Pavletich v Accident Rehabilitation and Compensation Insurance Corporation

Decision no. 23/96 IN THE DISTRICT COURT DCA No. 103/95 AT WELLINGTON UNDER THE Accident Rehabilitation and Compensation Insurance Act 1992 AND 19 / 94/ 0117 IN THE MATTER of an appeal pursuant to Section 91 of the Act BETWEEN J. PAVLETICH APPELLANT AND ACCIDENT REHABILITATION AND COMPENSATION INSURANCE CORPORATION RESPONDENT Heard at Auckland: 14 February 1996 Date of Decision 18 Apair 1996 Appellant in person A. Howman as Counsel for the respondent RESERVED DECISION OF JUDGE J.H. LOVELL-SMITH The issue in this appeal is whether the appellant has suffered medical misadventure. On 5 May 1994, the appellant lodged a claim in respect of his pain and suffering in respect of a reaction to an anti-tetanus injection he received at Middlemore Hospital following an injury to his head when a money box full of coins fell on his scalp and forehead. He suffered a small laceration which was 2. closed with steristrips and was given an anti-tetanus injection. As a result of the injection, the appellant claimed that the needle had entered his heart, and this accounted for on-going pain which he described as pins and needles. He claimed to suffer the pain all over his body, such that sometimes he could hardly walk and in particular he incurred headaches. The Corporation's file reveals this matter has been dealt variously as a claim for medical misadventure and a claim for cover pursuant to s.8(2)(d) of the Accident Rehabilitation and Compensation Insurance Act 1992, and had been initially referred to the Corporation Medical Misadventure Advisory Unit. On 27 May 1994, the Medical Misadventure Advisory Unit wrote to the appellant and asked him to provide it with an account of his circumstances. The appellant replied by letter. He stated he had suffered on-going amnesia as a result of the blow to his head. In response to this condition, he stated he had been given an injection which led to on-going pain described as pins and needles. He claimed to suffer this pain all over his body and in particular, he stated that he incurred headaches. The Corporation then obtained a report of the appellant's treatment at the Emergency Department of Middlemore Hospital, which was provided by a Dr Mclaren in a report dated 3 August 1994. The appellant had been offered medical attention at Middlemore on four occasions. On 26 April 1993, he had been treated for the blow to his head. A laceration on his forehead was closed with steristrips and he was given an injection of anti-tetanus toxide. This time, the appellant had no neurological symptoms, and his general condition was satisfactory. On 9 September 1993, the appellant attended the Emergency Department complaining of periods of forgetfulness. Haematological and 3. Biochemical investigations proved to be normal. A CT scan of the head and electron encephalogram were arranged and revealed normal conditions. returned to the Emergency Department on 20 September 1993, this time complaining of pains in his left arm and chest. X-rays done at this time revealed marked degenerative state in the appellant's cervical spine, and he was given a course of Naproxen. The fourth occasion the appellant attended the Emergency Department was on 2 May 1994, when he complained of shooting and burning pains in his head, arms and legs. Examination revealed no cervical spinal tenderness, although there was some restriction in neck rotation. A neurological examination was normal. He also complained of bilateral tinnitus, but examination of hearing and ear drums was normal. He was treated with a soft cervical collar and given Paracetamol. On 31 August 1995, the Medical Misadventure Advisory Unit advised the appellant that it proposed to reach a conclusion that his condition was not as a result of medical misadventure. The appellant advised the Unit in a letter dated 8 September 1994 that he did not agree with this conclusion. On 25 October 1994, the Corporation informed the appellant that his claim had been declined. A review hearing took place on 28 March 1995. The Corporation sought and obtained further medical evidence concerning the appellant, a total of four additional reports. Dr David Haycock in his letter to the Corporation of 1 November 1995, said he had no information or record concerning the appellant's claim. Dr Peter Sandin wrote to the Corporation on 3 October 1995. In his report he said he had examined the appellant on four occasions, three of which had been in connection with the upper respiratory 4 tract infections, the final relating to a pancreas complaint which had been treated with medication. . South Auckland Health in a letter to the Corporation of 12 October 1995, enclosed copies of the results of CT scans which had been performed upon the appellant. The CT scan revealed no abnormality in the appellant's neurological condition, but did note the marked degenerative change in the appellant's cervical spine. The report concluded that there was no evidence of a recent bony injury. Ms Cairn did leave open the possibility that the blow to the head could have produced cord trauma without an obvious fracture, but confirmation of this would require an/RI scan. Dr Jonathan Simcock, a Neurologist, reported to the Corporation in a letter dated 12 January 1996. Dr Simcock was confident that the appellant had normal power in all his muscle groups, that his neurological and general medical condition was normal. Dr Simcock concluded that the appellant showed clear evidence of elaboration of symptoms which had no organic cause. In his submissions to me, the appellant was adamant that the needle had broken when the anti-tetanus injection was administered, and that he believed that needle had now travelled to his heart. At the review hearing, however, he had also described tinnitus which had never stopped, that his lungs were now bursting and he was a very sick man. He also said he had suffered strokes after the treatment at Middlemore ten or more times. He emphasised, at the review hearing, that he was not complaining about his neck, but the pins and needles he suffered were the result of the tetanus shot or medication. I have to agree, however, with Counsel for the respondent's submission that the appellant's claim is simply unsupported by any medical evidence. There is no dispute that at the time of his injury the appellant received an 5. injection of anti-tetanus toxide, but there was no evidence to support the appellant's contention that a needle has now pierced his heart. The medical evidence reveals the appellant has been given medical treatment for a number of complaints, but again there was no evidence that these various treatments have or could have caused the appellant to suffer the pain of which he complains. There is no evidence to suggest that any of these medical treatments were prescribed or administered improperly or in error. Dr Simcock has concluded that there is no evidence of any causal association between any of the symptoms which the appellant has received, and the symptoms of which he now complains, and is unable to identify any neurological abnormality. Ms Cairn's report from South Auckland Health refers to the appellant's degenerative condition, but she does not in any way support the conclusion that the appellant's complaints can be attributed to the various treatments he has received. The possibility that the appellant's pain could be in direct consequence to the blow to his head is a matter outside the scope of this appeal, but the conclusion has not been supported by Dr Simcock or any other medical evidence. I would agree with the Review Officer that the appellant was repeatedly investigated neurologically and generally, haematologically and biochemically, including CT scans, X-rays and ECG's. His ears were investigated and all results were normal except for the degenerative spine. The appeal is dismissed. There will be no order for costs. Jane H. Lovell-Smith) District Court Judge