Arlene Fernandez and Australian Postal Corporation - [2014] AATA 703

[2014] AATA 703

Division	GENERAL ADMINISTRATIVE DIVISION
File Numbers	2013/1744, 2013/3697, 2013/4960
Re	Arlene Fernandez
APPLICANT
And	Australian Postal Corporation
RESPONDENT

DECISION

Tribunal	G. D. Friedman, Senior Member
Date	26 September 2014
Place	Melbourne

Applications 2013/1744, 2013/3697 and 2013/4960: The Tribunal sets aside the decisions under review and substitutes the following decision:

(a)Ms Fernandez suffered incapacity as a result of injury identified as chronic muscle and tendon strain right hand and arm and sore wrist/arm (right hand), ganglion found in right wrist arising out of or in the course of employment, or to which employment with the respondent contributed to in a significant degree, subject of claims for compensation dated 22 March 2006, 29 July 2010 and 22 July 2013, which gives rise to entitlement to compensation pursuant to the Safety, Rehabilitation and Compensation Act 1988 (the SRC Act).
(b)From 16 January 2013 to the present date and at the present date Ms Fernandez was incapacitated for work and undertook medical treatment in respect of the injury for which she is entitled to compensation pursuant to the SRC Act.
(c)The respondent shall pay to Ms Fernandez:
(i)The costs of all medical and related treatment expenses incurred in respect of the injury pursuant to s 16 of the SRC Act;
(ii)Weekly payments of compensation in respect of incapacity for work for all periods when Ms Fernandez’s actual earnings were less than the normal weekly earnings pursuant to s 19 of the SRC Act, and in particular, in the periods 23 to 28 March 2012 and 15 to 18 May 2012, at the rate for no work capacity.

(d)The respondent shall pay Ms Fernandez’s reasonable legal costs and disbursements of the proceedings to be agreed, or taxed in default of agreement, pursuant to s 67 of the SRC Act.

......................[sgd]..................................................

G. D. Friedman, Senior Member

COMPENSATION – right upper limb injury – previously accepted condition – whether liability has ceased – whether compensation payable for two periods in 2012 – whether 2013 right wrist/arm injury significantly contributed to by employment

Safety, Rehabilitation and Compensation Act 1988 (Cth) ss 16, 19, 67

REASONS FOR DECISION

G. D. Friedman, Senior Member

26 September 2014

Arlene Fernandez has worked for the respondent since 2000. At relevant times she was working as a video coder/mail officer and in 2006 she suffered an injury to her right hand. On 4 April 2006 the respondent accepted liability for right arm pain/wrist elbow – possible carpal tunnel syndrome. In 2010 Ms Fernandez reported an injury to her right hand when lifting tubs of mail, and on 13 August 2010 the respondent accepted liability for chronic muscle and tendon strain right hand and arm (the 2010 injury). On 21 February 2013 the respondent made a reviewable decision that there was no liability at 16 January 2013 or to date for compensation for incapacity and medical treatment for the 2010 injury (Application 2013/1744).
On 17 June 2013 the respondent made a reviewable decision that Ms Fernandez has no present entitlement to compensation in respect of incapacity for work for the periods 23-28 March 2012 and 15-18 May 2012 resulting from chronic muscle and tendon strain right hand and arm (Application 2013/3697).
On 5 June 2013 Ms Fernandez reported pain in her right hand and arm while sorting mail (the 2013 injury). On 28 August 2013 the respondent made a reviewable decision to deny liability for compensation in respect of sore wrist/arm (right hand), ganglion found in right wrist (Application 2013/4960).
Ms Fernandez seeks review of the decisions.

LEGISLATIVE BACKGROUND

Sections 16, 19 and 67 of the Safety, Rehabilitation and Compensation Act 1988 (the SRC Act) provide:
16 Compensation in respect of medical expenses etc.
(1)        Where an employee suffers an injury, [the respondent] is liable to pay, in respect of the cost of medical treatment obtained in relation to the injury (being treatment that it was reasonable for the employee to obtain in the circumstances), compensation of such amount as Comcare determines is appropriate to that medical treatment.
…
19 Compensation for injuries resulting in incapacity
…
(2)      Subject to this Part, [the respondent] is liable to pay to the employee in respect of the injury, for each week that is a maximum rate compensation week during which the employee is incapacitated, an amount of compensation…
…
67 Costs of proceedings before Administrative Appeals Tribunal
…
(8)       Where, in any proceedings instituted by the claimant, the Administrative Appeals Tribunal makes a decision:
…
(b)      setting aside a reviewable decision and making a decision in substitution for the reviewable decision that is more favourable to the claimant than the reviewable decision;
the Tribunal may, subject to this section, order that the costs of those proceedings incurred by the claimant, or a part of those costs, shall be paid by the responsible authority.

