Bradbury v State of New South Wales (NSW Police Force)
[2025] NSWPICMP 471
•1 July 2025
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | Bradbury v State of New South Wales (NSW Police Force) [2025] NSWPICMP 471 |
| APPELLANT: | Bradbury |
| RESPONDENT: | State of New South Wales (NSW Police Force) |
| APPEAL PANEL | |
| MEMBER: | Catherine McDonald |
| MEDICAL ASSESSOR: | Dr Michael Davies |
| MEDICAL ASSESSOR: | Dr Sophia Lahz |
| DATE OF DECISION: | 1 July 2025 |
| CATCHWORDS: | WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); motor vehicle accident accepted as having caused aggravation of pre-existing condition which led to multiple strokes; Medical Assessor (MA) asked to assess nervous system; Held – MA failed to assess whole person impairment (WPI) because he considered that the strokes were not a result of the injury; paragraph 29 of Procedural Direction PIC 6 - Medical Assessments; re-assessment required; MAC revoked. |
BACKGROUND TO THE APPLICATION TO APPEAL
On 11 December 2024 Peter Bradbury lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Medical Assessor John O’Neill, who issued a Medical Assessment Certificate (MAC) on 13 November 2024.
Mr Bradbury relies on the grounds of appeal under s 327(3)(c) and (d) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act):
· the assessment was made on the basis of incorrect criteria, and
· the MAC contains a demonstrable error.
The President’s delegate was satisfied that, on the face of the application, at least one ground of appeal was made out, being that the Medical Assessor made a demonstrable error in making a determination on causation that was outside the scope of his function. We conducted a review of the original medical assessment, limited to the grounds of appeal on which the appeal is made.
Rule 128 of the Personal Injury Commission Rules 2021 (the PIC Rules) and Procedural Direction PIC7 – Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with r 128(1) of the PIC Rules.
The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed 1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5).
RELEVANT FACTUAL BACKGROUND
Mr Bradbury was injured in a motor vehicle accident in the course of his employment on 26 March 2023 during which air bags were deployed. He returned to work after a few days but during the weeks after the accident he experienced dizziness associated with blurred vision. On 19 April 2023 he was taken to Ryde Hospital and was diagnosed as having had multiple strokes, possibly due to vertebral artery dissection. While in hospital, he was given the wrong medication which resulted in a manic episode and he was transferred to Royal North Shore Hospital and later to Gosford Hospital. His claim for compensation was accepted.
Mr Bradbury claimed permanent impairment compensation based on a report by Dr Abraszko dated 28 July 2023. She assessed 15% whole person impairment (WPI) as a result of a brain injury, assessing him in relation to mental status and emotional and behavioural impairments. Mr Bradbury made a claim for compensation based on Dr Abraszko’s report.
On 18 April 2024, Dr Mellick reported to the Police Force and said that the motor vehicle accident should be regarded as the cause of Mr Bradbury’s symptoms and neurological abnormalities. Dr Mellick said there was no assessable impairment and said that a diagnosis of post-traumatic stress disorder explained Mr Bradbury’s clinical condition.
The Police Force issued a decision notice under s 78 of the 1998 Act on 5 June 2024. The notice confirmed that liability was accepted by the Police Force in respect of a left hand injury and “aggravation of pre-existing vertebral artery stenosis injury, which resulted in a stroke.” The only dispute raised by the notice was whether Mr Bradbury had reached the threshold to recover permanent impairment compensation.
Mr Bradbury commenced proceedings. In his Application to Resolve a Dispute he claimed permanent impairment compensation in respect of his nervous system.
The Personal Injury Commission was not required to determine any issues as to liability. The referral to the Medical Assessor asked him to assess Mr Bradbury by reference to his nervous system.
The Medical Assessor said that there was no impairment of Mr Bradbury’s nervous system. He said that the accident did not result in vertebral dissection but that the stroke was the result of a pre-existing condition rendered likely by a history of poorly controlled diabetes and smoking. He did not assess WPI.
SUBMISSIONS
Both parties made written submissions. They are not repeated in full, but we have considered them.
In summary, Mr Bradbury submitted that the Medical Assessor made a determination inconsistent with his function by making a determination as to causation. Mr Bradbury’s injury was accepted as a nervous system injury resulting from the aggravation of pre-existing left vertebral artery stenosis resulting in a stroke. Despite the evidence and the agreement of the parties, the Medical Assessor sought to causally relate the neurological injury to poorly controlled diabetes and smoking. He also said that the Medical Assessor failed to give any weight to Dr Abraszko’s evidence and failed to explain why his opinion differed.
