Johnston v Australian Manufacturing Workers Union
[2022] NSWPICMP 232
•25 May 2022
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | Johnston v Australian Manufacturing Workers Union [2022] NSWPICMP 232 |
| APPELLANT: | Patrick Thomas Johnston |
| RESPONDENT: | Australian Manufacturing Workers Union |
| APPEAL PANEL: | Member Richard J Perrignon Dr Paul Curtin Dr Tommasino Mastroianni |
| DATE OF DECISION: | 25 May 2022 |
| CATCHWORDS: | WORKERS COMPENSATION- Appeal from assessment of 13% whole person impairment (4% face, 9% skin); whether assessor filed to give reasons for assessing 4% (face) instead of 5%, within the available range for a Class I impairment; whether assessor erred in assessing a Class I impairment in respect of the skin; error identified in respect of the assessment of skin; Held- Medical Assessment Certificate set aside; on further examination, Class II impairment assessed in respect of the skin; replaced with an assessment of 21% whole person impairment (4% face, 18% skin). |
BACKGROUND TO THE APPLICATION TO APPEAL
The appellant worker, Mr Johnston, appeals from the Medical Assessment Certificate of Medical Assessor Dr Giles dated 22 November 2021. Dr Giles assessed a 13% whole person impairment (4% face, 9% skin).
Mr Johnston had claimed compensation for whole person impairment by way of a skin disorder - lesions on his face and elsewhere, including basal cell carcinomas - resulting from sun exposure in the course of his employment. He was referred to Dr Giles for assessment of whole person impairment (scarring) as a result of injury on 28 October 2010 (deemed date).
In respect of the face, Dr Giles assessed a class 1 impairment with a range of 1% to 5%, from which he selected 4%. In respect of the skin elsewhere on the body, he selected a class 1 impairment, with a range of 1% to 9%, from which he selected 9%, being the maximum impairment assessable in that class.
Mr Johnston alleges that, in respect of facial disfigurement, the assessor failed to give reasons for preferring a 4% impairment to the 5% impairment previously assessed by Approved Medical Specialist Dr Gillam in her Medical Assessment Certificate of 4 April 2011, and more recently assessed by Dr Lai and Dr McGlynn.
In respect of the skin, he alleges that the assessment of a class 1 impairment was in error, and that the evidence merited a class 2 impairment, which compels an assessment of impairment greater than 9%.
The Appeal Panel conducted a preliminary review of Dr Giles’ medical assessment in the absence of the parties and in accordance with the NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment (4th edition) (the Guidelines). Having identified error in the Medical Assessment Certificate, it referred the worker for examination by Medical Assessor Dr Curtin, whose report is considered below.
Submissions
The appellant worker seeks a referral for examination by a member of the Panel and, should such a referral be made, leave to adduce a supplementary statement.
In brief summary, he submits as follows:
(a) With respect to the assessment of facial disfigurement:
(i)Within class 1, no criteria are specified for the selection of any particular percentage impairment from 1% to 5%. In those circumstances, the selection of a level of impairment is a matter for the application of the assessor’s clinical judgment and expertise.
(ii)A Medical Assessor may have regard to the assessments of other clinicians, but is not bound to agree with them: Pitsonis v Registrar of the Workers Compensation Commission [2008] NSWCA 88.
(b) With respect to limitations on the activities of daily living in the context of the assessment of the skin:
(i)With respect to self-care and personal hygiene, the assessor failed to take into account evidence of limitation. Dr Lai took a history in 2021 of the need to avoid long showers in to keep the skin dry and dressings on excision sites dry, and to use specialised skin products, lip balm and moisturiser. He also noted the appellant’s need for protective clothing to avoid sun exposure.
