“Walking – Mrs Daoud requires assistance in mobilising around her home. This is mainly for reassurance purposes only although on days when her mobility is reduced, she requires assistance at her hips to ensure that she remains balanced inside her base of support. In the short periods in which Mrs Daoud is left alone, she is able to ‘furniture walk’ from her lounge to the dining room where there is a chair which she can rest on. She does not use a walking aid. She is then able to walk a short distance to either her commode or into the kitchen where she can transfer onto a perching stool. When mobilising outdoors Mrs Daoud prefers to have the assistance of one person either side of her rather than to use a walking frame or a wheelchair. She is able to walk with this assistance for periods of up to 10 minutes prior to requiring a rest. She finds this very painful particularly in her left knee. Her daughter states that it is at a very slow pace. Whenever she is mobilising, Mrs Daoud is susceptible to dizzy spells which can cause her to lose her balance. Stairs – Mrs Daoud requires the use of hand rails on both sides and one person in front and behind to prevent her from falling forwards or backwards. She only has to use the stairs to descend in the morning where she is assisted by two carers, and to ascend at night where she is assisted by her family.”
“2. Mrs Daoud attended the consultation in a wheelchair during which she sat as I talked to her family. She did not appear to be in any discomfort. 3. Her daughter and husband helped her to dress and undress. … 7. In the limbs there was poverty of movement of the left limbs but I suspect that this was due to inhibition by pain at the shoulder and hip as there was no evident weakness or change of tone and no sensory loss of corticle inattention. … 8. Although Mrs Daoud attended the consultation in a wheelchair she was able to walk slowly with the help of one assistant. She was unable to walk heel to toe but Romberg’s Test was negative.”
“She is very depressed, moody and lacks concentration. Her memory is very poor and she cannot remember meeting people particularly their faces and names. She was fluent in Arabic and French as well as English but now cannot use her French language and only uses her Arabic partially. … She has loss of balance on walking in view of the weakness of the left sided upper and lower limbs. She lacks confidence with walking and can only walk with help. She is using her wheelchair mainly at present. She is unable to dress or look after herself and therefore needs help with personal hygiene. She is unable to do any housework or cook and feels that she has become housebound.”
“Mr Daoud tells me that recently attempts have been made by the family to wean Mrs Daoud out of the wheelchair by using a rollator which she is now using for standing & walking. … … Mrs Daoud needs help to dress & undress …. She also needs help to go to the toilet & back – I understand that she uses a commode downstairs since the house only has a toilet upstairs. Various adaptations have been carried out to the house. Although there are additional stair rails, she needs help to go up & down stairs.”
“Mrs Daoud tells me that she has pain almost everywhere but the most painful areas are the left shoulder & lower back – whilst the least painful area is the right shoulder. … Both knees hurt particularly when she is going up & down stairs but also when she stands & tries to walk. In general, they are painful all of the time but not specifically when she is sitting. … Mr & Mrs Daoud tell me that she gets out of doors with support & can walk with the rollator for no more than 5 minutes – during which time she suffers dizziness, tiredness & eventually has to stop due to pain mainly in the left knee.”
“She required help to stand up & walk across the carpeted floor by her husband using a rollator frame. She also required help to get onto & off of the examination couch. … I asked Mrs Daoud to stand without support but note that she can only do so for a few seconds – the restriction being related to dizziness as well as pain in her lower back & knees.”