In reply, the Police Force submitted that, while there had never been a dispute that Mr Bradbury suffered an injurious incident, there had been no finding made by the Personal Injury Commission as to the nature of the pathology. It said that the precise nature of the pathology and the impairment flowing from it was within the ambit of the Medical Assessor’s role. The Police Force said Dr Mellick and Dr Batchelor said that Mr Bradbury’s perceived cognitive impairment was likely to have a psychological source and that Mr Bradbury did not. challenge those findings. The Police Force said that the Medical Assessor did not err in assessing the nervous system at 0% and that it was apparent that he had regard to Dr Abraszko’s report and clearly indicated why he disagreed with her assessment.
PRELIMINARY REVIEW
We conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the Procedural Direction PIC 7.
As a result of that preliminary review, we determined that it was necessary that Mr Bradbury undergo a further medical examination because the Medical Assessor’s determination as to causation vitiated his assessment. He said that there was no physical signs of neurological impairment and that the stroke had not resulted in measurable impairment but did not refer to any part of AMA 5 or the Guidelines. The Medical Assessor erred in failing to undertake any assessment of Mr Bradbury’s WPI.
EVIDENCE
We have all the documents that were sent to the Medical Assessor for the original medical assessment and have taken them into account in making this determination.
Medical Assessor Lahz of the Appeal Panel conducted an examination of the worker on 5 June 2025 and reported to us on 10 June 2025. Her report forms part of these reasons.
The parts of the MAC that are relevant to the appeal are set out below.
FINDINGS AND REASONS
The procedures on appeal are contained in s 328 of the 1998 Act. The appeal is by way of review of the original medical assessment but the review is limited to the grounds of appeal on which the appeal is made.
In Campbelltown City Council v Vegan[1] the Court of Appeal held that an Appeal Panel is obliged to give reasons. Where there are disputes of fact it may be necessary to refer to evidence or other material on which findings are based, but the extent to which this is necessary will vary from case to case. Where more than one conclusion is open, it will be necessary to explain why one conclusion is preferred. On the other hand, the reasons need not be extensive or provide a detailed explanation of the criteria applied by the medical professionals in reaching a professional judgement.
[1] [2006] NSWCA 284.
In Queanbeyan Racing Club Ltd v Burton[2] the Court of Appeal held that an Appeal Panel is not limited to the ground held to have been made out by the delegate but may consider all grounds of appeal raised in the application. However, the panel is not permitted to look for errors which are not part of the grounds of appeal on which the appeal is made. We have only considered those grounds specifically raised by the appeal.
Medical evidence
[2] [2021] NSWCA 304 at [26].
Dr Abraszko said in July 2023:
“Mr Bradbury provided consistent history with radiological investigations and neurological findings.
As a result of motor vehicle accident, he suffered from the multiple strokes in right parietal, bilateral occipital lobes in the posterior cerebral arteries territory, due to the vertebrobasilar insufficiency, most likely as a result of dissection of vertebral arteries. That was a direct result of his whiplash injury sustained in the motor vehicle accident.”
She assessed Mr Bradbury under chapter 5 of the Guidelines and chapter 13 of AMA 5, using the Clinical Dementia Rating in Table 13-5 and Table 13-6. She assessed 10% WPI. Under Table 13-8 which applies to emotional or behavioural disorders, Dr Abraszko assessed 5% WPI. She combined her assessments to reach 15% WPI.
Dr Batchelor undertook neuropsychological testing on behalf of the Police Force on 22 March 2024. Her summary opinion was:
“(a) The current neuropsychological assessment revealed Mr Bradbury to demonstrate acquired cognitive impairment and specifically, disorders of sustained attention, recent memory for visual information, and executive functions, with the latter including poor planning, impaired strategic word retrieval, and disordered response regulation.
(b) Although possible that neurological damage secondary to vertebral artery pathology is causing cognitive dysfunction, the nature of the deficits evident on testing suggested that psychological distress is also contributing to cognitive impairment.
(c) It is recommended that Mr Bradbury undergo repeat neuropsychological assessment in 12 months time, following treatment from a clinical psychologist, to confirm the probable aetiology of his cognitive dysfunction.”
There is no suggestion in the file that any subsequent testing was sought. A/Prof Batchelor accepted the diagnosis of multiple strokes, possibly due to vertebral artery dissection.