(ii)With respect to limitations on physical activity, Dr Giles mentioned the worker’s need to swim very early in the morning to avoid sun exposure, but did not indicate whether he took this into account in assessing activities of daily living at limitation. He failed to take into account the matters reported by Dr Lai: limiting exercise to the morning or evening to avoid sun exposure, limitations on exercise while waiting for skin treatments to heal; and refraining from swimming and elevating his legs after procedures. He also failed to take into account the observations of Dr Clowse in 2016 that tight skin after surgery limited his physical movement.
(iii)With respect to sensory function, he failed to take into account the observation by Dr Lai that there was altered sensation with irritation in treated areas, the finding in 2020 by OPD Dermatology that there were two hyperkeratotic nodules with keratin plugs that were tender to touch, and the fact that previously excision sites have become infected.
(iv)With respect to limitations on travel, he failed to take into account Dr Lai’s report that the worker was restricted in his ability to travel by car during the day because of his need to avoid sun exposure.
(v)With respect to limitations on sleep, the assessor failed to take into account Dr Lai’s report that the worker has to lie on his side for comfort, and wakes when he rolls over, and Dr McGlynn’s observation that the ability to sleep was limited by skin itch.
(c) The appellant has a constant need for treatment, satisfying the third criterion for a class 2 impairment.
The respondent employer submits in summary as follows.
(a) With respect to the assessment of facial disfigurement:
(i)Within class 1, no criteria are specified for the selection of any particular percentage impairment from 1% to 5%. In those circumstances, the selection of a level of impairment is a matter for the application of the assessor’s clinical judgment and expertise.
(ii)A Medical Assessor may have regard to the assessments of other clinicians, but is not bound to agree with them: Pitsonis v Registrar of the Workers Compensation Commission [2008] NSWCA 88.
(b) With respect to assessment of the skin and the activities of daily living:
(i)The only limitation noted by Dr Giles was that the appellant swims very early in the morning to avoid sun exposure.
(ii)This is inconsistent with the appellant’s assertion that he avoids long showers in order to keep his skin dry and his dressings intact.
(iii)Dr Giles must have taken into account the history given to Dr McGlynn that the appellant avoids social and recreational activities in order to avoid sun exposure.
(iv)Restrictions on activities following a procedure are not relevant, as assessment can only be performed when maximum medical improvement is reached. By definition, it cannot be reached while the temporary effects of a procedure endure.
(v)Skin irritation from creams and other treatments are consistent with a class 1 impairment as assessed, as they satisfy the third criteria for class 1 impairment, namely that treatment be intermittent.
(vi)There is no evidence of limitation with respect to travel, as the applicant was driven by his wife to the assessment.
(vii)With respect to sleep, Dr McGlynn’s assessment took into account the limitations described by the appellant. As Dr Giles agreed with Dr McGlynn’s assessment, it is likely that he also took into account the fact that sleep was limited by itch.
(viii)Apart from sleep, the only other minor restriction is the need to avoid sun exposure which limits social and recreational activities.
(ix)All treatment required by the appellant is intermittent in nature, rather than constant. This satisfied the third criterion for a class 1 impairment.
Reasoning of the Medical Assessor
Dr Giles took a history at [4] that skin lesions were initially treated in about 2000, and that cancerous lesions emerged by about 2004. They have continued to do so, with solar keratoses.
He noted that the appellant continues to attend his dermatologist every three months, needing cryotherapy treatment on most occasions. His condition is also monitored monthly by his general practitioner (GP), whom he attends for other reasons. He noted that on the appellant’s last admission to hospital, a squamous cell carcinoma was removed from the right lower extremity, and a skin graft applied.
He confirmed that new lesions continued to develop regularly, requiring regular surveillance and treatment. He also noted that the appellant avoids sun exposure, and with respect to his activity of swimming, goes very early in the morning for that reason.
Dr Giles diagnosed at [7] actinic changes of the face, scalp, trunk and of both upper and lower limbs.
No error is alleged in respect of the selection of a class 1 impairment for facial disfigurement, which permits an assessment of from 1% to 5%, depending on the level of impairment. Dr Giles gave the following reasons for selecting a 4% whole person impairment at [10c]:
“In my opinion his impairment lies near to, but not at, the upper level of this range at 4%”.
