND: THE UNIVERSITY OF NEW SOUTH WALES

Defendant

ORDER

Judge: Gray J

Date: 24 June 2004

Place: Canberra

THE COURT ORDERS THAT:

1. There be judgment for the defendant.

1. The plaintiff, Maria Prag, claims damages against her employer the defendant, the University of New South Wales. The plaintiff claims that the nature of her duties in 1996 and 1997, which she says her employer was negligent in requiring her to perform, caused the onset of pain, rheumatoid arthritis and depression. She says that she is now totally incapacitated for employment.

2. Her claim is disputed by the defendant both as to liability and quantum.

Background

3. The plaintiff was born on 2 February 1944 in Slovakia where she was educated to the secondary level and undertook post secondary studies in chemistry. In 1969 she came to Australia. She was employed as a laboratory technician in the 1980s with the Catholic Education Office, Canberra (St Clare's College). From 1989 she was employed by the defendant as a laboratory technician. In 1989 she did a course of part-time study at CIT Reid College and received a Diploma of Applied Science.

4. She was employed by the defendant at its campus of the Australian Defence Force Academy (ADFA) where her duties were that of a laboratory assistant preparing experiments and supervising tests for the cadets. Each year she was responsible for a year of cadets/students and required to prepare solutions in bulk and then break them down for student experiments. She was responsible for the organisation of these experiments, the calibration of instruments and clearing up after classes.

5. There was an incident in October 1989 which was to have repercussions in the plaintiff's attitude to her employer. That incident involved some chemicals when she was cleaning out a refrigerator. As a consequence, she made a claim on the University but that claim was rejected in March 1990. However, when she applied for promotion in 1991 she found that claim "thrown in her face" by the head of the department, Professor Berman, at her interview. A year or so later she was, in fact, promoted and says that that did much to alleviate the hurt and anger that she had felt at her promotion interview. It is clear, however, that she had difficulties with certain of the staff members and, in particular, Professor Berman, the head of the department. The relevance of this aspect to her claim is problematic. It does not seem to be alleged that this disposed other employees to act adversely towards her. It was not suggested in cross-examination or submissions that this provided a motive for her to exaggerate her claim. However, it does seem to have affected her relationship with senior and supervising staff and her ability to communicate with them.

6. I found the plaintiff straight forward in her answers and of certain conviction. She is a person of definite views who holds to those views. Her personality is such that she would take her professional duties and her capacity to perform them very seriously indeed. These aspects of her character provides support for her claim that she was prepared to do the jobs assigned generally and that she would carry out her tasks without complaint unless she felt it absolutely essential to raise a matter affecting her work performance.

Change in duties

7. In May 1995 her work duties changed completely when she was employed to work on a special contract that her employer had entered into with the Shoalhaven Paper Mill. That work involved the testing of the properties of various samples of paper. The testing was designed by the Shoalhaven Paper Mill but required vigorous chemical and mechanical testing of the paper supplied. The project was conducted in conjunction with the Australian Archives and a portion of the testing took place at their premises at Mitchell. The other portion took place at the ADFA. The task was complex and demanding. Her immediate supervisor was a Dr McHugh and, from what the plaintiff said, at least in the early stages of the project, he attended every second day. She was also supervised, she said, by a Ms Cathy Ho from Australian Archives. Neither of the supervisors appear to have been involved in the physical work.

8. The work that she performed was the subject of detailed evidence by the plaintiff. Initially, the plaintiff received 14 samples to test. Those samples each contained 20 aged pieces of paper and 20 un-aged. She was required to test the paper for tensile, fold and tear. She had to prepare the paper by cutting a strip from each piece and giving it a humidity treatment before testing it in one of the three machines for those characteristics. Failure of a particular piece required its replacement and fitting into the machine. Comprehensive notes were required and the plaintiff was required to constantly monitor the machines. The cutting of the paper involved the use of a lever-type guillotine as well as a sliding guillotine. The lever guillotine required considerable pressure and, clearly, skill and concentration to cut the paper to the precise dimensions required. On Friday, 2 June 1995, which was the first week that the plaintiff engaged in this cutting operation, the plaintiff complained to Dr McHugh of sharp pain in her wrist which she said that she had sustained.