Dr Mellick examined Mr Bradbury and reported on 18 April 2024. His opinion as to causation was:
“The motor vehicle accident should be regarded to have been the cause of the symptoms and the neurological abnormalities reported above. It is likely that the major degree of the stenosis predated the injury. However, embolization has clearly occurred, more likely than not from the region of the stenosis as the impact would have resulted in transmitted forces involving cervical flexion which, in turn, would be transmitted to the vertebral artery and the area of stenosis in particular.
Although the angiograms do not identify thrombosis occurring at the site of the stenosis, it is more likely than not, having regard to the distribution of the emboli, that the emboli originated from the site of stenosis.”
Dr Mellick was asked:
“(g) Whether the brain injury was caused by the accepted stroke injury? If not, whether the brain injury was caused by the aggravation injury to the claimant’s left vertebral artery stenosis?”
He answered:
“The features identified in the scans constitute multiple small areas of infarct which constitute the brain injury. The relationship between the emboli and the vertebral artery stenosis is referred to above.”
Providing his assessment of WPI, Dr Mellick said:
“With reference to Chapter 5 of the SIRA Guides, Paragraphs 5.4 and 5.9 and to AMA5, Chapter 13, Table 13-5: memory 0.5, judgement and problem solving 0.0, community affairs 0.0, home and hobbies 0.0, personal care 0.0.
With reference to Table 13-8, emotional and behavioural disorder, he does not exhibit limitation of activities of daily living and daily social and interpersonal function.”
We observe that Dr Mellick did not provide a clinical dementia rating, even though he had not assessed 0 in all categories of Table 13-5.
The MAC
The Medical Assessor took a detailed history from Mr Bradbury as to the injury, treatment and present symptoms. He said:
“Mr Bradbury did have diabetes for an unspecified period prior to the accident. He had then been prescribed Metformin but he admitted he would often forget to take it.
He said he smoked on most days from the age of 20 until the accident. He thought he would be smoking in the order of five cigarettes a day.”
The Medical Assessor set out limited findings on examination:
“Gait was normal. He had no trouble walking heel-to-toe. Romberg’s was negative.
Uncorrected visual acuity was 6/9 on the right and 6/6 on the left. Cranial nerve examination was otherwise normal.
Limb power and reflexes were normal with both plantar responses flexor.
I noted a loss of vibration sense at both great toes. Mr Bradbury told me that he did not experience penile erections in the aftermath of the accident.”
The Medical Assessor said:
“A neuropsychological assessment was undertaken by Dr Jennifer Batchelor on 22 March 2024. She found ‘impairments of sustained attention, recent memory for visual information, executive functioning and the latter including poor planning, impaired strategic word retrieval and disordered response regulation.’ She thought that psychological distress was contributing to difficulties evident on testing.”
The Medical Assessor summarised the injuries and diagnoses:
“…In the three weeks following the accident Mr Bradbury had what, in retrospect, were three transient ischaemic attacks in the vertebrobasilar artery territory.
After feeling ill at work on 19 April 2023, Mr Bradbury was taken to Ryde Hospital where he had an elevated blood sugar level. A CT brain angiogram was performed and this showed what was felt to be a severe stenosis of the left vertebral artery.
Although apparently not articulated at the time, the concern would have been as to whether the stenosis of the distal left vertebral artery was as a consequence of pre-existing and previously asymptomatic atherosclerotic disease or due to a dissection of the left vertebral artery as a consequence of the minor head/neck injury sustained in the accident of 26 March 2023. …
On examination today there were no physical signs of neurological impairment as a consequence of the stroke sustained in the vertebrobasilar territory.
The stroke, itself, has not resulted in measurable impairment.
In terms of the likely mechanism for the stroke it is impossible to be absolutely didactic. The presence of dissection is usually apparent to an excellent neuroradiologist. Dissection was not mentioned in the reported angiogram studies. Occlusion from vertebral dissection usually occurs in the V2 segment rather than the V4 segment. The formal angiogram studies did show evidence of atheroma involving other areas of the cerebrovascular tree which could not have been caused by the accident. On balance, therefore, it is my view that the accident did not result in vertebral dissection but rather that the stroke was a consequence of pre-existing and asymptomatic intracranial atherosclerotic disease, particularly of the left vertebral artery. Atherosclerotic disease was rendered likely by a history of poorly controlled diabetes and smoking. If this decision is to be questioned then expert neuroradiological advice would need to be received with respect to the angiogram studies.