In respect of Dr McGlynn’s assessment of 5% dated 7 June 2021, Dr Giles said:
“I basically agree with his assessment, but I have not made any deduction for pre-existing solar damage …”
In respect of Dr Lai’s assessment of 5% dated 26 March 2021, he observed:
“He has assessed the facial impairment at 5% and I do not strongly disagree with that; …”
Dr Giles gave the following reasons at [10c] for assessing a class 1 impairment in respect of the skin, rather than the class 2 impairment preferred by Dr Lai:
“… [Dr Lai] assessed the damage to the skin elsewhere as having caused a Class 2 impairment and not only that, an impairment right in the middle of its range. I disagree with this because for a Class 1 impairment, the claimant has to have restriction in few of the normal activities of his daily life whereas a Class 2 impairment has to have restriction in some of these activities. I realise the distinction between these two is difficult to determine, but, in my opinion, I believe he only has restriction in a few of these activities.”
Assessment of facial disfigurement
Par [14.3] of the Guides provides that the criteria for rating impairment due to facial disorders and/or disfigurement are those in Table 6.1 in the Guides. As indicated, Dr Giles assessed a class 1 impairment. There is no allegation that he erred in doing so. Class 1 allows an assessment of between 1% and 5% impairment, depending on the level of impairment.
It is alleged that Dr Giles failed to give reasons for selecting a 4% impairment, in light of the 5% assessed in 2011 by Dr Gillam, and more recently by Dr McGlynn and Dr Lai.
No criteria are specified in Table 6.1 for selecting any particular percentage within the allowable range. It is a matter for the Medical Assessor, based on their examination and exercising their clinical judgment, as to where on the spectrum of severity the impairment lies.
The essential reason for selecting 4% was given by him at [10c]:
“In my opinion his impairment lies near to, but not at, the upper level of this range at 4%”.
The issue as to where on the spectrum of severity the signs and symptoms of disease lie is an evaluative exercise, requiring the application of clinical judgment on a background of history taking and careful clinical examination. Having regard to the photographs supplied by Dr Giles and included in his Medical Assessment Certificate, and to his findings on examination, we are of the view that an assessment of 4% was reasonably open to him. It was not necessary to give any more reasons than he did, in order to understand the basis for his assessment.
As the respondent rightly submits, an assessor is not bound to accept the opinions of other assessors. In this case, Dr Giles was by no means bound to accept the assessments of Dr McGlynn and Dr Lai.
The fact that an assessment of 4% suggests an improvement in the level of impairment since Dr Gillam’s assessment in 2011 does not make the assessment illogical or otherwise demonstrate error, as the appellant suggests.
Dr Giles’ indication that he ‘basically agreed’ with Dr McGlynn’s assessment and did not ‘strongly disagree’ with Dr Lai’s assessment, was not inconsistent with his assessment of 4%. In its context, we interpret the word ‘basically’ to mean ‘almost’. The suggestion that he did not ‘strongly’ disagree with Dr Lai implies at least some disagreement.
We can discern no error, or the application of incorrect criteria, in Dr Giles’ assessment of 4%.
Assessment of skin disorders
As indicated, the appellant alleges that Dr Giles erred in assessing a class 1 impairment of the skin elsewhere on the body, in circumstances where the evidence supported a class 2 impairment.
The criteria for class 1 and class 2 impairment are supplied by Table 8-2 of the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th edition (AMA 5). The criteria for Class 1 are as follows.
(a) Skin disorder signs and symptoms present or intermittently present, and
(b) No or few limitations in performance of activities of daily living; exposure to certain chemical or physical agents may temporarily increase limitation; and
(c) Requires no or intermittent treatment.
The criteria for class 2 impairment are as follows.
(a) Skin disorder signs and symptoms present or intermittently present, and
(b) Limited performance of some activities of daily living, and
(c) May require intermittent to constant treatment.