9. His response was to arrange for other employees of ADFA to assist the plaintiff on an `as required' basis in relation to the cutting of this paper. The arrangement made is not entirely clear but certainly, from the plaintiff's point of view, she only felt that she got that assistance when her fellow employees were not required for other duties. In any event, because of the time restraints imposed upon her, it is clear that she continued to perform such of the cutting work as her duties required, even if there was no assistance available to her for this task.

10. During this time, the plaintiff did not seek any medical assistance but treated herself. On the plaintiff's behalf, it is contended that the nature of the duties and their effect on her had been pointed out to the employer and it was a breach of the employer's duty of care to her to either not take those duties from her or to provide appropriate assistance, neither of which the employer did.

The employer's response

11. Although the defence to the plaintiff's statement of claim denied that the plaintiff made any complaint of pain to any supervisor and asserted that assistance was provided as necessary and as requested, the employer chose not to call any evidence on these factual matters. I do not see why the plaintiff's evidence on these aspects should not be accepted. In cross-examination, the plaintiff agreed it was only on the one occasion that she made the complaint but that the response was to organise assistance which the plaintiff deposed to as being, in effect, inadequate. There is no reason why I should not accept the plaintiff on this latter aspect.

12. Over this time the plaintiff said that she had pain in her hand and forearm which she treated herself. It is significant that over this time she was seeing her general practitioner, Dr Webber, with a number of complaints involving headaches, back pain and depression but at no stage is any complaint recorded of hand or arm pain. She took no sick days off attributable to the hand and arm pain.

13. It is important to record that the plaintiff also made no further complaint at all to Dr McHugh about the effect of the work on her. Mr Williams QC, counsel for the defendant, was critical of no further complaint being made to her employer about the continuing nature of the pain in her hand and arm. Her reason, the plaintiff said, was that she did not want to lose her job. I think that, more accurately, it was a fear that she would be perceived as not capable of carrying out the duties of her employment. Having regard to her feelings about the previous occasion where she had complained, I consider, at least as far as she was concerned, this was a justifiable explanation for her attitude. However, it does have the unfortunate consequence that the employer was not made aware of any further difficulties that she may have had or of any inadequacy in the assistance that she considered should have been provided.

14. For this reason, I cannot say that the employer's response to the single complaint made about this particular aspect of her work was inadequate or required any further response. The nature of the work did not of itself call for anything other than the employer to make available additional assistance if required. It was the plaintiff's attitude and work ethic which had the unfortunate consequence of denying her that assistance. If a further complaint had been made, it may well have been incumbent upon the employer to do something further, but no further discussion of the circumstance that would require further action took place.

15. It also follows that I am unable to conclude that the defendant was, in some way, put on notice as to the plaintiff's capacity to undertake repetitive work generally. That is important because that circumstance is fundamental to any breach of the duty of care on the part of the defendant which the plaintiff seeks to make out in respect of a later incident.

The second incident

16. In May 1996, the plaintiff returned to the work that she had been doing before the paper cutting project. She apparently had no further work difficulties but in February 1997, in the course of preparing for a test for first year cadets, her task was to fill, over a period of time, some 700 dropper bottles with solution.

17. During the course of carrying out this task, the plaintiff needed to constantly work with her right hand to screw back on the tops of the bottles. As a consequence she says, "the soreness just came back in vengeance". She also described how, when she first started on this task, she asked her then supervisor for assistance to get the bottles down from the shelves because she had a sore hand. Her description of this incident was as follows -

Well how did it happen? How did it go when you started doing these, getting these bottles ready? - - - Yes, I - you see all these bottles - everything was on shelves. I needed to get them down. I could not. I could not lift. I had to ask for help.

Who did you ask? - - - My colleagues. Whoever was available. I asked them to help me because I had a sore hand to get me down all these boxes with the bottles and so on so I can start with this experiment. I also said to my supervisor, was that time Wayne Jealous.

...

And when you told him, what did you say to him, as best you remember? - - - I said I've got problem with my hand and I wouldn't mind if he would give me some help and he said, "Well, you'll just have to ask somebody if they [have] a free time to help you". That's all that he could do because all the other colleagues they had their own duties to do so I could not rely on them for constant help, just whenever - - -

Well did you - sorry? I interrupted you? - - - Just when someone had a little bit of free time to help me.