Having made the above points, there is no doubt that Mr Bradbury was genuine in presentation and that he has suffered impaired memory and concentration and particularly altered behaviour following the accident. His stroke did not affect areas of the brain which would give rise to memory impairment and nor did they affect areas of the brain which would give rise to altered emotion and behaviour. He did have a tendency to anger outbursts before the accident but this became much more prominent in the aftermath of the accident.
I believe the aforementioned symptoms are best explained on a psychiatric / psychological basis and he was diagnosed with PTSD in the aftermath of the accident. He is certainly better since taking Lexapro.
I believe any assessment of impairment arising from the accident needs to be by a psychiatrist.”
The Medical Assessor did not undertake an assessment of permanent impairment. Commenting on the other reports in the file, he said:
“I note Mr Bradbury was seen by Dr Abraszko, neurosurgeon. She felt the vascular impairment in the left vertebral artery was due to dissection and felt there was impairment of the nervous system in the areas of memory and emotion and behaviour. I have given my reasons as to why I disagree with that view.
I note Mr Bradbury was seen in consultation by Dr Ross Mellick, neurologist. He thought the left vertebral stenosis was pre-existing (atherosclerotic) but felt that the accident precipitated embolism. I do not agree that the accident, as reported, could have caused embolism from an atherosclerotic stenosis of the left vertebral artery. The accident could only be relevant in terms of causation of the stroke if it had caused dissection of the left vertebral artery.”
Consideration
While there are circumstances in which a Medical Assessor may be required to determine questions as to causation of an impairment,[3] the Police Force did not dispute that the stroke suffered by Mr Bradbury resulted from the motor vehicle accident. If there had been a dispute as to the Police Force’s liability for the stroke injury, it was required to be determined by a Member before referral to the Medical Assessor. Procedural Direction PIC 6 provides in cl 29:
“A liability dispute in relation to a claim for permanent impairment compensation must be resolved, either by agreement between the parties or determined by a member of the Commission, before the degree of permanent impairment is assessed.”
[3] Bindah v Carter Holt Harvey Woodproducts Australia Pty Ltd [2014] NSWCA 264 at [109]-[111].
The question of whether or not the stroke suffered by Mr Bradbury was a result of the motor vehicle accident had not been referred to the Medical Assessor. He was required to undertake an assessment of permanent impairment, accepting the agreement of the parties as to the injury and he did not do so.
It was therefore necessary that the assessment be undertaken afresh, which Medical Assessor Lahz did on behalf of the Appeal Panel. We adopt her report and her assessment and there is no utility in repeating the matters set out in it, noting the statement Ward P with whom the other members of the Court of Appeal agreed, in Coca-Cola Europacific Partners API Pty Ltd v Pombinho:[4]
“The statutory provisions assume power on the part of a medical member of the Appeal Panel to carry out a re-examination and assessment of the worker. It may be inferred that the Appeal Panel, in adopting the report and findings,was endorsing the reasoning in that report since that is where the reasons are to be found. I do not accept that the Appeal Panel was required to deliver separate or distinct reasons as to why the Appeal Panel (or two of the three members of it, perhaps) accepted Medical Assessor Glozier’s assessment in preference to the assessment of, say, the Medical Assessor. In my opinion, it was sufficient for the Appeal Panel to adopt Medical Assessor Glozier’s assessment (for the reasons contained therein).”
[4] [2024] NSWCA 191 at [88].
The report contains some abbreviations. MoCA refers to the Montreal Cognitive Assessment, a tool for the assessment of mild cognitive impairment. Table 13-5 provides a Clinical Dementia Rating (CDR) by assessing the categories of Memory (M), Orientation (O), Judgement and Problem Solving (JPS), Community Affairs (CA), Home and Hobbies (H) and Personal Care (PC).
For the reasons set out in Medical Assessor Lahz’s report, we assess 12% WPI.
For these reasons, we have determined that the MAC issued on 13 November 2024 should be revoked, and a new MAC should be issued. The new certificate is attached to this statement of reasons.
W24420/24
Medical Assessment Report of Peter Bradbury
5 June 2025 PIC Suites (Dr Sophia Lahz)
Mr Bradbury attended the appointment punctually. I explained the purpose of the assessment with regard to the WPI dispute (pertaining to motor accident on 26/3/23) inclusive of the fact that the decision regarding this would be made by an Appeal Panel comprising two medical members and one legal member.