“Vision/Hearing/Speech … 7.6 On questioning, Mrs Daoud said she forgets what she wants to say and to express. She responded in short sentences and her speech was slow. Mrs Daoud’s daughter informed me that, the day of the assessment was a good day and Mrs Daoud was very cooperative and was able to answer my questions. On questioning, she told me if Mrs Daoud was having a bad day, then she would just sit there, hear the questions but is unable to comprehend to respond. On questioning, I was told that Mrs Daoud had approximately 50% good days and 50% bad days, in a week. … Joint Range of Movement / Muscle Strength 7.13 On observation, Mrs Daoud appeared to have restricted neck movements. Her movements were very slow. Mrs Daoud closed her eyes when she was moving her neck and said that otherwise she feels dizzy. 7.14 On observation, Mrs Daoud had restricted movement in her left upper limb. In fact, she did not move her shoulder at all and said it is very painful. She was able to move her elbow, wrist and hand and the movements were very slow and uncoordinated. She told me her left hand was very weak and she does not use it at all due to the pain in her shoulder. 7.15 On observation, Mrs Daoud had restricted shoulder rotational movement in her right upper limb. She had normal movements in her elbow, wrist and hand. 7.16 Mrs Daoud tells me that her left knee gives way. On observation, the movements in her left hip, knee and ankle were fairly restricted, but she was doing it slowly due to general pain and ability. 7.17 Mrs Daoud did very slow movements in her right hip, knee and ankle which is partly due to disuse. She informed me that her right knee also gives way. I was told that Mrs Daoud’s left side is weaker than her right side. Pain 7.18 Mrs Daoud told me that she is in constant pain. She told me that she has pain which radiates up from her back to her neck and her left shoulder. She told me that both her knees are also painful. On a 0 to 10 scale where 0 is no pain and 10 is excruciating pain, Mrs Daoud informed me that her pain level is around 8 with painkillers. …”
“Sitting/Standing/Walking 8.1 Mrs Daoud was sitting on a 3 seater settee. She required assistance to stand up. She was able to walk up to her bedroom downstairs and she walked with a short, shuffling gait holding onto the furniture and then used a Zimmer frame for a short period. Mrs Daoud told me that during the day, she is able to walk around the house; she can walk to the kitchen and dining room. I was told that on a good day, she is taken outside the house, a couple of steps [from?] her front door to get some fresh air. She is also taken out for a drive once a week or so. On questioning, I was told that Mrs Daoud feels dizzy when sitting down or standing up and so someone is usually around to assist her. 8.2 I observed Mrs Daoud negotiate 2 steps; she held onto the banister and the handrail on the stairs and pulled herself up. She did so that one step at a time and found it difficult; her daughter was behind her. I was told that Mrs Daoud’s carer usually brings her down in the morning and Mrs Daoud’s husband or her younger daughter assist her to walk up the stairs. 8.3 On questioning, I was told that Mrs Daoud does not have a wheelchair and does not wish to have a wheelchair because she thinks she looks more disabled in a wheelchair. Transfers 8.4 I was informed that Mrs Daoud, although independent with some of her transfers, feels dizzy and so someone is usually close by or assists her. On observation, Mrs Daoud was assisted out of her chair by her daughter. She was able to get in and out of her bed and sit on the bed, however needed assistance from her daughter to lift her legs up. She also needed assistance to sit up in bed. 8.5 On questioning, I was told that Mrs Daoud is independent with regards to her transfers on and off the toilet. 8.6 I was informed that Mrs Daoud needs assistance to get in and out of the car. 8.7 I was informed that the bath has been taken out and a shower has been fitted for Mrs Daoud and she requires assistance with getting in and out of the shower.”
“19.25 In my opinion, the present care would be very similar to that at the time of my assessment. Mrs Daoud can mobilise from room to room with short, shuffling gait. She holds onto furniture or her Zimmer frame for support. A carer comes in the morning to assist with her selfcare, washing, assisting her to come down the stairs and get her breakfast …. … 19.29 On questioning, I was told that Mrs Daoud is unlikely to accept a wheelchair or any other equipment.”