ISSUES

The issues before the Tribunal are:

Does the 2010 injury continue to result in incapacity and the need for medical treatment from 16 January 2013 to the present date and at the present date?
Was Ms Fernandez incapacitated for employment for the periods 23 to 28 March 2012 and 15 to 18 May 2012 as a result of her accepted right wrist and arm condition?
Was the 2013 injury contributed to, to a significant degree, by Ms Fernandez’s employment?

DOES THE 2010 INJURY CONTINUE TO RESULT IN INCAPACITY AND THE NEED FOR MEDICAL TREATMENT FROM 16 JANUARY 2013 TO THE PRESENT DATE AND AT THE PRESENT DATE?

Ms Fernandez told the Tribunal that she grew up in India and completed a Bachelor of Commerce degree. She moved to Australia in 1990 and commenced working with Westpac Bank performing secretarial duties until 1997. In 2000 she joined the respondent as a video coder on a part-time basis which involved keyboard data entry of postal information for six hours per day. In 2004 she commenced full-time duties as a video coder. She said that in 2006 she was performing coding duties when she experienced pain in the middle finger of her right hand, which moved through her hand and wrist to her right shoulder and the base of her neck and the right side of her skull. On 4 April 2006 the respondent accepted liability for right arm pain/wrist elbow – possible carpal tunnel syndrome. She reduced her coding work and the symptoms subsided, and she resumed duties on a return to work rehabilitation program. In about May or June 2006 she commenced higher duties as a supervisor in video coding, which required less keyboard work. This role ended after about eighteen months.
In 2008 Ms Fernandez made a further claim for compensation in respect of her right wrist and elbow after she experienced pain in those areas. She was placed on modified duties for normal working hours. She changed to mail sorting and operating sorting machines, which included lifting tubs of mail.
In 2010 Ms Fernandez made a report of muscular pain in her right hand when she was lifting tubs of mail. On 13 August 2010 the respondent accepted liability for chronic muscle and tendon strain right hand & arm. Ms Fernandez said that she was treated with prednisolone and Voltaren gel and returned to work, but the pain returned and she took some time off work before returning on full-time hours with restrictions including a lifting limit of 10 kg and a rotation of duties. From March 2011 to October 2011 she reduced her working hours to six per day.
Ms Fernandez explained that in 2013 her lifting limit was reduced to 5kg but the pain continued. In October 2013 she was transferred to the Transport Division of the Dandenong Letter Centre where she has been performing administrative duties that involve some keyboard work but no lifting or repetitive work involving bending or twisting. In respect of her current situation Ms Fernandez stated that she continues to suffer pain in her right hand, although the pain has been reduced since she changed from duties involving mail sorting to administrative duties. She stated that she is able to perform some light household duties but tasks such as vacuuming or hanging out washing are too painful.
Under cross-examination Ms Fernandez stated that although she enjoyed video coding work she preferred the variety of performing mail sorting and other tasks because there was less strain on her right wrist and arm. She agreed that she had been involved in a motor vehicle accident in 2001 but could not recall details of any injury.
Dr V Mohan Doss, general practitioner, is Ms Fernandez’s treating doctor and stated in a report dated 15 June 2006 that Ms Fernandez was suffering from chronic tendonitis and tenosynovitis of the right hand, chronic muscle strain in the right arm and the right side of the neck, and the injuries were due to repetitive type of work and lifting heavy bags of mail at work. He noted that she was attending physiotherapy and taking analgesics, and needed to avoid further repetitive types of work.
Dr D Barton, consultant occupational physician, stated in a report dated 23 February 2007 that he took a history of pain in Ms Fernandez’s right upper limb and extending from the middle finger through the wrist, forearm, elbow, shoulder and into the right side of the neck, with the pain extending to the lower back. Dr Barton concluded that Ms Fernandez’s history did not point towards any particular physical diagnosis, but she may have had a mild soft tissue injury as a result of her work.
In a further report dated 25 May 2009 Dr Mohan Doss stated that Ms Fernandez had been suffering from chronic tendonitis and tenosynovitis of the right hand since 2006 and lateral epicondylitis of the right elbow and chronic muscle strain of the right arm and right side of the neck. He said that all of her problems were due to repetitive work with the respondent and that modified duties were helping her cope with the discomfort.
Dr K Muirden, consultant rheumatologist, stated in a report dated 30 July 2009 that Ms Fernandez suffered from the pain amplification syndrome fibromyalgia (a central nervous system condition that involves pain and is frequently associated with symptoms such as fatigue and joint stiffness), which was associated with widespread tender points in the absence of evidence of degenerative or inflammatory musculoskeletal pathology. He said that joint hypermobility is a congenital-based problem leaving joints vulnerable to physical stress and also to repetitive physical stress. Dr Muirden stated that he did not believe that fibromyalgia was caused by work but symptoms can be aggravated by physical stress including physical stress of a repetitive nature, and in this case the two underlying conditions were exacerbated by employment with the respondent. Dr Muirden did not consider that Ms Fernandez had voluntarily exaggerated her symptoms during his examination.
Dr A James, specialist occupational physician, stated in a report dated 17 September 2010 that she took a history of persistent upper limb pain from the middle finger up the right arm and elbow into the right side of the neck, with exacerbations associated with manual handling tasks in the workplace. She concluded that Ms Fernandez’s condition is consistent with a fibromyalgia-type condition in view of the clinical findings and the chronic nature of the condition, together with mild medial epicondylitis at the right elbow. Dr James stated that the syndrome was unlikely to resolve and that flare-ups of pain in the right arm were possible in the future. She recommended a modified return to work program with lifting restrictions (including a permanent 10 kg lift limit) and structured exercise.
Dr K Fraser, rheumatologist, stated in a report dated 2 February 2012 that he found mildly restricted movements of the cervical spine and a full range of movement in both shoulders, with complaints of slight pain at the extremes. There was no swelling or tenderness of the wrists. Upper limb reflexes were normal. Dr Fraser concluded that the mild neck stiffness probably related to degenerative changes in the cervical spine and was not caused or aggravated by her work. He said that he could not exclude soft tissue injuries in the affected areas from time to time, but that they have now resolved. He stated that there was nothing to suggest any physical basis for the upper limb symptoms and specifically no features of rotator cuff syndrome, epicondylitis, tendinitis or tenosynovitis, and he did not consider that there was any ongoing work-related injury.