Mr Bradbury is aged 56 and right-handed. He lives alone in Wyoming (Central Coast) and travelled to Sydney by train for the appointment. He lives alone, is single and unmarried and has no children.
He is originally from the Hornsby area, completed his schooling and then completed a bachelor’s degree in finance and economics. He reported a troubled family background with parental separation when he was young. He also has two half-sisters from whom he is estranged. His mother died of cancer when he was aged in his 20s and his father committed suicide many years ago. He worked for a limited time in a bank as a settlements clerk post university studies, although he found this not to his liking and very soon after a period of travelling and working in a service station, he entered the Police Force when he was aged 30.
Prior to the motor accident 26/3/23, he reported good general health and had been taking no prescribed medications. He did remember a hospitalization for injuries post MVA at age 15 although he could not provide any information as to the nature of those injuries. He spent several weeks in hospital and went on to recover without residual effects.
He has always been quick to anger although matters are much worse since the recent strokes. “I have no restraint now…”. However, he denied any psychiatric history before the MVA/strokes. In the course of his police work over many years, Mr Bradbury has attended countless suicides and seen many corpses/distressing events although he was never psychologically distressed nor given a psychiatric diagnosis before the 2023 motor accident.
He ceased regular smoking in 2012 and consumes alcohol in moderation (20 standard drinks per year). Mr Bradbury has never taken recreational/illegal substances.
Since the accident, Mr Bradbury has been diagnosed with hypertension and diabetes. He has lost about 20 kg due to poor appetite and now takes seven different medications including Metformin, Trajenta, Forxiga, Prexam, Nebivolol, Atorvastatin and Escitalopram.
Mr Bradbury has been in the Police Force for 25 years (14 years as a sergeant) performing general duties, although he is on the cusp of being discharged. His current work capacity certificate states that he is unfit for any work.
Mr Bradbury recalled the motor accident in March 2023. He said he had been driving when he became aware of an oncoming vehicle (truck) driving erratically. When he resumed looking straight ahead, he realised that the cars in front were braking (reportedly due to a tyre bouncing along the road). He slammed on the brakes although there was insufficient time, his vehicle rear-ending the one in front which in turn rear-ended a third vehicle.
He said there was a burn injury to the right hand from the airbag and a fracture involving the left hand. There was no loss of consciousness and he fully recollects all events. An ambulance did not attend the scene, and his vehicle was written off.
He resumed his usual general police duties shortly thereafter although not long afterwards, he became acutely unwell with nausea, dizziness and sweating, causing him to present to hospital where he reported that a scan showed a “couple of strokes”.
He explained that he was then prescribed “Clopidogrel” (blood thinner to reduce risk of strokes) although due to medical error, he was given a large dose of another drug “Clozapine” usually used for patients with psychosis. Subsequently, he had no recall of events for at least several days. He was told that he became very aggressive for a period. All he knows, is that he later woke up in ICU naked, with blood over his legs and with four intravenous lines in situ.
All told, he thought he was at North Shore hospital for a week and later moved to Gosford Hospital where he underwent further tests (unsure of the details).
After a few days, he was discharged home. There was no inpatient rehabilitation although he was sent to see multiple doctors/medical specialists for various treatment and medicolegal reasons. He also saw a speech pathologist due to earlier word finding difficulties although he said the latter resolved. In early 2024, he underwent a thinking and memory (neuropsychological) assessment with Dr Batchelor although he has not been made aware of the formal results.
Mr Bradbury passed a “ROSA” i.e. Rehabilitation, Safety Operations Assessment, which he said was really a “tick a box” police force assessment and permitted to resume work. He wanted nothing more than to resume his general policing duties on the road, in the field, never having enjoyed office-based tasks.
He did resume work (general policing duties), not long after discharge and he undertook a graduated return to work programme progressing to full duties. He was able to complete his usual duties although post-work day fatigue was an issue and he would typically arrive home, only to collapse on the couch.
After the hospital admission, he noticed significant differences in himself inclusive of irritability/disinhibition/angry outbursts, slowed mental processing, poor memory/concentration and pronounced fatigue especially late in the day.
After hospital discharge, he recounted several angry episodes occurring in doctor’s waiting rooms (induced by the practitioner running late, or else due to the clerical staff mislaying his waiting list number). There was an instance in which the office staff threatened to call security due to strong language/raised voice.
