FIRST REPORT OF MR NICHOLAS HOWARD JENKINS

Transcription

1 FIRST REPORT OF MR NICHOLAS HOWARD JENKINS Dated : 27 April 2015 Specialist Field : Emergency Medicine Claimant : Xxxx Address : xxxx Date of birth : xxxx Age at time of accident : 30 years Marital status : Married Occupation : Ceiling Fixing Dry Lining Worker On the instructions of : xxxx, Solicitors Accident date : xx March 2010 Mr Xxxx was examined on 31 December 2014 at 9.45 am in Cornerstones, 315a Cyncoed Road, Cyncoed, Cardiff. He was unaccompanied during the examination. He did not produce any photographic identification. Name Mr Nicholas H Jenkins Address Cornerstones, 315a Cyncoed Road, Cyncoed, Cardiff CF23 6PD Telephone number nickhjenkins@btinternet.com Reference NHJ/ED/Xxxx, JL Page 1 of 27

2 CONTENTS Paragraph number Paragraph contents Page number 1 Introduction 3 2 The issues addressed and a statement of instructions 4 3 Review of the evidence 5 4 My opinion 15 5 Expert s declaration 19 6 Statement of truth 21 7 Statement of conflicts 22 APPENDICES 1 My experience and qualifications 2 The documents that I have examined 3 Chronology 4 Glossary of medical terms 5 Copy of Letter of Instruction 6 Definition of Disability Page 2 of 27

3 1 INTRODUCTION 1.01 I am Nicholas Howard Jenkins. My specialist field is Emergency Medicine. My qualifications are BSc MBBCh FRCS FCEM MCh. In 1989 I was awarded the Robert Jones Gold Medal and Prize by the British Orthopaedic Association. As an Emergency Medicine Consultant I dealt on a daily basis with the entire spectrum of acute injuries ranging from the treatment of minor injuries to the resuscitation of patients with serious life threatening injuries. Full details of my qualifications and experience entitling me to give expert opinion evidence are in Appendix Summary of the case 1.02(i) The case concerns Mr Xxxx who sustained a neck injury on xx March I have been asked to comment upon that injury. 1.02(ii) There is a chronology of the key events in appendix Summary of my conclusions 1.03(i) This report will show that in my professional opinion Mr Xxxx sustained a sprain of a constitutionally degenerate/arthritic neck in the index accident. 1.03(ii) Whilst Mr Xxxx continues to experience ongoing neck symptoms and in my opinion it would be reasonable to attribute a period of up to three months worth of symptoms to the injury sustained in the Page 3 of 27

4 index accident and any symptoms beyond that period should be considered to be constitutional in origin. 1.03(iii) Mr Xxxx told me that he took a couple of days sickness leave from work as a result of the injury sustained The parties involved Mr Xxxx (Claimant) 1.05 Medical terms and explanations I have indicated any medical terms in bold type. I have defined these terms in a glossary in appendix 4. 2 THE ISSUES TO BE ADDRESSED 2.01 I have been instructed by xxxx Agency on behalf of xxxx, Solicitors, who have requested that I address the issues stated in their Letter of Instruction, xx October I enclose a copy of that Letter of Instruction in Appendix 5. Page 4 of 27

5 3 REVIEW OF THE EVIDENCE 3.01 Documents Minor Injury Unit Notes, xxxx Hospital The documentation below has been summarised from the Minor Injury Unit notes and does not represent my personal opinion (i) The notes indicate that Mr Xxxx was registered in the Minor Injury Unit at hours xx March (ii) Mr Xxxx was examined by an Emergency Nurse Practitioner (ENP) at hours. The ENP noted that Mr Xxxx stated that he had sustained an injury at work the previous day. It was noted that Mr Xxxx had been wearing a hard hat and had walked into a scaffold bar thus jolting his neck. It was noted that Mr Xxxx had not lost consciousness, was not nauseous and had not vomited. Mr Xxxx complained of a mild frontal headache. The ENP noted that Mr Xxxx had no neurological deficit (iii) The ENP noted that Mr Xxxx had no significant previous medical history and took no medication (iv) Examination revealed that Mr Xxxx was alert and orientated. His pupillary reactions were normal and Mr Xxxx complained of no dizziness or blurring of vision. It was noted that Mr Xxxx complained of a mild frontal headache but had not taken analgesia. Examination of the head and neck revealed no obvious swelling or Page 5 of 27

6 deformity. There was no bruising, no wounds and no grazes. There was no bony tenderness of the forehead or cervical spine. There was minimal tenderness of the right sternomastoid muscle. It was noted that there was a full range of movement of the neck but Mr Xxxx s pain was increased on lateral rotation (v) (vi) Neurological examination revealed no abnormality. A diagnosis of a soft tissue injury/neck sprain was made. Mr Xxxx was provided with advice and reassurance. He was advised regarding RICE (rest, ice, compression, elevation) and provided with a written advice card. Mr Xxxx was provided with analgesia and was discharged from the department with the advice to return should there be further problems. Page 6 of 27