Dr Fraser expressed the view that local muscle tenderness in the posterior cervical/shoulder girdle region suggested a diagnosis of fibromyalgia which might also explain the more widespread upper limb symptoms. He did not believe that this could be attributed to Ms Fernandez’s employment, but concluded that fibromyalgia was generally considered to be due to psychosocial factors. In a further report dated 18 September 2012 Dr Fraser said that Ms Fernandez was suffering from a disease process rather than an injury, and he did not consider that Ms Fernandez’s employment with the respondent exacerbated or aggravated the putative fibromyalgia. Dr Fraser added that pain amplification is not an uncommon accompaniment of fibromyalgia.
Under cross-examination Dr Fraser agreed that at the time of his assessment of Ms Fernandez he was not provided with complete clinical notes from the general practitioner, radiology reports or reports from all relevant medical practitioners, and he based his reports on a single clinical examination. He agreed further that he did not undertake a full body examination of Ms Fernandez or take a history of factors such as fatigue, unrefreshed sleep, cognitive problems and somatic symptoms such as headaches, chest pain irritable bowel syndrome and abdominal pain which are part of the 2010 American College of Rheumatology classification criteria for the diagnosis of fibromyalgia. In respect of psychosocial factors, Dr Fraser agreed that he did not ask Ms Fernandez any questions about her social issues, workplace relations or family relationships.
Dr Mohan Doss stated in a report dated 16 March 2012 that he disagreed with Dr Fraser. He said that as Ms Fernandez’s family doctor over a lengthy period he knew her physical conditions well and he reiterated that she was suffering from chronic tendonitis and tenosynovitis of the right hand, chronic muscle strain of the right arm, and fibromyalgia, although he was unhappy to use the word fibromyalgia since Ms Fernandez was not affected in parts of her body other than the right upper limbs. He said that all her conditions aggravated her pre-existing degenerative spine condition and were due to repetitive work with the respondent.
Dr J Seneviratne, neurologist, stated in a report dated 29 April 2013 that he took a history of right arm pain experienced by Ms Fernandez after performing manual and lifting duties with the respondent. Dr Seneviratne concluded that most of the symptoms were probably related to a musculoskeletal/soft tissue injury, with no evidence of a nerve injury or neurogenic process affecting the right arm. He recommended modified duties with restrictions on lifting weights.
Dr J Rupasinghe, consultant neurologist, stated in a report dated 29 June 2013 that there were no signs of a central objective neurological disorder or peripheral neuropathy, and no specific objective abnormality except a mild right acromial bursitis. Dr Rupasinghe identified right bicep tendon tenosynovitis, neuropathic-type pain down the right forearm and medial right elbow tenderness, and concluded that the right upper limb pain and paraesthesia (tingling of the skin) were likely to be multifactorial. Physiotherapy, analgesia and occupational assessment were recommended through a rehabilitation program.
Mr L Sedal, consultant neurologist, stated in a report dated 11 September 2013 that the prognosis was uncertain as Ms Fernandez did not have symptoms or signs of an ulnar nerve lesion at the right elbow. He concluded that the clinical picture suggested that the diagnosis would be rheumatological rather than neurological.
Dr G Khurana, consultant neurosurgeon, stated in a report dated 19 February 2014 that he took a history from Ms Fernandez that symptoms in the right arm never went away, but would increase with more use of the right arm and decrease when the right arm was rested, for example during holidays. Her current treatment was Panadol and Endep when required. No physiotherapy or hydrotherapy and no steroids were used at present. Dr Khurana said that Ms Fernandez told him that overall her symptoms have improved considerably, particularly over the previous few months, which she attributed to a change to administrative duties in October 2013.
Dr Khurana concluded that there has been a significant improvement in Ms Fernandez’s condition of mechanical strains to the right upper extremities as a result of altered duties since October 2013, and he expected her symptoms to continue to improve if these duties continue. He said that she does not require any specific treatment at this time. He found no neurological condition and said that he was not convinced that the diagnosis was fibromyalgia, based on ultrasound reports and symptoms being confined principally to the upper extremity. He attributed the right upper extremity joint inflammatory condition to Ms Fernandez’s employment with the respondent.
Mr M Khan, orthopaedic surgeon, stated in a report dated 19 February 2014 that during the course of Ms Fernandez’s occupation over a period of time she developed a mild flare-up of the pre-existing cervical disc degeneration at the C5-6 level of the spine and had developed a mild tendinopathy of the rotator cuff tendons in the right shoulder due to her repetitive strenuous duties with the respondent. He said that she also developed the accepted condition of lateral epicondylitis during her work.
Mr Khan considered that Ms Fernandez was experiencing central sensitisation of pain triggered by the original injury which has occurred repetitively over time as in 2004, 2006 and in 2008, and her condition presented as a complex pain syndrome which comes under the term of fibromyalgia syndrome rather than a diagnosed condition. He noted that fibromyalgia syndrome is often associated with depression and diffuse muscular pain with trigger points of pain, swelling, fatigue and cramps in the affected muscles. He said it seems to have affected Ms Fernandez’s cervical spine, right shoulder blade, right arm and forearm down to her right wrist and hand. Mr Khan said that she continues to have residual after-effects from her work-related condition. She reasonably requires medical treatment in respect of the condition, particularly if she has a flare-up of pain and she will require adequate medication and pain management. He said that Ms Fernandez has suffered incapacity for work as a result of her condition and that the condition was significantly contributed to by her employment.
In oral evidence Mr Khan said that rather than focusing on fibromyalgia, he preferred to consider Ms Fernandez’s symptoms as arising from the injuries at work which triggered pain emanating from the brain. He said that he agreed with Mr Khurana’s doubts about a diagnosis of fibromyalgia.
The Tribunal finds that Ms Fernandez presented as a credible witness. Her description of symptoms over a number of years has remained consistent during examination by various doctors. There is no suggestion by any of the doctors that she has been feigning or exaggerating her symptoms. The respondent accepted her claims for compensation in 2006, 2008 and 2010 for injuries to her right upper limbs arising from her employment. The Tribunal accepts that the pain suffered by Ms Fernandez in her right arm from her fingers to her wrist, arm, shoulder and neck arose from work-related video coding and general duties as a mail sorter with the respondent. This pain has flared up from time to time due to her work duties.