And who was some of those that you asked? - - - One colleague who helped me, that was Kate Baddock.

And was there - were you doing anything at work by that time to assist you, taking anything or any steps in connection with your arm? - - - No. I actually went to a doctor, to my GP and he suggested me to put ice packs on my hand, that would relieve the pain.

The incident deposed to refers to the plaintiff's sore hand preventing her from being able to get the bottles from shelves. I do not regard the incident as making it clear to the employer that the cause of the soreness was the repetitive screwing of the caps on the bottles. I do not think that the employer was made aware of this cause.

18. At one stage it appeared that this incident was relied upon to say that the employer did not provide the assistance that it should have to assist the plaintiff in screwing the caps on the bottles. The evidence does not support that. It only relates to the assistance that the plaintiff required to get the bottles down from the shelves. I think the plaintiff's case has to be that it was negligent of the employer to allow her to perform these duties at all and that conclusion very much depends on the circumstances of which the employer could be said to be reasonably aware. The plaintiff's evidence, put at its highest, does not satisfy me that the employer knew, or ought to have known, of the plaintiff's difficulties with repetitive activity.

19. Very shortly after this incident the plaintiff was not able to continue. She was asked -

Well, by the middle of March of 1997, how was your arm then? - - - I got to the stage that the flask, I could not hold it, dropped out of my hand and I just was in so much pain. I don't know the exact day but I just went and I said, "I'm sorry, I'm not - I can't continue this my day. I have to see the doctor again". And that was the last time ...(indistinct) ...

She went to see Dr Webber on 25 March 1997 and did not return to work.

20. I am not satisfied that the defendant can be said to be in breach of its duty of care to the plaintiff by not preventing her from carrying out her duties with respect to the dropper bottles. It is unclear when the conversation with Mr Jealous occurred but I take it as occurring very shortly before she saw her doctor. The occasion that the plaintiff saw her doctor is documented and coincided with the time she stopped work. In light of that, there is no evidence that any failure to provide assistance caused or contributed to her condition. The previous incident with the paper cutting was not, in my view, of sufficient moment having regard to the employer's state of knowledge for the employer to require that the plaintiff avoid any form of repetitive work. A further important aspect is that the plaintiff had, on at least three earlier occasions, when she, in previous years, had dealt with first year students, fulfilled the task that she was undertaking in February 1997 with the dropper bottles. There is no suggestion that she had experienced any difficulty on those earlier occasions. I am not able to see why her employer was not entitled to think that there was no difficulty in her carrying out this particular task.

21. I do not consider that the plaintiff has established that the defendant was negligent.

Causation

22. A further obstacle to the plaintiff succeeding in this action is in her establishing that the rheumatoid arthritis, which was diagnosed shortly afterwards, as being brought about by the injury she sustained consequential upon the incident with the dropper bottles. There was no evidence that her earlier incident with the paper cutting had done so.

23. After the consultation with her general practitioner on 25 March 1997, there was a further consultation on 17 April 1997 reporting an improvement in her condition but then there was a deterioration and involvement of all her peripheral joints. She consulted Dr Hughes, a physician specialising in sports medicine, and he arranged for blood tests and bone scans subsequently diagnosing her as having rheumatoid arthritis. She was referred to Dr Bertouch, a specialist rheumatologist who confirmed the diagnosis.

24. The plaintiff's case relies upon the view formed by Dr Bertouch, an extremely well qualified rheumatologist, that the plaintiff's acute rheumatoid arthritis was "triggered" by the work related injury referable to that which took her to the general practitioner on 25 March 1997. The plaintiff also claimed support from Dr McGrath, a specialist in occupational and muscular skeletal medicine. In his report, Dr McGrath distinguished the right arm pains which had developed in association with repetitive activity at work resulting in forearm impairment and the development of rheumatoid arthritis. He also expressed the opinion that the "forearm impairment work" may have contributed to the development of the rheumatoid arthritis. Those views were significantly qualified by his opinion that it was the exposure to chemicals during the course of the plaintiff's work that could have caused the rheumatoid arthritis.

