“There are cases where, as a matter of justice and policy, a court should say that the evidence adduced (whatever its type) is too weak to prove anything to an appropriate standard, so that the claim should fail.”
“George is a 47 year old gentleman who was involved in an industrial accident five weeks ago. He was exposed to Stainless Steel and Cast Iron welding fumes and as a result spent five days in hospital. He suffered permanent damage to his lungs which are now reported to be 12% effective. One week ago George’s partner had noticed some odd behaviour which has declined since. His personality has completely changed as he is showing signs of regression to a childlike state. His partner reports childlike behaviour making childish noises and gestures and also talking incongruously like a child. His mood has become increasingly (unsure) as one minute he is laughing and then he suddenly starts to cry. This was evident during the assessment. Most information as listed from his partner as he didn’t have the capacity to fully understand (sic) and respond to questions asked. After medical review the A&E doctor stated his presentation is not directly due to his accident. All medication has been prescribed therefore it will require further ongoing psychiatric assessment to acquire a diagnosis. This onset has been noticeable and from information from his partner he was fully functioning prior to the accident and until a week ago his mental state was normal. George is becoming increasingly frustrated due to his limited functioning since the accident and has harboured feelings of guilt as his partner has had to take on a high work load. As a result they have had to sell their house in Bolton and move into their business in Burnley for practical reasons. George’s sleep pattern has been disturbed and he is not sleeping well. He has also become despondent as he is normally a high functioning person scuba diving around the world, managing a cattery and kennels, keeping horses for shows and working as a welder. He was well liked and very active. Since the accident he has been told he will never partake in these activities again and his business and horses will be sold. I believe that this acute level of stress has severely impacted on George’s mental state and attributes to his current presentation. He also continually repeated during the session that he would be returning to work tomorrow. He showed no insight into his current presentation. If he sees steam or smoke it triggers agitated and frightened behaviour possibly related to experiences of accidents.”
“George has had many major life events recently which he has struggled to cope with. His presentation appears to be a direct result of these problems as medical staff has ruled out physical causes.”
“I considered hospital admission for this gentleman but his partner was reluctant for this to happen as she feels he would be unable to cope. She states she is able to manage him currently and due to his presentation I agreed he would not cope with acuity of an inpatient ward which would be further detrimental to his mental health. He relies heavily on his partner and looks to her for all his needs. There appear to be no risks other than if he was to be left alone but his partner assures me this will not happen. I have accepted him for home based treatment and due to his address now being in Burnley have referred accordingly to Burnley CRHT”
“Sats 95% on air. Lungs only 12% efficiency”
“Admitted with hallucinations, short term memory loss and personality and behaviour problems. All symptoms started after he had fume inhalation 5/52 back. Denies sensation over right side of face and felt grip is slightly weak on right, however both were very soft neurological signs and not very reliable”
“There is no clear organic cause for his symptoms…I think people started to think that this man had a brain injury. I must stress that there is absolutely no evidence for this. This seems to be triggered by the traumatic event of being exposed to smoke…”
“The initial assessment has highlighted that cognitively Mr Connor has a very short attention span and he is easily distracted…..Mr Connor presents with bizarre behavioural patterns. He makes limited eye contact and had developed ticks which become more pronounced when he is agitated or upset. His speech and behaviour presents are very childlike.”
“George is the claimant in a personal injury claim from which he may recover substantial damages. The appointment of a property and financial affairs Deputy will help him to manage large sums of money and to ensure that funds are spent wisely and last as long as possible. The order appointing Rebecca Connor as Deputy would ensure that the finances are dealt with appropriately and in accordance with his best interests, avoiding George from being in a vulnerable financial position.”
“An impairment of, or a disturbance in the functioning of, the mind or brain and the purpose for which the order is needed cannot be effectively achieved in a way which is less restrictive of his rights and freedom of action.”