He also recounted several discussions with doctors during which he almost “lost it” and “wanted to throw the doctor’s body out the window and/or wring his neck”. He also considered smashing the Perspex screen between him and the doctor. He often felt neither listened to nor believed.
Mr Bradbury is aware that he now readily says exactly what he is thinking before considering whether it would have been best left unsaid. Oftentimes, after he has expressed his thoughts, he feels remorseful because he knows this tendency is not winning him friends and actually driving people away.
He said too that there had been several instances at work where he “spat the dummy” when previously he would have been able to rein in his thoughts/actions. He also became quicker to throw an offender to the ground, in the event of any resistance to instructions and he was also very quick to upbraid his fellow officers if he did not think they were doing their job properly. He was speedier too to tell an offender exactly what he thought of them in no uncertain terms e.g. referring to them face to face as “grubs”. He found himself sometimes apologising to fellow officers for speaking his mind too readily and for being unable to filter.
Mr Bradbury’s aggression/irritability is always verbal. There have been no instances of physical violence towards either people or else inanimate objects.
Mr Bradbury was stood down from general policing duties in late 2023 following submission of a neurosurgical report finding he lacked fitness to carry a gun due to anger management problems. Of note, there had been no concerning events at work, involving his conduct with the gun. In fact, he said that one of his strengths before the motor accident had been an ability to defuse violent situations whereas after the strokes/MVA, he was less able to de-escalate conflicts, rather he could well inflame the situation, later regretting his actions and utterances.
Mr Bradbury was referred to a psychologist who suggested a diagnosis of PTSD and in turn sent him to a psychiatrist. The psychiatrist whom he still sees every 3 months prescribed Lexapro, an SSRI antidepressant which he says has helped him calm down. He has found 4-6 weekly sessions with the psychologist helpful in terms of keeping him calm although he can still become easily unleashed if people look at him the “wrong way “or else speak to him in a manner he perceives as disrespectful.
His psychiatric and psychological treatment interventions are being funded by NSW Police which he appreciates. He likes his psychologist who just lets him vent and does not dictate what he should do. He is also thankful to have no financial problems. He has had neither loans nor a mortgage for many years.
Since the accident, Mr Bradbury has become estranged from his younger sister whom he had hitherto communicated with regularly. He does not like the way in which she speaks to him. He finds her conversation “disrespectful”.
He has lost friends whom he also describes as being disrespectful. He recently had an altercation with a former friend who thought it amusing when a mutual girlfriend made Mr Bradbury a cake in the form of Shrek (because it was thought he looked like Shrek, given that he is bald). He found this very embarrassing/offensive especially as the cake was presented to a large group of acquaintances, causing him humiliation. He was very angry with this friend for finding the situation so amusing. There was an ensuing argument in which they agreed to disagree, and they are no longer in contact.
After being stood down from work, Mr Bradbury explained that he felt very depressed, very “dark” for a period. He was living alone, had no partner, no kids and now no job. He did consider self-harm although with help from the antidepressant medication and psychologist, his thoughts are significantly less dark now. However, he added, that he would not actually tell a doctor, even if he still felt suicidal.
For two months after ceasing work in late 2023/early 2024?, Mr Bradbury said he rarely left the house, being very concerned that he could become embroiled in a confrontation which he could not de-escalate given proneness for irritability.
Mr Bradbury regained his driving licence (through the doctor) about a month after the strokes. There have been no instances of road rage although he can nonetheless still “sit and fume”. He gave the example of feeling annoyance when he sees people’s arms external to their cars, thinking to himself “put your arm back inside if you want to keep it”. Careless pedestrians randomly walking across the road also make him feel angry.
He had thought that manager in the Police Force would eventually “tick a box” so he could return to work. However, when he saw a news story about a police officer murdering his (same sex) partner, he knew that he would remain permanently off work. He has no plans now of re-entering the police force nor for that matter any other kind of workplace in any capacity. He noted: “I would be sacked because I would “crack up” and fight with people”.
He feels now a sense of relief that he is no longer a policeman- violent crimes and floods he sees on the news, are no longer his problem. However, he did initially miss his work and sometimes he feels bored, knowing he does not have many friends and also he has few hobbies. By 2pm, he is often fatigued and lies down. He mentioned too fitful sleeping habits with a tendency for waking up to ruminate about events taking place over 10 years ago. He often dwells on regrets about things he said and did many years ago. He feels naturally frustrated that he focuses unhelpfully on events taking place so long ago.