There is no issue between the parties that criterion (a), which is common to both classes 1 and 2, was satisfied. There can be - and is, as we understand it - no issue that the worker required at least intermittent treatment, satisfying criterion (c) of both classes.
In our view, the evidence supports a finding that the worker required constant treatment, for the following reasons. Mr Johnston's medical advisers have recommenced treatment with Acitretin medication on a daily basis. This is a powerful drug, effective in the treatment of keratinisation disorders, but which requires monitoring because of the risk of liver damage. Not only does it have to be taken daily, but also monitored regularly. Mr Johnston also gives a history, supported by the medical records, of the regular use of salicylic acid cream to control keratinizing lesions on his arms and legs.
As indicated, the sole reason given by Dr Giles for selecting class 1 over class 2 was that criterion (b) for class 1 was satisfied, but not for class 2. He said at [10a] - emphasis added:
“Because of this damage, he needs to avoid sun exposure but as only a few of the normal activities of his daily life have been restricted, I believe he has sustained a Class 1 impairment, but this impairment is situated at the very top of the range at 9%.”
And at [10c] - bold emphasis added:
“… for a Class 1 impairment, the claimant has to have restriction in few of the normal activities of his daily life whereas a Class 2 impairment has to have restriction in some of these activities. I realise the distinction between these two is difficult to determine, but, in my opinion, I believe he only has restriction in a few of these activities.”
Par [1.24] of the Guides provides that the relevant activities of daily living are those in Table 1-2 of AMA 5. They are as follows:
1. Self-care and personal hygiene
2. Communication
3. Physical activity
4. Sensory function
5. Non-specialized hand activities
6. Travel
7. Sexual function
8. Sleep.
If, on the evidence before the Medical Assessor, there was limited performance of some of these eight activities, class 2, criterion (b) would be satisfied.
In its submissions, the insurer accepts that there was evidence of limitation with respect to sleep, which was reported by Dr McGlynn to be limited by skin itch. It says that, in agreeing with Dr McGlynn’s assessment, the assessor accepted that sleep was so limited. We accept that submission.
The insurer also submits that Dr Giles accepted there was a limitation in that swimming was confined to very early in the morning to avoid sun exposure. That is also correct, in our view. We interpret that as a limitation on physical activities.
Together, those two limitations constitute limitations on two of the activities of daily living listed in Table 1-2. Criterion (b) for a class 2 impairment requires limitation in ‘some’ of those activities. In the passage quote above, Dr Giles formulated the test for criterion (b) as follows:
“… a Class 2 impairment has to have restriction in some of these activities”
That formulation was in our view correct. ‘Some’ is not defined in AMA 5. It must be accorded its ordinary meaning, which is more than one. On the basis of the limitations accepted by Dr Giles, there was limitation of more than one of the activities of daily living. Criterion (b) was satisfied.
There is no dispute that criteria (a) and (c) were also satisfied. In the circumstances, the assessor should have assessed a class 2 impairment. The failure to do so demonstrates error.
We also take into account the appellant’s submissions as to his limitations in respect of the other activities of daily living - for instance:
(a) Sensory function: Dr Lai’s finding that there was altered sensation with irritation in treated areas, and
(b) Travel: Dr Lai’s report that the appellant was restricted in his ability to travel during the day to avoid sun exposure.
These are evidence of more activities of daily living which are limited by the effects of injury. The failure to take them into account also constitutes error, requiring that the certificate be set aside.
For completeness, and in deference to the submissions made, we add the following observations.
(a) We are not persuaded by the respondent’s submission that travel is not restricted because he was driven to the examination by his wife. The fact that he travels on one occasion in order to attend a very important event does not contradict his need to avoid sun exposure on other occasions. It is beyond doubt that a person with his skin disorders needs to avoid sun exposure, including while travelling.
(b) There is no need to have regard to the findings of Dr Clowse in 2016 and of OPD Dermatology in 2020. An assessor must assess the worker as he presents on the day. The observations of Dr Lai and Dr McKinnon in 2021 are in a different category. They assessed the worker much closer in time to the assessment of Dr Giles, and provided evidence of subsisting limitations on the activities of daily living.