“‘24. I was then discharged home for a week and put on medication. On the10th February 2010 after seeing my GP when she saw there was no improvement she sent me immediately up to Bolton Royal Hospital where I was put under the care of Mr Kevin Jones a Chest Consultant. I was told my lung capacity was reduced from thirty to twelve and that I had damaged the lining of my lung and that in turn had put a strain on my heart. The hospital wanted to keep me in but I found it very distressful there and asked to go home. The hospital agreed to do so and I was then sent home with steroids and inhalers. I was told “at best I would be a severe asthmatic.”
“…when we got there they then referred us onto the crisis team for home. The crisis team gave us a letter to take to the Blackburn General Hospital for toxicology tests on 22 February. I was kept in there until 23 February, I couldn’t sleep there, I was very distressed in hospital.”
“Life made him happy and he showed it. In every breath he took it produced another smile and in turn he made others smile, a precious gift to have indeed.”
“Normally George would have taken bed rest as his symptoms were extremely severe. He was however concerned that he needed to finish the job and there might not be further contract work for a number of months.”
“..his manner was like a child and he would often sit in a foetal position with his iPod brought into his chest. He appeared scared of individuals and would back away if approached. If a car pulled into the drive he would literally hide. He began talking to himself and kept repeating words. His body shook and he struggled to focus or concentrate. He was unable to keep eye to eye contact with individuals and would move his head and vision. His conversation went off at tangents and it was difficult to maintain focus.”
“..he developed hyper sensitivity to smells and exhibited behaviour more like what one would encounter with someone affected with mental illness. He did not make sense and his behaviour became increasingly alarming. He couldn’t stay in the kitchen because anything, smoke or steam caused extreme panic. Loud noises also caused irritation. He lost the ability to socially interact and was no longer able to engage in conversation. He lacked the social antenna to gauge social situations. He exhibited extreme emotions with highs and lows, laughing or crying at a moments notice.”
“George was also prone, as he was in hospital, to having hallucinations. He would refer to conversations with family members who were dead.”
“My husband’s symptoms have continued in the same manner since his initial exposure at Castle Cement. He cannot be left independently. I currently receive help and support by way of care for George and he has been registered disabled. We are currently in receipt of benefits as a result of his injuries.”
“Initially when George came home from hospital in 2010 George would not go out of doors and was also disorientated. It has only been over time that it has proved possible to persuade him to do so……however George cannot be allowed to roam about unsupervised and consequently if he does go out to look after the animal, feed the chickens, or do woodworking in the barn, I ensure that he takes his mobile phone so that I can ring him if he is not back within 5-10 minutes. He will occasionally muck out but he is very messy and this is a job that I usually do.”
“George remains uncomfortable with strangers and completely dependant on me and his carers. There have been many occasions when I have found him collapsed in an unconscious state. When these incidents occur they take 15-20 minutes to rouse him and he remains in a disorientated state. These episodes used to occur about twice a week before his medication was changed in March 2013 and now occur about once a week. I have not sought medical assistance when these episodes take place. The most recent episode occurred on Saturday and Sunday just gone.”
“Telephoned Becky today to explain that I would be coming later today as once I had researched the bus timetable I wouldn’t be able to get there until 1:50pm but would still stop the two hours agreed leaving at 3:50pm. Becky said that this was fine. I arrived at George’s house at 1:50pm to once again find George and his wife making their lunch and watching TV. Me and George chatted away whilst they ate their lunch and Becky continued to watch TV. George then asked me if I would help him outside as he needed to make some dogs mats for the kennels. So me and George went up to the stables and I helped George with the task. George was very relaxed telling me horsey stories and places he had been around the world. Whilst outside Becky shouted over to George that she was going out to the shops. George shouted back that this was OK and continued chatting to me. I didn’t get a chance to ask Becky where she was going or how long for or what happens to George when it is time for me to go as she drove off. Whilst chatting to George he told me that Becky wanted to speak to Linda regarding my visits with George. He said that Becky was hoping for more from the service and wasn’t really happy with how we had been spending our time. He said that Becky felt that Temple St Staff weren’t properly trained and wanted a specialist to work with George to do more mental tasks with him. Whilst we were outside Becky telephoned and asked George if he was ok and if I was still there. She then said that she was on her way back and checked to see what time I was leaving. Again I did not speak to Becky to confirm what I should do when it was time for me to leave and she did not give George any messages or instructions for me to follow. At 3:50 it was time for me to leave and Becky was not back. George began hurrying me up and was concerned that I may miss my bus. I asked George if I should wait until Becky arrived back but he was insistent that he was fine and that she was on her way back so I said goodbye and made my way to the bus stop leaving George outside carrying on with his task. Once at the bus stop I saw Becky approximately two minutes later arrive back. ”
“Rebecca said that George had had a bad day yesterday. I asked what makes a bad day. George calls it a bad head day. Rebecca said that George on a bad day cannot cope with anything and has to stay in bed. Rebecca advised me that prior to the accident other than when George was in bed he would only be indoors around two hours per day. I asked about George’s breathing and Rebecca said that his breathing has improved slightly but still gets breathless. He doesn’t go outside when windy, he sleeps slightly sat up to help with the breathing.”