Most of his friends, Mr Bradbury said have stopped inviting him out because he says they know he is a “prick”. Prior to the motor accident, he would go to dinners and there would be working bees completing handyman tasks at friends’ homes. He rarely goes out nowadays. He occasionally goes for a walk or else visits the beach. He spends time watching TV, watching Youtube, completing chores and specific home projects which provide him with purpose. He also likes to mow his elderly neighbour’s yard. She is always respectful and thankful towards him. He has no friends in whom he would be comfortable to discuss problems or else confide his feelings. “I am a big boy and have to look after myself…”
Mr Bradbury does not dwell on distressing policing events he has seen over the years although occasionally when watching movies or news stories involving death, he thinks of corpses he has seen. He said that can sometimes even “smell” them. He said such thoughts were not distressing, he just regards them as “memories”. Prior to the 2023 motor accident/strokes, he did not have such thoughts and as noted there was no psychiatric history before the motor accident.
He reports poor memory since the accident/strokes and highly reliant now on a paper diary. He recounted multiple instances of forgetting where he had parked the car, forgetting to complete all of a series of tasks e.g. going to the chemist, grocery shopping and having a blood test. He might have to come home three times before he has completed all intended activities and this causes him anger and frustration. He also used to forget to take his medications and sometimes he still comes home with only half of the intended groceries. He also walks into a room and then can’t remember why he is there. Once out of the room, he often can’t recall why he left.
He uses a whiteboard to keep track of sporadic tasks e.g. organising an electrician for an odd job, paying a car registration. When it doesn’t happen, the tradesman does not attend or else does not return his call, Mr Bradbury follows up and often has words with the tradesman who has not followed through with the promised activity.
Most of Mr Bradbury’s bills are set up on direct debit or else he would forget to pay them.
Mr Bradbury maintains his home, completes shopping, cleaning and cooking (just one meal per day given his appetite remains depressed).
Mr Bradbury does not acknowledge low mood. His main concerns (as noted) are proneness for confrontation/angry outbursts, poor memory, fatigue and poor concentration such that he can’t focus on a book for long. He also continues to feel “slowed up” mentally.
Mr Bradbury does not play any sports, engages in very limited social activities and does not undertake any specific social, recreational or voluntary activities. He has never been a person keen on the gym and he is not doing any structured exercise.
Mr Bradbury is considering whether he should arrange a dog for some company. He had been a very busy when working full-time whereas he now has too much time on his hands.
Mr Bradbury no history of seizures.
He does not report any problems with vision, hearing, smell or taste.
Mr Bradbury has noticed mild decrement in balance.
On examination, I found Mr Bradbury a tall, strongly built man with height 184 cm and weight 104 kg.
He was initially somewhat taciturn although once rapport was established, he was an informative historian. He also expressed appreciation that I had been on time for his appointment, given lateness is a trigger for angry outbursts.
On the MoCA, he scored 28/30, the only deficit being with respect to short-term memory.
Gait was normal.
There were no focal neurological abnormalities with respect to tone, power, reflexes or sensation. Coordination of the upper and lower limbs was normal.
The only neurological abnormality I noted was a right-sided palmomental (frontal release) reflex. There were no other frontal release reflexes present.
Cranial nerves were normal although olfaction (smell) was not formally assessed. However, no deficits were reported with respect to either smell or taste.
Conclusions
Mr Bradbury suffered multiple small cerebral infarcts (strokes) after the motor accident, involving the occipital lobes, right parietal lobe and bilateral cerebellar hemispheres.
Of note, despite 25 years in the Police Force with exposure to many potential traumatic events, there was no psychiatric history and there were no formal psychiatric diagnoses.
He presented in a straightforward manner throughout the medical assessment.
Mr Bradbury was a senior police officer, who before the accident (he said) had an excellent memory and been well respected at work. Whilst he could be quick to anger before the motor accident/strokes, he had been able to de-escalate disputes and able to rein in unhelpful thoughts without expressing them. He had been an officer to whom others came for advice due to breadth of experience.
Since the strokes, he has experienced problems with anger management, dispute escalation with verbal aggression, estrangement from friends and family members and interpersonal issues at work.
He used to often read although due to poor concentration; he has ceased this activity.
He has also suffered from daytime fatigue, sleep disturbance, poor memory, slowed mentation and concentration difficulties since the motor accident/strokes.