25. Dr Bertouch's views were directly challenged by two expert witnesses relied upon by the defendant, Professor Muirden, a consultant rheumatologist, and Dr Hassall, also an eminent consultant rheumatologist. Both these witnesses were of the view that the work that the plaintiff was doing was an unlikely cause for rheumatoid arthritis and was coincident to the onset of the disease.

Expert evidence

26. The qualifications of these experts was not challenged. I deal with their evidence on the basis that they have furnished to me, as the trier of fact, criteria enabling evaluation of the validity of their conclusions (see Makita (Australia) Pty Ltd v Sprowles [2001] NSWCA 305; (2001) 52 NSWLR 705 at 729 [59]). I also adopt the approach referred to by the High Court in Ramsay v Watson [1961] HCA 65; (1961) 108 CLR 642 at 645 -

A qualified medical practitioner may, as an expert, express his opinion as to the nature and cause, or probable cause of an ailment. But it is for the jury to weigh and determine the probabilities. In doing so they may be assisted by the medical evidence. But they are not simply to transfer their task to the witnesses.

27. Dr Bertouch, in his initial response to Dr Hughes by letter of 17 July 1997 said -

You had made a diagnosis of rheumatoid arthritis and noted that there was no history of joint pain prior to the onset of symptoms in April this year. You therefore concluded that the condition had been triggered by her work situation.

Thereafter follows a summary of the plaintiff's past medical history and Dr Bertouch's examination of her. He concludes -

In summary Mrs Prag has acute rheumatoid arthritis which has been triggered by a work related injury. As you know this is an unusual situation but there is well recognised documentation of rheumatoid disease coming on after stress either physical or emotional.

His report contains no other explanation of why he should have arrived at this conclusion.

28. A number of other reports were made by Dr Bertouch to Dr Hughes concerning the plaintiff's condition and her proposed treatment but not as to the cause of her condition. In a letter to the plaintiff's solicitor on 14 September 1998, Dr Bertouch provided a "supplementary medico legal report" in respect of the plaintiff. Under the heading "Relationship of rheumatoid arthritis to work activities", Dr Bertouch said this -

Major textbooks in rheumatology include heavy occupational work or work in health areas as being associated with the onset of rheumatoid arthritis. There have also been reports of rheumatoid arthritis occurring after prolonged or undue physical or emotional stress. There is also a correlation between increased morbidity and mortality in rheumatoid arthritis and lower levels of formal education.

Although impossible to prove it would be difficult to deny that Mrs Prag's rheumatoid arthritis is related to the effects of work related activities and stress.

29. In a report dated 23 July 2001, to the plaintiff's solicitor, Dr Bertouch said this -

With reference to the aetiology of Mrs Prag's rheumatoid arthritis I would not change any of my previous comments made either by report or by telephone evidence in the past. The cause of rheumatoid arthritis is simply not known. A variety of different aetiological factors have been proposed all of which are unproven. In addition there have been a wide variety of observations made regarding rheumatoid arthritis which are completely unexplained. Examples include the remission of rheumatoid arthritis during pregnancy and the negative association between rheumatoid arthritis and gout and rheumatoid arthritis and schizophrenia. In the northern hemisphere the onset of rheumatoid arthritis is more frequent in winter than in summer.

The lack of proof concerning any aetiological factor as the cause of rheumatoid arthritis means that all possibilities need to be included when considering potential causes. In Mrs Prag's case there is a temporal relationship between the repetitive work that she did with her hands as a technical officer and the onset of the condition of rheumatoid arthritis. In the Textbook of Rheumatology edited by William Kelley in the chapter by Edward Harris jnr entitled Clinical Features of Rheumatoid Arthritis (which I enclose) there are pertinent comments regarding trauma. The author makes the point that it is difficult to study such precipitating factors and there is no evidence that any have a direct cause and affect [sic] relation although there is at least one study published in 1970 by Hellgren titled The Prevalence of Rheumatoid Arthritis in Occupational Groups which states that occupations involving heavy outdoor labour or work in health fields were associated with rheumatoid arthritis.

There are also published studies which do not show any association between rheumatoid disease and trauma. Accordingly one cannot conclude definitively that trauma is a cause of rheumatoid disease but given the fact that no cause has ever been proven then equally one cannot exclude trauma as a cause of the condition. [My emphasis.]