“8.1 Cognition: Concentration is said to remain poor …. 8.2 Behaviour: Unfortunately Mrs Daoud remains generally anxious, agitated, low in mood, tearful and labile …. 8.3 Physical: Walking remains slow and limited, even with the help of the walking frame. Mrs Daoud complains of pain in her knees and leg, and lower back. She describes the pain as sometimes unbearable, limiting greatly what she can do on a day-to-day basis. I understand that she continues to have a left-sided weakness …. 8.4 Activities: Mrs Daoud spends most of her time sitting in the house watching television. She does manage to coast-walk around the house but there is a degree of risk in her falling. I understand that she is unable to go into the garden alone ….”
“60. I asked Mrs Daoud and her family about the present situation. Mrs Daoud was not really able to engage in conversation. I heard that she had been using a wheelchair though recently a Zimmer frame had been introduced. … 66. … She is able to walk up a corridor. She has been requiring help for more or less every activity ….”
“82. It was very difficult to assess limb power but I got the impression that limb power in fact was either normal or near-normal on the left side compared to what was a left hemiplegia initially. The same applied with regard to leg movement. All movements were very limited by slowness and possibly reduced motivation to move …. 83. She was in a wheelchair throughout but was able to stand with help but was so unsteady on her feet by what I thought was more an anxiety of her situation but it was not possible to actually test her balance in any way.”
“5.3 Sherihan feels her mother’s worst problem is the pain, and the cognitive deficit with very poor memory and concentration, problems with word finding, and severe mood swings. … Mrs Daoud … complains of pain in the left shoulder, her lower back, and her left knee, she also avoids using her left arm because she is fearful of making pain in the shoulder worse. 5.4 Sherihan informs me that her mother attended the Pain Clinic for the first time about two weeks before our meeting …. 5.5 Sherihan feels her mother is at her best two days a week when her father is not working or when they are all at home ….. 5.6 Mrs Daoud got up from the sofa with some difficulty pushing up on her feet and her right hand, and she avoids using her left arm. She got up slowly and steadied herself on the mantelpiece before walking very slowly with a shuffling gait, supporting herself on furniture and the walls with her right arm. She then used her frame which she keeps in the study/second reception room. After Mrs Daoud walked the short distance from the sitting room to the breakfast room she was clearly exhausted, and rather breathless. 5.7 Mrs Daoud is always shadowed up and down the stairs and goes up right leg first very slowly dragging her feet, and has a break on the way up …. 5.8 During our conversation Mrs Daoud nearly fell over in the hallway, partly because of problems with balance and dizziness but also because a rug needs to be stuck down, or preferably removed to prevent her tripping over it. … She has lost her balance and fallen trying to stand up as she was giddy, and more recently was distracted and fell when Sherihan was walking her out to the car.”
“6.1 Mrs Daoud goes to bed at the same time as her husband between about 11 and 12 midnight. Mr [Tadrous] walks behind her up the stairs, along the landing and up the step to the bedroom. She sits in the side of the bed and her husband helps her to undress and put on her nightdress. She can get into and out of bed and stand supporting herself on a zimmer frame, but she walks in pain and finds it difficult to reposition so sometimes needs help at night. … 6.4 Mrs Daoud can walk from the sitting room to the breakfast room to use the commode during the day. … 6.5 … She showed me how she can make herself a cup of tea but she cannot carry anything as she feels unable to stand or walk unaided. 6.9 Family between them try to take Mrs Daoud out for a drive or short walk most days, which is dependent on how she is feeling. When Sherihan visits her mother mid week she tries to take her out, when Mrs Daoud will use a rollater frame, and supported by Sherihan walk very slowly for 10 to 15 minutes, but she is very fearful of crowds.”