He has socially withdrawn particularly when initially stood down from work due to concerns that he could become involved in confrontations due to short fuse and emotional/behavioural dysregulation.
Neurological examination was unremarkable aside from the presence of a frontal release reflex, a right-sided palmomental reflex. This is an abnormal finding in an adult male of this age and indicative of organic impairment due to disruption of the frontal connections with cerebellum and/or other cerebral regions.
A neuropsychological assessment on 22/3/24 (Dr Jennifer Batchelor) showed cognitive impairments affecting sustained attention, visual memory, executive function (higher order planning, organising and decision making) and disordered response regulation, correlating with the history Mr Bradbury has provided.
Whilst psychological distress reportedly contributed to the abovementioned neuropsychological findings (according to Dr Batchelor), the presence of multiple strokes involving the posterior circulation, on the balance of probabilities has also contributed to Mr Bradbury’s reported difficulties with memory and behavioural regulation.
On MoCA assessment, there were demonstrable difficulties with short-term memory.
There is a condition referred to as cerebellar affective cognitive syndrome characterised by distractibility, impulsivity, lack of empathy, emotional dysregulation, rumination and obsessive behaviour, anxiety, dysphoria and depression. The condition is caused by disruption of the connections between the cerebellar and frontal regions due to ischaemia/stroke or else brain trauma.
Mr Bradbury has features of an organic brain syndrome due to presence of multiple strokes. There is nervous system impairment due to the strokes incurred post motor accident. There is neuropsychological evidence to support this contention. Brain scans indicate various cerebral infarcts (stroke) and also clinical examination indicates a right-sided palmomental (frontal release) reflex which would not usually be present in a middle-aged adult.
Referring to CDR Table 13-5 page 320 AMA5, there is “benign forgetfulness” for which he compensates with a paper diary/whiteboard M=0.5. He is fully oriented O=0. There is slight impairment in problem solving with mental slowing JPS=0.5. There is slight impairment in community activities in that he is no longer working and experiencing difficulties with some daily activities due to cognitive deficits CA=0.5. Home and hobbies HH are slightly impaired (loss of reading activities) due to poor concentration HH=0.5 whilst he is independent with personal care PC=0.
Following the instructions on page 319 of AMA5 CDR=0.5 i.e. class 1 1-14% WPI. I deem the lower part of the range i.e. 4% WPI for mental and integrative function based on his complaints regarding (cognitive) fatigue and cognitive slowing.
According to Table 13-8, there is also impairment for emotional and behavioural disorders fitting within class 1 1-14% WPI. I deem this in the mid-range severity given the history he has provided of angry outbursts and episodes of emotional dysregulation i.e. 8% WPI.
Paragraph 5.4 on page 31 of the Workcover Guidelines refers to AMA5 chapter 13 disallowing combination of cerebral impairments. However for the purpose of the Workcover Guidelines, cerebral impairments such as mental status/integrative function and emotional and behavioural impairments can be combined according to paragraph 5.4 of the Workcover Guidelines.
Following combination of 8% WPI (emotional and behavioural) with 4% WPI (CDR for mental and integrative status) there is 12% WPI cerebral impairment according to the Combined Values Chart of AMA5.
In summary, there is 12% WPI due to nervous system injury with no applicable deduction for pre-existing condition.
WORKERS COMPENSATION DIVISION
APPEAL PANEL
MEDICAL ASSESSMENT CERTIFICATE
Injuries received after 1 January 2002
Matter number: | W24420/24 |
Applicant: | Peter Bradbury |
Respondent: | State of New South Wales (NSW Police Force) |
This Certificate is issued pursuant to s 328(5) of the Workplace Injury Management and Workers Compensation Act1998.
The Appeal Panel revokes the Medical Assessment Certificate of Medical Assessor John O’Neill and issues this new Medical Assessment Certificate as to the matters set out in the table below:
Table - whole person impairment (WPI)
| Body Part or system | Date of Injury | Chapter, page and paragraph number in NSW workers compensation guidelines | Chapter, page, paragraph, figure and table numbers in AMA 5 Guides | % WPI | Proportion of permanent impairment due to pre-existing injury, abnormality or condition | Sub-total/s % WPI (after any deductions in column 6) |
| Nervous system | 26.3.2023 | Chapter 5 | Chapter 13, Table 13-5, p 319, Table 13-8 p 325 | 12 | Nil | 12% |
| Total % WPI (the Combined Table values of all sub-totals) | 12% | |||||
0
3
0