Richard Mark Abada (Plaintiff/Appellant) v 1. James Gray and Another
| Jurisdiction | England & Wales |
| Judge | LORD JUSTICE HUTCHISON,LORD JUSTICE MUMMERY,LORD WOOLF, MR |
| Judgment Date | 25 June 1997 |
| Judgment citation (vLex) | [1997] EWCA Civ J0625-19 |
| Court | Court of Appeal (Civil Division) |
| Docket Number | QBENF 96/0008/C |
| Date | 25 June 1997 |
[1997] EWCA Civ J0625-19
IN THE SUPREME COURT OF JUDICATURE
IN THE COURT OF APPEAL (CIVIL DIVISION)
ON APPEAL FROM THE QUEEN'S BENCH DIVISION
(MR ROGER TITHERIDGE QC (Sitting as a Deputy High Court Judge))
Royal Courts of Justice
Strand
London WC2
The Master of The Rolls
(Lord Woolf)
Lord Justice Hutchison
Lord Justice Mummery
QBENF 96/0008/C
MR C GARDNER QC with MR S BRILLIANT (Instructed by Withy King & Lee, Bath, BA1 2JE) appeared on behalf of the Appellant.
MR S MILLER QC with MISS M BOWRON (Instructed by Wood Awdry Wansboroughs, Devizes, Wiltshire) appeared on behalf of the Respondents.
The appellant Richard Abada was seriously injured in a road accident on 11th January 1984 when he was almost 20 years old. His physical injuries consisted of a dislocation of the left shoulder; the complete dislocation of the fifth lumber vertebra onto the first sacral segment; and a fracture of the spinous process of the fourth lumber vertebra. The dislocation of the fifth lumber vertebra was not diagnosed and treated until 7th March 1998, after the plaintiff had suffered much pain and anxiety. He has considerable permanent physical disabilities as a result of these injuries.
On 5th August 1984 the plaintiff was diagnosed as having acute schizophrenia. He still suffers from this severe mental illness, which is treated by drugs which have in turn caused the development of epilepsy for which also he needs drug therapy.
The plaintiff brought proceedings for damages against the driver of the vehicle in which he had been a passenger and later joined the Motor Insurers Bureau and the Salisbury District Health Authority. Some agreement was reached between the driver and the M.I.B. on the one hand and the Health Authority on the other, which enabled the claim to proceed against the driver and the M.I.B. alone, and from an early stage liability for the accident was admitted.
The plaintiff's claim, as amended, included the assertion that his schizophrenia had been caused by the accident and its after-effects. The contention on his behalf at the trial, which took place in October 1995 before Mr. Roger Titheridge Q.C. sitting as deputy judge of the High Court, was that the schizophrenia had been caused by a series of stressful events beginning with the accident itself and all attributable to it. These occurrences, to which I shall return, were referred to by the doctors as "life events", a term which the judge defined as meaning "events that cause stress [or] anxiety greater than the anxiety caused by minor troubles and tribulations of everyday life …. Adverse life events is probably a better expression". The principal issue the judge had to determine was whether on the balance of probabilities the schizophrenia had been caused by the accident. The importance of this issue was that if causation were established the plaintiff would be able to recover much larger general damages (which would include damages for schizophrenia and epilepsy); and further that, if it were decided against him, his claim for past and future loss of earnings would substantially fail because, whatever the disabling effect of his physical injuries, his schizophrenia would anyway have prevented him from working.
The judge, who heard conflicting evidence from four distinguished psychiatrists and was shown other medical reports and records relating to the plaintiff and whose attention was drawn to a large number of articles and other publications on the subject of the causation of schizophrenia, found that the plaintiff had not established that his illness was caused by the accident. It is that finding which is challenged in this appeal.
In order that the basis of the challenge to the judge's conclusion can be understood, I must say something about the nature of (i) schizophrenia, (ii) the life events relied on and (iii) the divergent views of the four medical witnesses.
(i) Schizophrenia
The illness is characterised by fundamental distortions of thinking and perception and by inappropriate blunted mood. The symptoms, which involve a wide range of cognitive and emotional dysfunctions thought to be indicative of fundamental brain dysfunction, may include delusions, hallucinations, disorganised speech, grossly disorganised behaviour and catatonic behaviour and diminution or loss of normal functioning. Depending on the symptoms exhibited, the illness is classified under a number of subtypes—paranoid, disorganised, catatonic, undifferentiated and residual -symptoms of one or more of which may be seen in the patient either simultaneously or sequentially. I need say no more about symptoms because the diagnosis was not in issue in this case. What was in issue was the aetiology of schizophrenia.