The Tribunal places significant weight on the evidence from Dr Mohan Doss, who has been Ms Fernandez’s family doctor for a considerable time. The clinical notes from Dr Mohan Doss confirm Ms Fernandez’s evidence of her attendances at the medical practice and are consistent with her evidence about the various symptoms and the flare-ups experienced by her from time to time. The Tribunal accepts his diagnosis of chronic injury to joints and tendons of the right upper extremity.
The Tribunal also places weight on the evidence from Mr Khan and Dr Khurana, who were both provided with a detailed clinical history including radiological and clinical records. Their reports in February 2014 support the ongoing diagnosis of an upper extremity joint condition. This appears to be consistent with the conclusions of Dr Seneviratne and Dr Rupasinghe in 2013.
The Tribunal places less weight on Dr Fraser’s evidence. He was not provided with a complete clinical picture of Ms Fernandez and his first report was prepared without the benefit of radiology or clinical records. His physical examination of Ms Fernandez on 1 February 2012 appears to have been brief and by his own admission there was not a full body examination which would be required for a proper assessment for a diagnosis of fibromyalgia under the American College of Rheumatology classification criteria. He did not take a history of, or find evidence of, symptoms such as lack of refreshed sleep, fatigue, cognitive or somatic problems which form part of the classification criteria.
Further, Dr Fraser noted that generally fibromyalgia is due to psychosocial factors but he did not substantiate this opinion or relate it specifically to Ms Fernandez because he did not take a history of psychosocial factors from her.
The Tribunal takes into account the evidence from Mr Khan, Dr Muirden and Dr James who indicated that fibromyalgia-like pain in the upper limbs may be exacerbated by work-related duties.
On all the material the Tribunal finds that as at 16 January 2013 to the present date and at the present date Ms Fernandez was incapacitated for work as a result of the 2010 injury.