7 General Practitioner s Notes The documentation below has been summarised from the General Practitioner s notes and does not represent my personal opinion (i) There are no documented consultations with the General Practitioner in relation to the injuries sustained xx March The first documented consultation following the index accident is dated xx May 2010 and is for an unrelated issue (ii) The relevant pre-accident documentation reads as follows: The notes contain a computer-generated discharge summary from the Accident & Emergency Department of the xxxx Hospital indicating that Mr Xxxx attended the department on xx March 2005 following a road traffic collision when he complained of injuries to the neck and back. A diagnosis of a bilateral neck injury was made. The notes contain an entry dated xx December 2007 when it was noted that Mr Xxxx would be investigated by way of an MRI scan of the cervical spine. The notes do not contain the results of such a scan. The notes indicate that Mr Xxxx was involved in a significant road traffic accident in xxxx when he sustained multiple injuries including fractures of the right elbow, left wrist, the pelvis, the right tibia and the left foot. Page 7 of 27

8 Mr Xxxx consulted his General Practitioner in May 20xx complaining of polyarthralgia. Mr Xxxx has a past history of low back pain (iii) The bundle of notes provided dates from 1971 until 14 September Page 8 of 27

9 3.02 My interview with Mr Xxxx and subsequent medical examination, 31 December Past medical history (i) Mr Xxxx told me that he is normally well and specifically stated that prior to the accident xx March 2010 he had no pre-existing neck problems (ii) Mr Xxxx told me that he had been involved in a road traffic collision approximately five years ago when he sustained various injuries to his lower body Immediate events (i) Mr Xxxx described sustaining an injury whilst working on xx March He told me that he was walking up a ramp wearing a hard hat when the forehead region of his hat struck a scaffolding bar (ii) (iii) Mr Xxxx told me that this caused his neck to jerk backwards. Mr Xxxx told me that he felt physically uninjured immediately after the accident but over the next 30 to 60 minutes experienced a progressive stiffness of his neck and shoulders (iv) (v) Mr Xxxx told me that he reported the accident. Mr Xxxx told me that he attended a Minor Injury Unit the following day from where he was discharged following clinical examination. Page 9 of 27

10 Progress (i) Mr Xxxx told me that he has since continued to experience neck problems (ii) Mr Xxxx told me that he has consulted his General Practitioner on a number of occasions primarily in respect of symptoms in relation to his ankles. He told me that he has mentioned his neck symptoms to his General Practitioner but his General Practitioner has told him that his neck cannot be x-rayed Current symptoms (i) Mr Xxxx continues to experience symptoms in relation to his neck and shoulders and told me that there has been no improvement in his symptoms since the injury was sustained (ii) Mr Xxxx told me that he experiences discomfort in his neck and shoulders especially when working with an extended neck (i.e. looking upwards) and working with his arms above his shoulders (iii) (iv) (v) Mr Xxxx told me that he also experiences occipital headaches. Mr Xxxx told me that his symptoms do not disturb his sleep. Mr Xxxx told me that he experiences a crunching sound from his neck on neck movements (vi) Mr Xxxx did not describe any arm radiation of symptoms nor neurological symptoms. Page 10 of 27

11 Effect on employment (i) Mr Xxxx told me that he took a couple of days sickness leave from work following the index accident but told me that he then returned to work as a result of financial necessity (ii) Mr Xxxx told me that his work involves working with ceilings and thus working with his neck in an extended position with his arms above his shoulders thus exacerbating his symptoms Loss of amenity (i) Domestic activities Mr Xxxx told me that he found difficulty in helping with the housework in the early weeks following the accident (ii) Driving Mr Xxxx told me that he experiences stiffness of his neck when driving. Page 11 of 27

12 Clinical examination, 31 December (i) General (i)a Mr Xxxx was noted to be 6 foot 1 inch tall and weighed 16 stone 1 pound (102.6 kg) (BMI = 29.7 kg/m²) (WHO definition = overweight ) (i)b Neck movements during the anamnesis were spontaneous and apparently pain free (i)c (ii) (ii)a (iii) (iii)a (iii)b Mr Xxxx s gait and posture were normal. Mental State There was no evidence of anxiety or depression. Neck and Shoulders Examination of the neck and shoulders revealed no deformity. Mr Xxxx indicated the paraspinal musculature and the trapezius musculature bilaterally as his site of neck discomfort. He also indicated that he experiences discomfort deep to his scapulae (iii)c (iii)d (iv) (iv)a There was no localised tenderness. Movements of the cervical spine and shoulders were full. Neurological There was no evidence of neurological abnormality. Page 12 of 27