Family, twin and adoption studies have established beyond reasonable doubt that schizophrenia or the liability to develop schizophrenia is genetically transmitted, though as to the mode of transmission there remains scope for differences of opinion. The studies referred to have shown that the appropriate lifetime expectancy of developing schizophrenia for relatives of schizophrenics is as follows:
| Relationship. | Percentage Risk |
| Parent | 5.6 |
| Sibling | 10.1 |
| Sibling-one parent affected | 16.7 |
| Children | 12.8 |
| Children-both parents affected | 46.3 |
| Aunt, uncle, nephew, niece | 2.8 |
| Grandchildren | 3.7 |
| Unrelated | 0.86 |
Further confirmation of the theory of genetic influence is provided by studies involving adopted children (which have shown that the risk of development of the illness in such children was consistent with the figures stated above, which tends strongly to negative the idea of environmental influence). And in studies of twins it has been shown (where one twin has developed the illness) that in non-identical twins, the risk for the other twin is not significantly different from that in the case of ordinary siblings whereas in identical twins, who share the same genes, the risk is as high as 46%.
That those developing schizophrenia have a genetically based predisposition to develop the illness was not disputed by the medical witnesses: and three of them (Dr. Swan and Dr. Davison called by the plaintiff and Dr. Reveley one of those called by the defendants) were in agreement that something more was necessary to convert the predisposition into the illness. The essential differences of medical opinion centred on whether life events can have that effect and, if they can, whether they did so in this case. I shall return to this aspect of the case in (iii) below.
(ii) Life events
I can deal with these quite briefly, because it was conceded by Dr. Cutting, one of the experts called for the defendants, that if the plaintiff's case as to the aetiology of schizophrenia was accepted, then the life events which he had experienced were such as would have engendered very high stress levels and on the basis of which it would have been open to the judge to conclude that they were a causative factor in the plaintiff's development of schizophrenia. The judge found that the plaintiff had experienced the following sequence of adverse life events in consequence of the accident:
(a) The trauma of the accident itself, in which he had been trapped in the overturned car and seriously injured.
(b) The severe pain resulting from the undiagnosed L5 dislocation.
(c) The stress of hospitalisation in January and March 1984, exacerbated by his dislike of hospitals stemming from unhappy experiences he had when admitted to hospital as a very young child.
(d) Because of his strange gait resulting from accident-induced deformity, he was subjected to ridicule by youths in the neighbourhood with the result that he had by July 1984 become increasingly reclusive.
(e) Worries occasioned by the dilemma as to whether to agree to submit to corrective surgery. I should mention some dates. The plaintiff's serious spinal injury was diagnosed by Mr. Carvell, an orthopaedic surgeon, on 7th March 1984 and the plaintiff was admitted to Odstock Hospital for bed-rest and traction. On 9th and 11th March Mr. Carvell discussed the possibility of operations for internal fixation followed by spinal fusion, explaining the potential advantages of and the risks inherent in such treatment, and advising him to have the operation. The plaintiff refused, and left hospital in mid-March, but the question of whether he should have an operation remained live. In April Mr. Carvell wrote to the plaintiff's G.P. saying that any future surgery would have to be done at Southampton and on 25th July Mr. Carvell saw the plaintiff and his parents and again discussed the pros and cons of an operation, about the advisability of which by then it seems Mr. Carvell was much more doubtful, though the plaintiff himself was more amenable than he had been to the idea. It was arranged that the plaintiff should be referred to another surgeon at Oswestry.
The judge summarized his conclusions about all above matters in these words:
…..the stress of the accident, the pain that followed, his reaction based largely in my judgment on his personality to hospital treatment, what he was told about the possibility of an operation, first of all in March then repeated in July, all this must have been a matter of stress for anyone. So it is that I accept that there were stressful events in the period from January to August, and that those events all stemmed from the accident.
(iii) The conflict of medical evidence
What follows is not intended to be a detailed review of the...
To continue reading
Request your trial