“If not, can you say with any certainty when Miss Riley is likely to recover?”
“Is Miss Riley now well enough to conduct a trial starting on or after the 12 th May 2011, if not why not? 71. In respect of question 4, she is not well enough to conduct the trial starting on or after the 12 th May 2011 by reason of her severe depression without psychotic symptoms. You are referred to the following paragraph in Dr Naguib’s … report of 27 th April 2011... “It remains my opinion that Miss Riley’s current clinical depression is secondary to the alleged harassment and discrimination at work. Miss Riley’s depression is disabling her from moving on with her plan and she feels stuck until justice happens.’ The CPS considers that even if this trial is postponed there is a real prospect that Miss Riley will find herself in exactly the same situation of incapacity on the next occasion because her depression is reactive to a situation which cannot be resolved until she participates in her trial. a. Do you agree with the quotation from Dr Naguib’s report and the CPS’s view expressed as above? b. Are you able to provide any firm prognosis for the Claimant so as to be able to identify a date upon which she is likely to be ready to commence a trial, or is it your view that she is unlikely to recover her capacity to recover until after such a trial? 72. In respect of 5a, I can agree that Miss Riley’s depression is disabling her from moving on with her plans and that she feels stuck until justice happens. 73. In respect of 5b, I can provide a further prognosis in so far as there is good research data using normal clinical patients where the STAR* D protocol was followed. 74. In this protocol about 70% of patients had a remission of their illness by the time the fourth tier of the protocol was completed. In the NHS setting I would expect it to take about 6 months to move between tiers on the protocol although this could be reduced to as little as 3 months in an assertively managed service or in a private setting. It would thus take between 12 – 24 months to reach the fourth tier. 75. While Ms Riley has had weekly psychotherapy for a prolonged period I am uncertain of the modality and it is quite clear from a variety of studies with her level of depression, psychotherapy is an inappropriate intervention in terms of recovery. 76. The primary steps would be to try a separate anti-depressant and then augment that with further treatment, namely other anti-depressants. She may well require the intervention of community psychiatric nurses and visits at home with a rehabilitation programme. There is about a 37% probability of remission by the end of the first tier rising to about 70% by the end of the fourth tier with a smaller proportion of patients improving after each tier. 77. However, the presence of PTSD in the past and the presence of ongoing psychosocial stressors namely financially issues and the on going litigation would suggest that the probabilities are less than those stated above. 78. As litigation is a major stressor it may well be the case that recovery is unlikely until after there is a solution in one manner or another.”
“Don’t think hits balance of probabilities at a year, might be as high as balance of probabilities at two years but range extends far more below. STAR*D data talks about 70% at fourth tier. If litigation is ongoing will reduce below that. Because of PTSD other factors will also be below that. Some questions emerging as to whether 70% is overall optimistic in any event but not digested yet”
“Upper part of range, it’s the balance of probabilities most of the range is below” 34. Dr Naguib in oral evidence about the two year point said as follows: “percentage probability at that point question depends on how she is going to respond. Approach was more and more assertive. The significant probability is very difficult to give a percentage. Not in disagreement with his (Dr Wise) opinion. Bases his figures on researches and trials would not elevate room for improvement into probability”
“Both experts agreed that litigation was a significant stress and that the determination of the litigation would be a step in the possible recovery of the claimant. The difficulty I am faced with, what Mr Cohen described as the chicken and an egg situation, is that the Claimant is not fit to attend the hearing to achieve determination of finality of the litigation and accordingly she will continue to be affected by the stress or worry associated with litigation which, until it is resolved one way or another, will not form part of the process towards her recovery. Dr Wise’s view, that the Claimants probability of entering remission is less than the 70% probability of achieving remission, when looking at clinical population was not essentially challenged.”
“In my judgment, on the basis of the totality of the medical evidence the Claimant will not be fit enough to attend the hearing in 12 months, and on the balance of probabilities, not before the expiry of 2 years, having regard to the severity of her condition and Dr Wise’s opinion that she falls outside the statistical bases of a conclusion 70% of the public would achieve recovery by the end of the fourth tier of the STAR*D protocol.”