“1. The account of Mrs Daoud and her family Mrs Daoud and her family do not feel that there has been any significant change in her symptoms over the last two and a half years. They feel that they have learned to adapt to her disability. She has a number of continuing problems. a) Physical disability Mrs Daoud’s mobility is still significantly limited. She is able to walk with a three-wheeled frame perhaps 100 yards on the flat. She requires the use of a wheelchair for longer distances. She manages stairs with aids. Mrs Daoud and her family find it difficult to define why she continues to have limited mobility. They feel that an element of this relates to low back pain, an element to poor coordination, and an element to dizziness. They also recognise that an element relates to anxiety about the possibility of falling, although she has had no further falls since the time of discharge. Right upper limb function is normal. She still has some difficulty holding a cup and drinking with her left hand. She cannot feed herself with her left hand. …”
“Examination of the limbs revealed rather variable increase in tone in the left sided limbs, with normal tone at times. Examination also revealed rather variable weakness in the left sided limbs. Examination of the left upper limb was limited because of pain around the left shoulder, but full power was obtained at times. Examination of the left leg revealed full power at times. … She walked with a three wheeled frame with rather short steps.”
“Presenting Problems … Functionally she has severely impaired mobility and is cared for by her family …. Environment … The existing accommodation does not suit Mrs Daoud’s needs. The stairs are a particular hazard and, given that Mrs Daoud is at risk of falling, the use of the stairs is fraught with danger. Given that she climbs the stairs under close supervision of her family, if she was to fall they would be unlikely to stop her and there could be severe consequences of serious harm to Mrs Daoud and family members. … Chair Mrs Daoud has significant problems sitting from standing; she was sitting on a low, deep sofa in the lounge on the visit. She struggles to stand due to pain in her back, left side and due to the dizziness she experiences …. … Mobility Mrs Daoud walks around the home using a Zimmer walking frame, or furniture and she walks holding on to things or she holds onto her family. When she walked through to the dining room on the assessment she held the therapist’s arm. She walks very slowly and is anxious that she could fall due to her dizziness. Mrs Daoud avoids movement to avoid the risk of falling, this is very disabling. Mrs Daoud goes out 2 to 3 times a week with her family in the car, but she finds places with crowds difficult to handle like shopping centres, and including church. She uses a 3-wheeled walker outside …. There is a wheelchair for outdoor use if required. Stairs … Mrs Daoud only climbs the stairs twice a day, down in the morning and up again in the evening. The family are very concerned that Mrs Daoud could fall on the stairs and there have been some close calls re falls. The family shepherd/ shadow Mrs Daoud on the stairs with one person above and below her on the stairs ….”
“4.1 … She walked very slowly into the room with an aide.”
“[Mrs Daoud] has significant mobility problems. She suffers constant pain. … She is totally dependant on others for most day to day activities. She will never work again. She needs constant care and attention. She needs specially adapted accommodation. … The Defendant is referred to the attached medical reports on condition and prognosis.”
“34. My mum can only move her left arm about halfway up and has no grip. We exercise her by trying to get her to hold a mug, for example. She also has problems with her hip, in fact, as I have said, the whole of her left side is weak. Her range of movement is limited and she suffers a great deal of pain. … … 50. She is in pain pretty much all the time, on a daily basis,and we try to control this with painkillers. This seems to be reasonably effective, but it does not help mum with the problems she has of weakness and lack of mobility. … 60. We also try to keep her as physically active as possible. We get her to do exercises to keep her joints mobile and we make sure that she walks every day, even if it just for 10 minutes. When she does go out for a walk, we must make sure that it is a quiet time of the day, as she gets disturbed by lots of people, by traffic, etc. … 62. My mum and dad’s house is rented from the Church. It is a small, 3-bedroom, terraced house and it is difficult for my mum to get around, not only because of the stairs, but because there are also steps between some of the rooms. To get from mum’s bedroom to the bathroom, you have to go down a sizeable step, which she sometimes forgets about and trips over ….”