WAS MS FERNANDEZ INCAPACITATED FOR EMPLOYMENT FOR THE PERIODS 23 TO 28 MARCH 2012 AND 15 TO 18 MAY 2012 AS A RESULT OF HER ACCEPTED RIGHT WRIST AND ARM CONDITION?

Ms Fernandez emphasised that the respondent had previously accepted her claim for chronic muscle and tendon strain right hand and arm. She told the Tribunal that on 7 March 2012 Dr Mohan Doss issued a medical certificate stating that she was fit to work full hours on modified duties for the period 9 March 2012 to 1 April 2012, and she commenced these duties. She said that on 22 March 2012 she attended the First Aid room and reported pain in her right hand, shoulder and the right side of her neck, which she attributed to the performance of her duties. She attended Dr Mohan Doss on 23 March 2012 and he issued a medical certificate for aggravation strain stating that she was totally incapacitated for work for the period 23 March 20012 to 28 March 2012. She said that Dr Mohan Doss issued a further medical certificate on 29 March 2012 stating that she was fit to resume modified duties from 29 March 2012 to 26 April 2012.
In respect of the period 15 May 2012 to 18 May 2012 Ms Fernandez told the Tribunal that that on 24 April 2012 Dr Mohan Doss issued a medical certificate stating that she was fit to work full hours on modified duties for the period 27 April 2012 to 25 May 2012. She said that she attended Dr Mohan Doss on 15 May 2012 after experiencing upper limb pain. He issued a medical certificate for muscular strain aggravation and stated that she was totally incapacitated for work for the period 15 May 2012 to 18 May 2012. Ms Fernandez said that Dr Mohan Doss issued a further medical certificate on 23 May 2012 stating that she was fit to resume modified duties from 20 May 2012 to 22 June 2012.
Mr Khan stated in his report that as Ms Fernandez’s condition has left her with sensitisation of pain and the development of a fibromyalgia-type condition over a period of time, this has affected her capacity for employment for the period 23 March 2012 to 28 March 2012 and 15 May 2012 to 18 May 2012.
The Tribunal accepts Ms Fernandez’s evidence that she suffered an aggravation or exacerbation of the symptoms of her accepted condition at work on 22 March 2012 while she was undertaking full hours with restrictions as recommended by Dr Mohan Doss. She attended the First Aid room and consulted Dr Mohan Doss for treatment. Similarly, the Tribunal accepts that she attended Dr Mohan Doss on 15 May 2012 after suffering a further aggravation of the symptoms. These consultations are recorded in Dr Mohan Doss’s clinical notes.
The Tribunal is satisfied that Dr Mohan Doss, who was familiar with her physical condition, acted reasonably in issuing the relevant medical certificates in his professional assessment that she was incapacitated for work as a consequence of aggravation or exacerbation of her symptoms of the accepted condition that occurred during the performance of her duties with the respondent.
On all the material the Tribunal finds that Ms Fernandez was incapacitated for employment for the periods 23 to 28 March 2012 and 15 to 18 May 2012 as a result of her accepted right wrist and arm condition.