(c) As Dr Giles accepted that the requirement to confine swimming to very early in the morning to avoid sun exposure constituted a relevant limitation (in our view, a limitation on physical activity), it is unnecessary to consider the respondent’s submission that this contradicts the appellant’s assertion as to the need to avoid long showers.
Further examination
Being satisfied of error in respect of the assessment of skin disorders, the Panel referred the worker for assessment of the skin only to Dr Curtin, who is a member of the Panel.
There was no objection to the worker relying on his supplementary statement. Its contents have been taken into account.
Report and assessment of Medical Assessor Dr Curtin
Dr Curtin examined the worker on 22 April 2022. His report and assessment follows.
“1. The worker’s medical history, where it differs from previous records
The history is largely unchanged although some additional details have emerged. Mr Johnston’s documented history of treatment for non-melanoma skin cancer and actinic skin change date back 22 years. He also has a long history of occupational ultraviolet light exposure from his work as a shipwright from 1958 to 1978, and subsequently from his employment as a full-time union organiser until 2008 when he retired. A Medical Assessment Certificate in 2011 assessed permanent impairment at that time at 8%. Mr Johnston feels that his general health in the past has been very good and that he has always enjoyed exercise and keeping fit. At some point in the last 12 months, he was unsure of the date, he suffered a collapse from bradycardia and subsequently had a pacemaker installed. He was then able to resume his usual routine of daily swimming, which apparently involves 20 laps of the pool every morning. The only medications he takes are those related to the management of his skin condition, namely Acitretin tabs and the regular use of topical salicylic acid cream.
Current symptoms and effects on Activities of Daily Living
Despite treatment, he still develops new skin lesions and says that he sees a Dermatologist every three months and his General Practitioner about once every six weeks for various skin treatments. He is now very careful to avoid undue exposure to the sun. Exercise is an early morning activity as is any gardening or maintenance required at his house where he lives with his wife. His activities are further restricted when he requires any surgical treatment or cryotherapy which leave painful areas on his skin for two or three weeks at a time. He then has to be careful washing or showering, swimming is suspended, and his sleep is also often disturbed at night. He does not admit to any particular embarrassment about scarring to his face and body as a result of skin treatments. He is aware of some disfigurement, but makes no attempt to hide his face, and his body is generally fully covered with clothing when out and about in public.
2. Additional history since the original Medical Assessment Certificate was performed
None.
3. Findings on clinical examination.
Mr Johnston was a thin, fit looking man of 80 years with a BMI of 25.5 (72 kg and 168 cm). He had a very fair complexion with blue eyes, and a fringe of white hair around his bald scalp. His skin was generally very pale, reflecting a lack of exposure to the sun. Nevertheless, there was widespread evidence of actinic damage, particularly on his forearms and lower legs, with multiple solar keratoses, lentigenes and uneven pigmentation. There were several small suspicious lesions on his legs and also on his face warranting further investigation. By virtue of his fair complexion, most of the scarring on his face was not particularly noticeable. There were small skin grafts on both sides of his nose, and these grafts were slightly indented although the overall shape of his nose was undisturbed. Similarly, despite various small scars, both ears presented a normal shape and outline.
The dorsal aspect of both arms and hands presented a continuous patchwork of pigmentation, reflecting multiple cryotherapy treatments over the years. Multiple small keratoses were visible although Mr Johnston said that the salicylic acid cream was effective in keeping these in check.
The upper parts of his back, neck and anterior chest were also heavily affected with multiple lentigenes and patchwork pigmentation.
His legs were largely affected below the knee where there was additional deformity due to prominent varicosities. Skin graft donor sites were evident on both thighs.
4. Results of any additional investigations since the original Medical Assessment Certificate
There were no additional investigations.