13 Analysis of Evidence (i) Mr Xxxx describes having sustained an extension injury to his neck in the index accident xx March 2010 when he hit the forehead region of his hard hat against a scaffolding bar (ii) Mr Xxxx s injury was documented at the Minor Injury Unit when Mr Xxxx attended the Unit on the day following the accident (iii) Mr Xxxx told me that he has consulted his General Practitioner on a number of occasions in relation to ongoing neck symptoms, although those symptoms are not documented within the bundle of notes provided (iv) The quality of Mr Xxxx s symptoms is typical of the symptoms experienced from a degenerate/arthritic cervical spine and whilst Mr Xxxx stated that he had experienced no neck problems prior to the index accident, I would note that the documentation indicates that he attended an Accident & Emergency Department on xx March 20xx, having sustained a neck injury in a road traffic collision. He was involved in a high speed road traffic collision in August 20xx when he sustained multiple fractures and there is a note in the General Practitioner s notes dated xx December 2007 indicating that Mr Xxxx s cervical spine would be investigated by way of an MRI scan. Page 13 of 27

14 3.02.8(v) Whilst the mechanism of injury described by Mr Xxxx could be expected to result in a soft tissue injury of the neck, such an injury would not be expected to result in protracted symptoms and in my opinion Mr Xxxx s ongoing neck symptoms are a reflection of a constitutionally degenerative cervical spine. Page 14 of 27

15 4 MY OPINION 4.01 Diagnosis 4.01(i) Sprain, cervical spine 4.02 Prognosis 4.02(i) In my opinion Mr Xxxx sustained a sprain of a constitutionally degenerate cervical spine in the index accident xx March 2010 and the clinical course of that injury has been described above. 4.02(ii) Under normal circumstances one would expect the symptoms resulting from such an injury to be short lived however the presence of pre-existing degenerative disease would probably be responsible for the symptoms experienced being of greater magnitude and of greater duration than would have been the case in a patient with a previously normal neck. 4.02(iii) In my opinion it would be reasonable to attribute a period of up to three months worth of symptoms to the index accident but any symptoms beyond that period should be considered to be constitutional in origin. 4.02(iv) In my opinion the injuries sustained would not be expected to alter the natural history of the pre-existing degenerative process. Page 15 of 27

16 4.03 Treatment requirements 4.03(i) Whilst Mr Xxxx s symptoms may be improved by treatments such as Physiotherapy or manipulative therapy in the form of Osteopathy, in my opinion any such treatment would be a reflexion of the constitutional process affecting Mr Xxxx s neck and in my opinion Mr Xxxx will not require any future treatment as a direct consequence of the injury sustained in the index accident Future complications 4.04(i) In my opinion Mr Xxxx s neck injury will not be responsible for any future complications. Page 16 of 27

17 4.05 Note regarding conflict of interest 4.05(i) Mr Xxxx was treated at the Minor Injury Unit of xxxx Hospital which is part of the Cwm Taf Heath Board group of hospitals. I was employed by the Cwm Taf Health Board August 2012 until November Consistency of account 4.06(i) Mr Xxxx answered the questions during the interview in a straightforward manner and I was unaware of any deliberate attempt to exaggerate symptoms or their effects My opinion regarding loss of amenity/disability 4.07(i) Mr Xxxx told me that he took a couple of days sickness leave from work following the index accident and described how the nature of his work has affected his neck symptoms. In my opinion the period of sickness leave described was consistent with the injury sustained and directly attributable to the index accident. In my opinion it would be reasonable to have expected Mr Xxxx s working activities to have exacerbated his symptoms during the first three months following the index accident. 4.07(ii) In my opinion Mr Xxxx s injury will not compromise his future working abilities. 4.07(iii) Mr Xxxx described how his symptoms have affected various aspects of normal daily life and in my opinion it would be Page 17 of 27

18 reasonable to attribute a period of approximately three months loss of amenity to the injuries sustained in the index accident. 4.07(iv) I have referred to the Definition of Disability in Appendix 6. In my opinion the injury sustained has not resulted in a disability. Page 18 of 27

