“We agree that the average 53.2 year old man can expect to live 30.5 more years. We agree that the life expectancy of the claimant is reduced. We agree that the particular combination of problems in the claimant makes arriving at a life expectancy figure for him difficult. We agree that the life expectancy of the claimant is influenced by his spinal cord injury, his head and related issues, his intrapulmonary problems and tracheostomy, bronchiectosis and pulmonary fibrosis complicated by respiratory failure requiring continuous oxygen therapy, 4 litres a minute, and age-related deterioration of pulmonary function. We agree that all spinal cord-injured persons, especially low tetraplegics, have respiratory compromise. We agree that the claimant has a worse respiratory state than the average tetraplegic. Professor Woods and Dr Hind agree that the factors that make his respiratory state worse than the average tetraplegic include respiratory failure predominantly due to his pulmonary fibrosis, bronchiectosis, requirement for nebulised bronchodilator therapy, tracheostomy and risk of aspiration.”
“In a situation such as Mr Rowe a clinical assessment based on experience but guided by the available published evidence must be a key facet.”
“At a relatively late stage in proceedings Dr Hind produced reports of research in new material which appeared to show that in the sample to which it related there was a starkly reduced life expectancy. One of the main issues between the experts was the extent to which the new material was relevant. Mr Gardner had seen the claimant on three occasions: in December 2003, August 2006 and June 2007. He described what in his view were positive features, for example good housing and medical care, and negative features, for example the respiratory risks. He had experience in these features from patients with spinal cord injuries who also had severe respiratory difficulties. Although he could not treat the respiratory disease, his experience enabled him to assess the extent to which it contributed to reduced life expectancy. He acknowledged that he had few patients who were receiving oxygen therapy of 4 litres per hour. Like the other experts he also accepted that the claimant had suffered from at least one chest infection since moving to Broad Lane although he described it as well-handled. Professor Woods had seen the claimant on two occasions in January 2004 and May 2007. He had also seen chest X-rays and CT scans. When he had first seen him the claimant was suffering from repeated life-threatening chest infections. When he saw him in 2007 these had decreased. His respiratory problems were the consequence of trauma caused by the accident and were not progressive conditions, as could be seen by comparing the CT scans of 2000 and 2002. It was for this reason that he doubted the utility of the new material which related to patients with degenerative disease. Like the other experts he was unable to say what the claimant’s need for oxygen was because it could not be measured. He agreed that there would be deterioration in lung function and that the effect of aging would be added to this. Dr Hind had seen the claimant on one occasion in July 2007. He has wide clinical experience of patients with pulmonary fibrosis and bronchiectosis and patients on long-term oxygen treatment, including at rates of 4 litres per hour. The claimant had lost a huge amount of lung function and was now dependent on oxygen. He had assessed the claimant’s life expectancy on the basis of what he considered to be the natural history of the lung condition and on his experience of patients with long-term oxygen therapy and on the new material, including the Fletcher curves. In his view the Fletcher curves which predicted the life span of patients illustrated the starkly reduced life expectancy of those with severely reduced lung function. These were patients who, like the claimant, were not smoking but were nevertheless subject to the accelerated aging process of those who had reduced lung capacity. No amount of nursing care could make up for the loss of lung function which the claimant had suffered -- such patients lived for years and not decades. He was totally dependent on others for his care. Dr Hind acknowledged that he was viewing the matter from the point of a respiratory specialist that said that a claimant’s problems were respiratory not neuro-respiratory. He accepted that the prognosis was better since the move to Broad Lane but said that he would have predicted a shorter life expectancy than three to five years before the move. He also accepted that the claimant had outlived his expectations. Professor Barnes had seen the claimant on two occasions in July 2005 and July 2007. He has no specific experience of treating lung disease of the type but approached the issue on the basis that there was an overlap between neuro-respiratory and respiratory disease.”
“It seems to me that Dr Hind’s view is over-pessimistic. It places too much emphasis on his experience of patients with degenerative respiratory disease and on the new material which relates to degenerative disease. The claimant does not suffer from such a disease. It also gives insufficient weight to the nature of the claimant’s spinal injuries and the overlap with the neuro-respiratory experience of Mr Gardner and Professor Barnes. I am also troubled by the way in which Dr Hind reached his figure of three to five years. His inability in the witness box to explain how he had reached this figure by reference to the Fletcher curves undermined my confidence in his method.”
“It also seems to me that the other experts had not paid sufficient regard to the fact that the claimant has, in the words of the joint statement, ‘a worse respiratory state than the average tetraplegic’. Although each of Mr Gardner, Professor Wood and Professor Barnes had considerable experience of treating respiratory conditions associated with spinal injury they had not, in my judgment, taken fully into account the particularly serious and specific problems in relation to his respiratory system and the problems that this was likely to cause to him in the future, in particular with chest infection.”
“Q[Miss Gumbel]: Can I ask you, Dr Hind, what we are simply having difficulty with, because this is not something attached to your report or explained in your report, is your working calculations. You have not produced those. You have produced these curves and we can look at it and see how you might have done it but we cannot see your working documents. Have you got your working documents? A: How do you mean? The scrap of paper? No I haven’t, I’m sorry, no. Q: It was a scrap paper,was it? It was not a computer programme or mathematically? A: No. I am afraid on paper. Q: It was simply done by drawing the curves by eye? A: Well we also know roughly how the line declines with age. Yes. Q: But what we are having great difficulty with is seeing how you get the 3 to 4 simply by drawing the line from… A: 3 to 5. Q: 3 to 5, I am sorry. From the sparse information on this chart I simply cannot see how we can accept that that is what that result is without seeing it. I am sorry to be difficult about it but this is the first time we have seen it. A: Yes.”
“Well, I think the answer is if you don’t have the scrap of paper, however you describe it, I am not sure that the matter can be taken very much further. I think it’s probably a matter for submission.”
“It seems to me that if this were a case where the claimant were to receive 100% of his damages the decision might be more finely balanced but he will not. If there is an order for periodical payments he will never be able to live his life as he wishes to live it and with the significant improvements noted by the experts, whereas if a conventional lump sum is ordered he will be able to do so for a substantial part of his life.”