WAS THE 2013 INJURY CONTRIBUTED TO, TO A SIGNIFICANT DEGREE, BY MS FERNANDEZ’S EMPLOYMENT?

Ms Fernandez told the Tribunal that on 5 June 2013, while working full hours on restricted duties, she was working on a Spectrum machine which is used in the sorting of mail when she experienced pain. She reported: Sore wrist/arm (right hand). Felt gradual onset of pain. Recent ultrasound found ganglion in right wrist. She attributed the injury to: Working on the spectrum coding & facing up mail, pain increased. Had first aid. Ms Fernandez said that she attended the First Aid room and her wrist was bandaged and she returned to work for the remainder of her shift, working to her restricted duties program. On 22 July 2013 Ms Fernandez lodged a claim for compensation. She agreed that a report dated 2 April 2013 from a radiologist included: Ultrasound Right Hand…A 2.5mm ganglion cyst is demonstrated dorsal to the scapholunate articulation.
Mr Khan stated in his report that at the time of his examination Ms Fernandez had improved considerably and was able to move her joint as well. He did not consider that the ganglionic cyst to be directly related to her injury sustained at work.
The Tribunal has already found that Ms Fernandez is a credible witness and accepts her evidence about the circumstances and nature of the 2013 injury that occurred during her employment with the respondent. This evidence was supported by her attendances on Dr Mohan Doss as shown by the clinical notes. On all the material the Tribunal finds that the injury was contributed to, to a significant degree, by her employment.

DECISION

Applications 2013/1744, 2013/3697 and 2013/4960: The Tribunal sets aside the decisions under review and substitutes the following decision:
(a)Ms Fernandez suffered incapacity as a result of injury identified as chronic muscle and tendon strain right hand and arm and sore wrist/arm (right hand), ganglion found in right wrist arising out of or in the course of employment, or to which employment with the respondent contributed to in a significant degree, subject of claims for compensation dated 22 March 2006, 29 July 2010 and 22 July 2013, which gives rise to entitlement to compensation pursuant to the Safety, Rehabilitation and Compensation Act 1988 (the SRC Act).
(b)From 16 January 2013 to the present date and at the present date Ms Fernandez was incapacitated for work and undertook medical treatment in respect of the injury for which she is entitled to compensation pursuant to the SRC Act.
(c)The respondent shall pay to Ms Fernandez:
(i)The costs of all medical and related treatment expenses incurred in respect of the injury pursuant to s 16 of the SRC Act;
(ii)Weekly payments of compensation in respect of incapacity for work for all periods when Ms Fernandez’s actual earnings were less than the normal weekly earnings pursuant to s 19 of the SRC Act, and in particular, in the periods 23 to 28 March 2012 and 15 to 18 May 2012, at the rate for no work capacity.
(d)The respondent shall pay Ms Fernandez’s reasonable legal costs and disbursements of the proceedings to be agreed, or taxed in default of agreement, pursuant to s 67 of the SRC Act.

I certify that the preceding forty-five (45) paragraphs are a true copy of the reasons for the decision of G. D. Friedman, Senior Member.

....................[sgd]....................................................

Associate

Dated 26 September 2014

Dates of hearing	16 and 17 September 2014
Counsel for the Applicant	Mr J Harris
Solicitors for the Applicant	Maurice Blackburn
Advocate for the Respondent	Mr B Dube
Solicitors for the Respondent	Sparke Helmore