“Attention all friends George seriously ill he has to sell the horses so if anyone can help please contact me. He could really use his friends right now because he always would help you if you need anything. Thank you”
“Very unsure, not able to be on his own, with his mental illness forgets what he is doing, needs constant prompting, finds it hard to walk any distance due to lung damage. George is never left on his own.””
“Since the LBM (believed to mean ‘last medical board’) on 27/7/10, there is no improvement in my condition. I have some neurological and psychiatric tests. I have carer seven days a week. I am frightened of going out. I cannot go out alone and need prompting to wash and dress. My wife does cooking, housework and cleaning. Carers supervise me while my wife is away at work. I am frightened of dark. I have poor sleep I need supervision both day and night. I am always anxious. I cannot cope contact with other people and became extremely agitated. I need help with all activities such as dressing bathing and meals. I am hypersensitive to certain fumes and find very difficult to cope with everyday smells. I cannot manage hot food or drinks I cannot tolerate change in temperature. I am unable walk near the freezer I am very short tempered. I have poor concentration and memory. I am still awaiting neuropsychological assessment and rehabilitation.”
“Record the statement as nearly as possible in the customer’s own words. Read it out to the customer for agreement and then ask him or her to sign it below.”
“Record details of your clinical findings include a description of the customer’s general state of health record the exact nature of any physical abnormality resulting from the accident/prescribed disease or not.”
“Assessment explained and consent obtained for examination. Customer appears withdrawn. No eye contact. Doing bizarre movements and has bizarre behaviour. Appears agitated. Has very poor concentration and memory. Lacks motivation, confidence and insight. Appears confused. Unable to manage serial seven (a task of counting back numbers from one hundred in sevens). Has severe cognitive impairment and severe learning disability. The client was uncooperative and he declined any physical examination. He declined to stand or walk he was not breathless at rest.”
“Brought in by police on Section 136. George lives at home with wife. Following an industrial accident five years ago he has needed constant care and presence of someone else. Today he left the farmhouse without telling his wife – carer and went for a walk. Wife became worried and called the police who sent out dog to find him… He was found in bramble bush lying down. Police say … that on finding him he picked up a piece of glass and stick as if to cut himself so they released the dog to stop this happening. George tells me he left the house today as he was feeling very stressed and overwhelmed. He says that this happens frequently following his brain injury. He says that he laid down in the bramble bush to think and then when he saw the dog he became scared and thought it was going to attack him and so he picked up a piece of glass and stick to defend himself. George denies any attempt at self harm or suicide intent. He says that his mood is 5/10. His wife says that he has been in a strange mood all day but this happens quite often. She was unsure if he would have tried to harm himself. George and his wife both inform me that he is very frustrated with his mental impairment following the accident and the limits to his quality of life. He has never had any psychological therapy for this.”
“Appropriately dressed Caucasian man. Speech was childlike in nature but of normal rate tone and content. Subjectively he rated his mood as 5/10 and objectively he was euthymic. No abnormal thoughts…. Patient reports visual hallucinations of his dead dad and horse. He says that he likes seeing them and chats to them about his concerns and worries. They don’t tell him to do anything but just listen to him. Orientated in time, place and person. George had good insight into his condition as a result of the brain injury.”