19 5 EXPERT S DECLARATION 1 I understand that my duty in providing written reports and giving evidence is to help the court, and that this duty overrides any obligation to the party by whom I am engaged or the person who has paid or is liable to pay me. I confirm that I have complied and will continue to comply within my duty. 2 I have addressed this report to the court. 3 I confirm that I have not entered into any arrangement where the amount or payment of my fees is in any way dependent on the outcome of the case. 4 I have shown the sources of all information I have used. 5 I have exercised reasonable care and skill in order to be accurate and complete in preparing this report. 6 This report includes all matters relevant to the issues on which my expert evidence is given. I have given details in this report of any matters which might affect the validity of this report. 7 I have not, without forming an independent view, included or excluded anything which has been suggested to me by others, including my instructing lawyers. 8 I will notify those instructing me immediately and confirm in writing if, for any reason, my existing report requires any correction or qualification. 9 I understand that; 1 my report will form the evidence to be given under oath or affirmation; 2 questions may be put to me in writing for the purposes of clarifying my report and that my answers shall be treated as part of my report and covered by my statement of truth; 3 the court may at any stage direct a discussion to take place between experts for the purpose of identifying and discussing the expert issues in the proceedings, where possible reaching an agreed opinion on those issues and identifying what action, if any, may be taken to resolve any of the outstanding issues between the parties; 4 the court may direct that following a discussion between the experts that a statement should be prepared showing those issues which are agreed, and those issues which are not agreed, together with a summary of the reasons for disagreeing; 5 I may be required to attend court to be cross-examined on my report by a crossexaminer assisted by an expert; 6 I am likely to be the subject of public adverse criticism by the judge if the Court concludes that I have not taken reasonable care in trying to meet the standards set out above. 7 I have read Part 35 of the Civil Procedure Rules, the accompanying practice direction and the Guidance for the instruction of Experts in Civil Claims 2014 and I have complied with their requirements. Page 19 of 27

20 8 I am aware of the practice direction on pre-action conduct. I have acted in accordance with the Code of Practice for Experts. Page 20 of 27

21 6 STATEMENT OF TRUTH I confirm that I have made clear which facts and matters referred to in this report are within my own knowledge and which are not. Those that are within my own knowledge I confirm to be true. The opinions I have expressed represent my true and complete professional opinions on the matters to which they refer. Page 21 of 27

22 7 STATEMENT OF CONFLICTS I confirm that I have no conflict of interest of any kind, other than any which I have already set out in this report. I do not consider that any interest that I have disclosed affects my suitability to give expert evidence on any issue which I have given evidence and I will advise the party by whom I am instructed if, between the date of this report and the trial, there is any change in circumstances which affects this statement. Signature... Date of Signature... Page 22 of 27

23 APPENDIX 1 - MY EXPERIENCE AND QUALIFICATIONS Qualifications My qualifications are BSc, MBBCh, FRCS, FCEM, MCh and I am an Expert Emergency Physician. Career Summary I initially pursued an Orthopaedic career, being appointed to the post of Lecturer and Honorary Senior Registrar in Orthopaedics at the University Hospital of Wales in During this period I conducted research into a specific wrist fracture (Colles fracture) which was published as a Master of Surgery thesis in 1989 and for which I was awarded the Robert Jones Medal and Prize by the British Orthopaedic Association in the same year. In 1987 I made a career change into Accident and Emergency Medicine and, after Registrar and Senior Registrar training, was appointed as Consultant in Accident and Emergency at Nevill Hall Hospital, Abergavenny, in I undertook a weekly Fracture Clinic at Brecon War Memorial Hospital until December 2004 and subsequently supervised three follow up clinics per week at Nevill Hall Hospital. One particular interest is that of sports injuries and until October 2001 I undertook a weekly operating list which was primarily concerned with arthroscopic surgery of the knee. In August 2012 I moved to the Royal Glamorgan Hospital. In November 2013 I moved to the University Hospital of Wales where I worked as a Consultant in the Emergency Department of that Hospital until March In addition to my Clinical work I was Vice Chair of the College of Emergency Medicine s National Board for Wales , and Chaired the College s Training Standard s Committee I subsequently undertook the role of Higher Specialty Training Lead for that Committee. I was an Examiner for the Fellowship Examination of the College of Emergency Medicine Page 23 of 27

24 APPENDIX 2 - THE DOCUMENTS THAT I HAVE EXAMINED Minor Injury Unit Notes, xxxx Hospital (2 pages) General Practitioner s Notes (112 pages) Page 24 of 27

25 APPENDIX 3 - CHRONOLOGY xx xx xx xx Attendance Accident & Emergency Department with neck injury following road traffic collision. General Practitioner notes MRI scan cervical spine. The index accident. Attendance Minor Injury Unit. Page 25 of 27

26 APPENDIX 4 - GLOSSARY OF MEDICAL TERMS Lateral aspect Occiput Polyarthralgia Scapula Sternomastoid muscle Trapezius outer aspect back of the head pain in many joints shoulder blade large muscle on the side/front of the neck large muscle of the neck and shoulder girdle Page 26 of 27

27 APPENDIX 6 - DEFINITION OF DISABILITY A person is disabled if s/he has a physical or mental impairment that satisfies the Equality Act (2010) definition that the impact of the disability has a substantial and long-term adverse effect on a person s ability to carry out normal day-to-day activities. Page 27 of 27