Download Session 5.1 - Medical Reports - Practical Tips

Instructions
You have received instructions from Acme Ltd, a self- insured employer that runs
the Acme Hospital. It rejected a claim for compensation by Ms Scott and she has
filed an application for review.
Ms Scott is a 64 year old woman who works as a nurse at the Acme Hospital.
Your instructions reveal that on 15 April 2016 she submitted a claim form with
an attached medical certificate alleging an injury to her right knee. She has
severe arthritis in her knee joints. She claims that in the week prior to 7 April
2016 she was very busy at work and was spending much more time than usual
on her feet. She claims that at the end of her shift on 7 April 2016, she felt severe
pain in her right knee of a type that she had never experienced before. She took
rostered leave from 8 to 12 April 2016. She alleges that she aggravated her preexisting arthritis in her right knee at work over the period from 1 to 7 April 2016
.The indications are that Ms Scott is genuine. Your client believes that what has
happened is that her arthritis has manifested itself and her complaints have
nothing to do with what happened at work. Your preliminary inquiries suggest
that the week before 7 April 2016 was not especially busy.
If the problem is simply a manifestation of her underlying arthritis your client
wonders whether she is fit to perform her job. If this is going to be an ongoing
problem Acme will need to think about her future and given her age it made
need to contemplate offering her a package.
Acme thinks it would also be helpful to know whether there is any form of
treatment or rehabilitation that might assist in getting her back to work and
whether there are any modifications that it can make to her work that might
help her.
You obtain instructions to get an independent medical report from Dr Smart.
Typical template
Dear (insert name of doctor)
Re (insert name of worker)
We confirm that we act on instructions from (insert name of client).
We confirm that we have made arrangements for you to examine (insert name
of worker) at you rooms on (insert date and time).
(insert brief history)
We enclose by way of background the following material:
(list relevant documents)
Following your examination could you please answer the following questions:
1 Is the injury complained of consistent with the stated cause?
2 Has the worker suffered any, and if so what incapacity for work?
3 If so, what is the worker’s capacity for normal and/or alternative duties at this
time and when do you envisage that the worker will have the capacity for normal
and/or alternative duties?
4 What is the worker’s prognosis and please provide any other information that
you consider could assist in the worker’s rehabilitation?
We refer you to the attached copies of the Supreme Court Rules/Practice
Directions and Expert Witness Rule for your information. Please advise in your
report that you have received a copy of these directions.
Yours etc.
Letter of request based on typical template
Dear Dr Smart
Re Pauline Scott
We confirm that we act on instructions from Acme Pty Ltd.
We confirm that we have made arrangements for you to examine Ms Scott at
you rooms on 2 August 2016 at 10.00 am.
Ms Scott claims that she her right knee at work on 7 April 2016.
We enclose by way of background the following material:
Claim for compensation dated 15 April 2016
Medical Certificate dated 15 April 2016
Copy MRI Report dated 6 May 2016
Following your examination could you please answer the following questions:
1 Is the injury complained of consistent with the stated cause?
2 Has the worker suffered any, and if so what incapacity for work?
3 If so, what is the worker’s capacity for normal and/or alternative duties at this
time and when do you envisage that the worker will have the capacity for normal
and/or alternative duties?
4 What is the worker’s prognosis and please provide any other information that
you consider could assist in the worker’s rehabilitation?
We refer you to the attached copies of the Supreme Court Rules/Practice
Directions and Expert Witness Rule for your information. Please advise in your
report that you have received a copy of these directions.
Yours etc.
Report in response to a typical request
Dear Lawyer
Re Ms Scott
Thank you for your letter of 3 July 2016 requesting a report on Ms Scott.
I saw her at my rooms as arranged on 2 August 2016.
History
Ms Scott told me that she has been treated conservatively for osteoarthritis in
both of her knees since 2011. She said that she was always aware of some pain
in her knee joints, it was tolerable and never interfered with her work as a nurse
at the Acme Hospital. She said in the week prior to 7 April 2016 she was very
busy at work and was spending much more time than usual on her feet. She said
that by 14 April 2016 the pain in her right knee was intolerable and she saw her
GP Dr White the following day and that she provided her with a PMC.
She said that she has not worked since and that if anything, her pain has got
worse.
Examination
On examination she moved with some discomfort when sitting, standing and
moving on the examination bench. There was decreased range of extension and
flexion of both knees.
The MRI scan reported degeneration in both knees.
In answer to the specific questions in your letter:
1 Is the injury complained of consistent with the stated cause?
No
2 Has the worker suffered any, and if so what incapacity for work?
If she is to be believed she is unable to undertake her duties as a nurse.
3 If so, what is the worker’s capacity for normal and/or alternative duties at this
time and when do you envisage that the worker will have the capacity for normal
and/or alternative duties?
If Ms Scott’s arthritis is preventing her from carrying out her normal duties that
incapacity is likely to continue.
4 What is the worker’s prognosis and please provide any other information that
you consider could assist in the worker’s rehabilitation?
Ms Scott has evidence of arthritis in both of her knees. Given the length of time
since she last worked and the persistence of her symptoms my impression is
that there may be other factors contributing to Ms Scott’s disability but I am
unable to state what these might be.
I confirm that I received a copy of the Supreme Court Rules/Practice Directions
and Expert Witness Rule.
A better letter of request
Dear Dr Smart
Re Pauline Scott
We confirm that we act on instructions from Acme Pty Ltd.
We confirm that we have made arrangements for you to examine Ms Scott at
you rooms on 2 August 2016 at 10.00 am.