30. As I said earlier, Dr McGrath also expressed the view that "the forearm impairment work" may have also contributed to the development of rheumatoid arthritis in the plaintiff's case. His report, dated 1 June 1998, went on to say -

Although the origin of rheumatoid arthritis is probably multi-causal, it has been established that copper irons are toxic producing oxidative stress capable of inhibiting a number of key enzymes. They are also capable of generating significant levels of oxidative free radicals.

I am satisfied that, in the evidence that he gave before me, he was directing his attention to the possibility that the rheumatoid arthritis may have had some connection with toxic exposure to chemicals. He also expressed the view that he was not a specialist in relating to issues concerning rheumatoid arthritis and that he would defer to those that were. His views provide no support for the plaintiff's case on this aspect.

31. Dr Hassall examined the plaintiff on 9 November 1998. In a report of 11 December 1998, he considered whether the cause of her present disabilities had been caused by her employment with the defendant. He said -

Although it is possible that her musculoskeletal symptoms have all occurred as part of the evolution of rheumatoid arthritis, it is more likely that she has two distinct problems: a regional pain syndrome causing pain in her right arm, occurring soon after she began the paper project, and reasonably attributable to the work which she was doing; and rheumatoid arthritis, the major cause of her present disability, and almost certainly unrelated to the nature of her work. I believe that depression is contributing importantly to her disability, and that some of her pain is probably due to generalised fibromyalgia, secondary to her depression.

Musculoskeletal pain is a common occurrence in the workplace, and when it affects the arm, neck and shoulders it is often attributed to overuse, and attracts diagnostic terms which are interchangeable: regional pain syndrome, localised fibromyalgia and repetitive overuse syndrome. I am enclosing a document which summarises conventional views about this condition, which is usually regarded as a type of pain amplification syndrome. Emotional factors are often among the amplifying influences, as are such factors as pressure at work, styles of management, job satisfaction etc.

32. Dr Hassall then goes on in his report to discuss what produces rheumatoid arthritis and concludes that whatever the role that trauma may play in producing or aggravating rheumatoid arthritis, a case such as the plaintiff's cannot be reasonably regarded as "traumatic" within the meaning of that term in the context of what might produce rheumatoid arthritis or cause it to develop.

33. In a later report of 8 May 2001, Dr Hassall extensively considered the literature on the link between physical trauma and rheumatoid arthritis. He also commented upon the views that Dr Bertouch expressed presumably in the workers compensation proceedings taken by the plaintiff. Those views are set out in Dr Hassall's report of 8 May 2001 in the following passage -

3. Comment on the evidence of Dr Bertouch, as contained in the enclosed transcript:

It is appropriate to comment on his response to questions about the likely role of the plaintiff's work with regard to the development of rheumatoid arthritis (RA). Asked (on p68) to "venture an opinion concerning the likelihood of onset of rheumatoid arthritis at a later time in Mrs Prag's life ... ... if she hadn't had this traumatic work at work (sic)", Dr Bertouch replied: "So, there is a chance that this could have been a spontaneous condition, could have come on spontaneously, but one would have thought as I have said in my report, that the temporal relationship with the - perhaps it could be described as an excessive physical activity in relationship to the work she was doing, would be a likely cause for the condition that she has". And when asked further (p68) "And these might not have come on at all, had she not been exposed to this work?" he replied (pp68-69): "Well, it's guesswork to say but look, yes, there is a possibility it could have come on, but I guess we're in the realm of speculation. The chance would be low, but possible". [Dr Hassall's emphasis.]

I comment that these views are only before me as a result of Dr Hassall's report, but I will accept them as Dr Bertouch's opinion.

34. Dr Hassall strongly criticised these conclusions proposed by Dr Bertouch. He disputed that the plaintiff's work experience could be said to be physically traumatic in the usually accepted sense. He reviewed the literature and concluded that trauma of this nature is very infrequently associated with the onset of rheumatoid arthritis. Dr Hassall's conclusion was that, notwithstanding Dr Bertouch's views and for the reasons that he expressed, the work that the plaintiff was doing would have been an unlikely cause for her rheumatoid arthritis and that had she not been exposed to this work, the chance of her developing rheumatoid arthritis would have been virtually certain. I find that the reasoning adopted by Dr Hassall, based on the studies and determination of rheumatoid arthritis in populations, is persuasive.