“I met Mr George Connor accompanied by his wife at a consultation on22 September 2014 . The situation was virtually incomprehensible. Mrs Connor had no medical information explained to me that the only letter she had from Manchester had been entrusted to you (it was not entirely clear who the letter was addressed to). I am not even in a position therefore to contact the Manchester again to try and recover a report. In the end I was limited to your document: severe anoxia in February 2010 in the workplace linked to chemical poisoning? I have never seen any picture following a cerebral anoxia such as the one Mr Connor presented with. He was unable to sit in the waiting room next to other patients; he had to be out in an individual room. I was not able to approach him, or touch him. I have no contact with him during the consultation. He only reacted when my mobile phone vibrated making a reference to my mobile phone and his one. His wife did not speak French, had no clear question, showed me a photo of Mr Connor before that anoxia to explain to me that nothing was the same anymore. I believed I understood that they had settled in France only since April 2014 buying 19 hectares with six lakes and developing a fishing business?”
“On the12/2/2010 I began to suffer mentally from the effect of the accident…”
“GP referral, shortness of breath since exposure to welding fumes. Works at Castle Cement. Works as general maintenance… 22/1/10 exposed to welding fumes in an enclosed space. Subsequently had “sulphurous cough” became progressively more SOB on exertion over the subsequent week. Still managing to work. More and more SOB on exertion with worsening non productive cough. 29/1/10, further …exposure to welding fumes…. deterioration in SOB. Admitted to Royal Blackburn for five days. Oxygen dependant for 5-7…..treated with Nebs (didn’t feel they helped) and steroids. After 5-7 course pred stopped – deteriorated with two days ….further 5-7 course steroids from GP …Improved. Deteriorated again since steroids stopped. SOB on minimal exertion.”
“He is a wreck. He is nervous. He frequently does not want to speak. He is anxious.”
“He is extremely child-like in many ways, both in his behaviour and in relation to his reliance on Becky. He also has physical and verbal ticks (sic) now which he did not have before.”
“ 82. It should also be said that this gentleman’s presentation is most unusual and bizarre in its form. However, I would put forward two alternative differential diagnoses in this case. These comprise: i. FO6.9 Unspecified Mental Disorder due to brain damage and dysfunction and to physical disease. The FO6 group in the Tenth International Classification of Diseases….which is the diagnostic system used in all British…hospitals, includes miscellaneous conditions causally related to brain disorder due to primary cerebral disease, to systematic disease affecting the brain secondarily, to exogenous toxic substances or hormones, to endocrine disorder and to other somatic illnesses….(diagnostic criteria for research set out).. This particular case seems to involve several different symptom complexes and is, therefore, not easily placeable in one of the classical types of organic brain disorders such as …… This gentleman certainly reports hallucinations and some memory difficulties, stereotyped behaviours, anxiety symptoms and delusional beliefs that others are out to get him. However, no single symptom element dominates the picture and hence ‘unspecified’ mental disorder due to brain damage and dysfunction and to physical disease category must be used. The weakness with this diagnosis is of course the failure so far to demonstrate organic brain damage, apart from at a symptom level and I would welcome (further tests). ii The other alternative diagnosis really formulates this case as a response to stress as well as physical problems with a diagnosis of Elaboration of Physical Symptoms for Psychological Reason, coded F68.0 in the Tenth ICD. In this group physical symptoms compatible with and originally due to a confirmed physical disorder, disease or disability become exaggerated or prolonged due to the psychological state of the patient. The patient is commonly distressed by this pain or disability and is often preoccupied with worries which may be justified and the possibility of prolonged or progressive disability or pain. It includes compensation neurosis. It is noted that dissatisfaction with the result of treatment or investigations or disappointment with the amounts of personal attention received in wards and clinics may be a motivating factor. Some cases appear to be clearly motivated by the possibility of financial compensation following accident or injuries but the syndrome does not necessarily resolve rapidly, even after successful litigation. ….(diagnostic criteria for research set out)..”