Ms Scott is employed as a nurse at the Acme Hospital. She is aged 64 years and
has severe arthritis in her knee joints. She claims that in the week prior to 7 April
2016 she was very busy at work and was spending much more time that usual
on her feet. She claims that at the end of her shift on 7 April 2016, she felt severe
pain in her right knee of a type that she had never experienced before. She took
rostered leave from 8 to 12 April 2016. After a brief return to work she claimed
that she was unable to continue working and submitted a claim for
compensation under the Return to Work Act 2014. She alleges that aggravated
her pre-existing arthritis in her right knee at work over the period from 1 to 7
April 2016.
We enclose a copy of the Medical Certificate dated 15 April 2016 that supported
her claim and a copy if a MRI Report dated 6 May 2016.
1 If Ms Scott’s assertion that she was very busy at work in the week prior to 7
April 2016 and was spending much more time that usual on her feet is correct
could that activity have aggravated her pre-existing arthritis in her right knee? If
so could you please explain the mechanism by which that might occur? If not,
could you please explain your reasons for coming to that conclusion?
2 Would your opinion be any different if it is found that Ms Scott was performing
her normal duties at her normal pace without excessive standing in the week
prior to 7 April 2016?
3 If Ms Scott’s pre-existing arthritis in her right knee has been aggravated by her
work, have the effects of that aggravation been spent and if not, are you able to
express an opinion as to when that might occur and whether any form of
treatment or rehabilitation might facilitate that?
4 Ms Scott occupies a senior nursing position at the Acme Hospital. Although she
provides some hands on care to patients by administering medications,
managing intravenous lines and observing patient’s vital signs, much of her work
is conducted in a seated position maintaining records and recording data and
giving directions to junior nurses and nurse aides.
In light of Ms Scott’s underlying arthritis is this work suitable work? Is Ms Scott
currently fit to perform such work? If not, what modifications to her work duties
are required to enable her to return to work?
We refer you to the attached copies of the Supreme Court Rules/Practice
Directions and Expert Witness Rule for your information. It is important that you
familiarise yourself with your obligations as an expert witness and express you
opinion in accordance with your obligations. Please confirm in your report that
you have received, understood and complied with these directions.
Response to a better request
Dear Lawyer
Re Ms Scott
Thank you for your letter of 3 July 2016 requesting a report on Ms Scott.
I saw her at my rooms as arranged on 2 August 2016.
History
Ms Scott confirmed that she is employed as a nurse at the Acme Hospital; that
she is aged 64 years and has severe arthritis in her knee joints. She told me that
in the week prior to 7 April 2016 she was very busy at work and was spending
much more time that usual on her feet.
In addition to the history that you provided, she told me that a number of staff
were on sick leave and that she had to spend much more time doing the hands
on work of a nurse than is usually the case. She said that she began to experience
worse than usual pain in her right knee over this period and that by the end of
her shift on 7 April 2016, she was in severe discomfort. She made no report of
her pain because she had rostered leave the following day and thought that her
pain would subside.
It did not and when she experienced more knee pain upon her return to work.
A few days later she consulted her GP, Dr White who provided her with a PMC
and she submitted a claim.
Ms Scott told me that she has been treated conservatively for osteoarthritis in
both of her knees since 2011. She said that although she was always aware of
some pain in her knee joints, it was tolerable and never interfered with her work
as a nurse at the Acme Hospital. She said that she has not worked since and that
if anything, her pain has got worse.
Examination
On examination she moved with some discomfort when sitting, standing and
moving on the examination bench. There was decreased range of extension and
flexion of both knees.
The MRI scan reported degeneration in both knees.
In answer to the specific questions in your letter:
1 If Ms Scott’s assertion that she was very busy at work in the week prior to 7
April 2016 and was spending much more time that usual on her feet is correct
could that activity aggravated her pre-existing arthritis in her right knee?
I commence by making a general observation based upon my learning and
experience.
Osteoarthritis is a cartilage degeneration disease that is of genetic origin. People
with arthritis often experience some pain when using the affected joint, but that
is not to say that the activity causes damage. Physical activity at work is
frequently associated with fatigue and some pain. That is why we have smoko's
and lunch time and go home at five and come back at nine. This enables the
body to rest and recover. Through rest our muscles relax and that in turn
prevents damage from happening. Moreover, in the case of people suffering
from arthritis, movement and use of the affected joint is recommended. That is
why rheumatologists say to patients with arthritis “use it or lose it”.
In this case Ms Scott does not allege that any particular movements were
associated with right knee pain. It is unlikely that merely standing would cause
such pain. If it did, it would be expected that on rest at the end of her shift the
pain would subside.
I therefore think it is unlikely that this activity aggravated her pre-existing
arthritis in her right knee.
2 Would your opinion be any different if it is found that Ms Scott was performing
her normal duties at her normal pace without excessive standing in the week
prior to 7 April 2016?
For the reasons just explained, no.
3 If Ms Scott’s pre-existing arthritis in her right knee has been aggravated by her
work, have the effects of that aggravation been spent and if not, are you able to
express an opinion as to when that might occur and whether any form of
treatment or rehabilitation might facilitate that?
In my opinion, for the reasons explained, I do not consider that Ms Scott’s preexisting arthritis in her right knee has been aggravated by her work.
4 In light of Ms Scott’s underlying arthritis is this work suitable work? Is Ms Scott
currently fit to perform such work? If not, what modifications to her work duties
are required to enable her to return to work?
For the reasons explained in my opinion Ms Scott’s work is in fact therapeutic
and will benefit her. It is, of course, essential that she have regular breaks. I
would encourage her to return to work as quickly as possible and to facilitate
that I would suggest allowing her to rest when she felt she needed to.
I have read the Supreme Court Rules/Practice Directions and Expert Witness
Rule that you provided and have endeavoured to write this report in accordance
with the duties and expectations of an expert witness.