35. Professor Muirden also examined the plaintiff and strongly supported Dr Hassall. In a report dated 25 July 2000, he expressed this view -

Having examined Mrs Prag, I consider it a privilege to read the clinical description and the comments of Dr J Hassall. I consider that there is very little I can say that adds much to the question of employment and the onset of rheumatoid arthritis. He comments on the role of autoimmunity in the causation and possible role of stress in relation to the onset of rheumatoid arthritis. The immune system is clearly involved in the origin and progression of the disease and it may be said that the immune system is vulnerable to stress of a wide variety of types - however, the onset of rheumatoid arthritis after a specific injury or form of physical stress is considered most likely coincidental. My experience in personally treating the disease over many years causes me to accept this view.

Temporal connection

36. Notwithstanding these views, Mr Salmon QC, counsel for the plaintiff, submitted that I should apply the comments of Rich J in Adelaide Stevedoring Co Ltd v Forst [1940] HCA 45; (1940) 64 CLR 538 at 563 -

I do not see why a court should not begin its investigation, ie, before hearing any medical testimony, from the standpoint of the presumptive inference which this sequence of events would naturally inspire in the mind of any common-sense person uninstructed in pathology. When he finds that a workman of the not-so-young standing attempts in a posture calculated by reason of the pressure on the stomach to disturb or arrest the rhythm of the heart a very strenuous task not forming part of his ordinary work and then collapses almost immediately and dies from a heart condition, why should not a court say that here is strong ground for a preliminary presumption of fact in favour of the view that the work materially contributed to the cause of death? From this standpoint the investigation of physiological and pathological opinion shows no more than the current medical views find insufficient reason for connecting coronary thrombosis with effort. Be it so. That to my mind is not enough to overturn or rebut the presumption which flows from the observed sequence of events.

37. Forst's case concerned the question of whether the deceased's exertion at work caused the coronary thrombosis from which he died. Underpinning the decision of the majority of the High Court, and the Full Court of the South Australian Supreme Court from whom the appeal was brought, is the opinion of an expert in that case that physical effort is commonly, but not invariably, the cause of coronary thrombosis (see 569). In contradistinction, it is not said in this case by any of the experts that trauma is commonly a cause of rheumatoid arthritis.

38. Although he was in dissent, the comment made at 569 by Dixon J in Forst's case is also relevant -

... I think that upon a question of fact of a medical or scientific description a court can only say that the burden of proof has not been discharged where, upon the evidence, it appears that the present state of knowledge does not admit of an affirmative answer and that competent and trustworthy expert opinion regards an affirmative answer as lacking justification, either as a probable inference or as an accepted hypothesis.

In Tubemakers of Australia Ltd v Fernandez (1976) 50 ALRJ 720 at 724, Mason J, after referring to this passage, said -

These observations elaborate with varying degrees of emphasis the general onus which lies upon the plaintiff on an issue of causation where the issue lies outside the realm of common knowledge and experience and falls to be determined by reference to expert medical evidence.

39. I accept that the question for determination in this case is not to be answered purely by reference to the expert opinions proffered. My task is to determine whether, on the whole of the evidence, I am satisfied on the balance or probabilities of the fact (Ramsay v Watson (supra) at 645).

40. I accept the significance of the temporal connection between the work trauma and the onset of rheumatoid arthritis but I have difficulty in giving it the import that Dr Bertouch does. I have already indicated that I prefer the reasoning and conclusions expressed by Dr Hassall and supported by Professor Muirden. I am not satisfied that there is a causal relationship between the work trauma suffered by the plaintiff and the onset of her rheumatoid arthritis.

41. There will be judgment for the defendant.

I certify that the preceding forty-one (41) numbered paragraphs are a true copy of the Reasons for Judgment herein of his Honour, Justice Gray.

Associate:

Date: 24 June 2004

Counsel for the plaintiff: Mr B Salmon QC with Mr J Sabharwal

Solicitor for the plaintiff: Lander & Co

Counsel for the defendant: Mr R Williams QC with Mr T Gotterson

Solicitor for the defendant: Hunt & Hunt

Date of hearing: 24 & 25 March 2003

Date of judgment: 24 June 2004