"Examination shows that the pain is mostly localised to the sacral area of the spine. There is tenderness in this area. Movements of the lumbosacral spine are restricted and painful and there are no neurological deficits in either lower extremity. SLR is 80° on both sides. X-rays of lumbosacral spine do not show any bony injuries. X-rays of sacrum and coccyx also do not show any evidence of bony injury. I have, therefore, advised her to attend for a course of physiotherapy. This will be ultrasonic therapy and some back exercises. I have told her that the pain could take some time to settle. She could obtain a ring cushion to sit on for her own comfort."
"[She] ..... sustained a soft tissue injury to the sacro-coccygeal junction of her back in a fall on6 December 2000 ..... [She] has never returned to work as a clerical officer. She continues to have pain over the sacro-coccygeal area. She finds it difficult to sit for more than twenty to thirty minutes. She uses a ring when sitting for prolonged periods. Clinical examination today shows that she has a flat back with loss of the natural curvature of the spine. There is a satisfactory range of back movement and she remains acutely tender over the sacro-coccygeal area. There is no abnormal neurology in her legs."
"Symptoms can usually be improved by hydrocortisone and local anaesthetic injection to the sacro-coccygeal area. This may have to be repeated a total of three times. It is an unpleasant injection to have without a general anaesthetic. It is kinder to give a short general and inject the hydrocortisone more accurately."
"I think with this treatment her remaining symptoms would slowly settle over the next six months and she would be able to return to her previous job and to her previous social activities."
"Thank you for your letter of 28 March with enclosure. Nobody can guarantee success with any surgical procedure. No patient can be forced to have treatment and it is reasonable under those circumstances to decline the suggested sacro-coccygeal injections. We shall arrange to see her for a further medical report in June/July 2002."
"She is wary of any hydrocortisone to the sacro-coccygeal area. She appreciates there is no guaranteed success with this treatment."
"Mrs Edmonds has made the decision not to proceed further with any hydrocortisone injection as the results cannot be guaranteed to be successful. One can only respect her decision. I think she is now left with permanent residual symptoms. I would not expect any significant improvement at this stage. However there should be no deterioration in the long-term either."
"1 I would have thought there would be a 50% chance of significant improvement with the proposed injections to the sacro-coccygeal area. 2 I would put the rate of no improvement at 20% and the rate of temporary improvement for up to three months as 30%. 3 The success rate tends to deteriorate the longer symptoms are present. I base the percentage success rate on a series of three injections, probably given at about six weekly intervals."
" ..... I needed to go away and think about it and discuss it with by husband and with my GP, and I also discussed it with friends. But when I discussed it with my GP he more or less said that he didn't think that I would benefit from it, or if I did it would be very, very short term. I must admit I was very nervous about these injections and I heard a few stories from friends that they hadn't worked on other people. My own GP didn't think that it was a particularly good idea. So, on that - and my nervousness of them - I decided not to go ahead."
"Q He said he could not guarantee ..... A Yes, he did he said that. When I'd gone up to his offices and I asked him, I said that I had had a word with by GP and I asked him could he give me any guarantees, and he said 'No, no.'"
"It was the fact that this injection might not work that kept you from having it."
"To be honest it's probably a number of reasons: the fact of being injected into my spine doesn't fair very well with me; the fact that my GP didn't give it his full consent, if you like, or what; and friends that I had spoken to had more of a negative response to it than a positive. So, it was a combination of things that really made me decide against it in the end."
"A Well, if I haven't it was an oversight on my part, but to turn the injections down wasn't something that I took lightly. I would not just take it on friends' advi[c]e. I had to speak to my GP who knows what I've been under for some time and who knew my condition because he had already referred me to a doctor in, a specialist in Dartford Hospital, I think it was. And after seeing that specialist he, himself, never - I mean it didn't come up - but he never recommended to have that injections or anything. All he recommended was for me to have physio."
"A ..... the thought of injections, and I was just worried. At that stage I hadn't seen my doctor so I hadn't really discussed it, except possibly with my husband about whether it would be good or not. I was just nervous about it."
"A ..... there's a lot of drugs I can't take, that I have a very bad reaction to, and I think it seems so pertinent maybe having an injection in your spine and not knowing what the reaction would be, you know. I was just concerned about it until I could speak to my GP."
"Q. You told us that he was not very enthusiastic about them? A. No, no, he wasn't. I've been seeing Dr Patel for some time and he knew my condition and I wanted his opinion of the injections. And, in his opinion, he didn't think that they would have a good long term effect."
"She was also concerned that there was no guarantee of success. But I have already said that there can be no guarantee of success for any surgical procedure."
"16 The only medical evidence in the case is that of Mr Osborne who thinks that Mrs Edmonds could have been back at work by June 2002. I think that a 50 per cent chance of significant improvement is a high percentage. Certainly a 20 per cent chance of no improvement is not such as to make it reasonable as to reject the treatment. Mrs Edmonds wanted to return to work. One would have thought that she would do everything in her power to try and get better as quickly as possible. 17 Mr Hillier has persuasively tried to submit that the defendants have not proved that Mrs Edmonds acted unreasonably. But persuasive though those submissions appear to be, I do not accept them. Mr Osborne gave very clear advice. Mrs Edmonds preferred the opinion of her GP and does not appear to have asked to see her treating surgeon again. She is not required to nurse the interests of the tort feasor, she is only required to act reasonably. I do not think that she has done this. 18 Accordingly, I hold that she has failed to mitigate her loss."
"The percentage of no improvement having been put at 20 per cent means that there is that small chance that the whole process would fail. But it is clearly Mr Osborne's position that she would have been able to return to work by June 2002."
"Then it is said that within days she was talking to her line manager and expressing her concerns and worries and she went to her GP."
"As described by Mrs Edmonds in the witness box, she said that the GP did not give full consent. She also said that he did not think it would be of benefit and she was nervous about it. There is no evidence from her general practitioner. Even if there was I would plainly have to prefer the opinion of Mr Osborne, who is a consultant orthopaedic surgeon, over the view of the general practitioner."
"I think that a 50 per cent chance of significant improvement is a high per cent."
"It is that Mrs Edmondsunreasonablyrefused to seek alternative jobs, or at least did not try hard enough. I though on the evidence that the claimant was on stronger ground as to this point, and I indicated as much to Mr Hillier. In the result it is unnecessary for me to form a view on it because of the view I have formed about the treatment point. Accordingly, I have not heard submissions from the defendants on that matter."
"Well, I needed to go away and think about it and discuss it with my husband and with my GP, and I also discussed it with friends. But when I discussed it with my GP he more or less said that he didn't think that I would benefit from it, or if I did it would be very, very short term. I must admit I was very nervous about these injections and I heard a few stories from friends that they hadn't worked on other people. My own GP didn't think that it was a particularly good idea. So, on that - and my nervousness of them - I decided not to go ahead."