“36. Mum’s daily routine is that she tends to sit on the sofa most of the day. She still only really feels safe going out with dad. As I have said, she will go out with us, but is more anxious. She will not go out with other people who help, such as her friends from church and we are not to[o] confident about her going out with her sister …. … 44. Physically, her mobility is very poor. She is in a lot of pain and she is weak down her left side. For example, we have to cut her food up for her and she just uses a [fork] in her right hand. She is in a lot of pain on a daily basis; you can tell when she tries to move, but does not like to show it. She also gets very frustrated. 45. When she first came home, there was some improvement in her condition. However, I would say that there was no great improvement in her mobility or the physical aspect of her condition, but there was definitely an improvement in her mood and the emotional aspects. Emotionally, she feels safer. Physically we do try and make her move and walk, but she only tends to respond to us and does not really listen to the carers, for example.”
“29. Our house is quite small. It is difficult for my wife to walk very far, partly because, I think, she has lost her confidence, but also partly due to her physical pain and disability, such as the fact that she is generally weak down her left side since the accident. She also finds it very difficult going up and down stairs; we always try and make sure that one of us is with her when she is on the stairs as she has fallen a number of times in trying to get up and down them. There are also steps, e.g. between the bedroom and the bathroom, which are difficult for Thereza. … 31. Thereza cannot really carry out even the simplest of normal, everyday tasks, like making a cup of tea or cooking anything. The girls and I do all of the cooking. 32. Thereza’s present condition is that she still suffers a lot of pain, especially in her lower back. She cannot move her left arm properly at all and so she cannot shower or dress herself etc. She gets dizzy every time she gets up or gets out of bed. She cannot walk very far; she gets tired and out of breath and has had a few falls.”
“23. The Claimants’ case involves contrasting the assertions about Mrs Daoud’s mobility to the experts and in the witness statements with what is seen on the DVDs. The Defendants have failed to produce an explanation for the chasm between the two. When this contrast is made there can be no explanation for it other than that Mrs Daoud and the Defendants conspired to give a wholly false account and impression of the sequelae of Mrs Daoud’s injuries. A person in the condition asserted in the original claim would be entitled to very substantial damages; a person in the condition seen in the surveillance evidence would recover only a small fraction of such damages (as, indeed, eventually happened). The Defendants’ only motive can have been dishonest financial gain. 24. The issue for the Court – which is one of fact – is whether the Defendants’ descriptions and presentations of Mrs Daoud’s mobility was so exaggerated as to amount to criminality. 25. As stated above, the Claimants’ focus is on Mrs Daoud’s locomotor abilities. This is because the contrast can be proved so straightforwardly for the purposes of this application. However, the Claimants make it clear that they do not accept for one moment that, by the time the DVDs were recorded, Mrs Daoud was suffering anything like the severity of the other sequelae also alleged. The parts of Mrs Daoud’s presentation the Claimants dispute are ‘sidelined’ in the reports in the first two trial bundles. Although these aspects do not form part of the pleaded case against the Defendants and are not essential to the finding of contempt, the Court will be invited to find that the whole claim was exaggerated grossly beyond anything conscionable. What happened went way beyond the product of an injured person’s and her family’s natural anxiety to see that she was understood; it went firmly into criminality.”
“The party arrived early in London and spent time window shopping and visiting a café. No sign of disability is seen. Then, when Mrs Daoud arrived in a street around the corner from Dr Gill’s consulting rooms in Harley Street, a walking aid was produced from the boot of the car. Mrs Daoud, with the connivance of the First and Third Defendants, used it to hobble as if seriously disabled in and out of the building where the examination took place. This sequence shows beyond doubt that the presentation to the experts in the original proceedings was a sham.”
“… On those occasions where my mother has been feeling highly stressed, pressured or nervous, and the only real instances I can think of of her being upset to this degree are when attending medical appointments, she will insist on using one of her walking aides [sic] ….”
“The ideal for the family would be for Thereza and me to move nearer to Sheri in Guildford and to bring the family back together again. This would also help Meri in travelling to, and working in, London. Ideally, I would like to be able to retire and look after my wife 24 hours a day, which would be easier for everyone and I believe that she would improve more quickly. However, as I have said, I cannot leave my job because we need the money.”