[5. Comments on the issues raised in the Decision of the Dispute Support Officer (31/01/2022)
The decision states that the “medical assessor erred in failing to provide adequate reasons when assessing facial disfigurement”. Various previous medical reports from Plastic surgeons (Dr Lai 04/03/21, and Dr McGlynn 07/06/21) had found a Class I facial disorder as defined in Table 6.1 of the WorkCover Guidelines and rated the impairment at the top of the scale at 5% WPI. Assessor Giles had also found a Class I facial disorder but had rated the impairment at 4% WPI without providing any explanation as to why he felt that a lesser figure was appropriate, merely saying that in his view the impairment lies near to, but not at, the upper limit of the range at 4%.. The report of Dr Lai refers to nasal distortion as a result of surgery to both sides of the nose to justify his assessment, while Dr McGlynn refers to “obvious skin graft scarring of the right ear” to justify his rating. It was open to assessor Giles to challenge both these assessments, because in the view of this assessor there is currently minimal deformity of either the nose or the ear as a result of previous surgery. Any alteration to the contour of the nose or ear would invite an assessment into the Class 2 category which requires “loss of supporting structure of part of the face”, but in Mr Johnston’s case, there is really no significant or noticeable alterations in the facial contours to require an assessment at the top of the range of the Class I category. The assessment of 4% WPI provided by assessor Giles therefore seems consistent with the findings at this examination.
Scarring on the face is assessed differently to scarring elsewhere on the body which is assessed by reference to Table 8-2 on page 178 of AMA5. In his appeal against the assessment made by Dr Giles, Mr Johnston raised concerns that the AMS did not fully consider the extent to which his ADLs had been restricted by his skin conditions, and had he done so he might have agreed with the opinion of Dr Lai that the impairment fell into the Class II category of Table 8-2, where higher impairment ratings were available compared to the Class I category chosen by the AMS. Dr Lai refers to the eight ADLs listed in Table 1-2, p599 of AMA 5 and says that in Mr Johnston’s case, two activities, self-care and travel have been restricted and therefore it could be said that “some” activities of daily living have been limited rather than “few”, and that therefore the impairment fell into the Class II category. Dr Lai also points out that the treatment requirements of Mr Johnston could be best described as “intermittent to constant” as required for Class 2 rather than the “no or intermittent treatment” that describes a Class I impairment.
Assessor Giles does not provide any detail regarding ADLs, stating only that there has been a restriction in only few of the normal activities of daily life. His MAC also provides little if any detail regarding the need for regular or constant treatment for Mr Johnston skin condition.]
The fact that Mr Johnston says that he is now taking Acitretin indicates that he is now under constant treatment for his skin condition. It is a powerful drug, effective in the treatment of psoriasis and keratinization disorders but which requires monitoring because of the risk of liver damage. There is no reference to this medication in the MAC, nor in the reports of Dr Lai and Dr McGlynn, but it is noted in the discharge summary of the Chris O’Brien Lifehouse dated 17/8/2021. Possibly as a result of this medication, the appearance of his skin at the current time seems less “active” than it appears in some of the earlier documented photographs where inflammation and ulceration was more obvious. Mr Johnston also says that he uses salicylic acid cream almost every night to control keratinizing lesions on his arms and legs.
With regard to the current restriction of ADLs, the pallor of Mr Johnstons skin is evidence of his habit in avoiding sun exposure. His social and recreational activities are therefore restricted and there is probably also some restriction in his capacity to travel. Restrictions in his self-care/personal hygiene and in his capacity to enjoy a restful sleep appear to be intermittent rather than constant. These restrictions occur in relation to episodes of surgery or cryotherapy that occur from time to time. Review of the final 18 months of the available GP notes (January 2019 to June 2020) reveals that he attended on 19 occasions, not all of which were related to his skin problem. There is only one record of cryotherapy administered by his GP, but there are references to 5 occasions when he had surgical procedures carried out in the Dermatology department at Concord Hospital. He frequently required dressings by his GP following these procedures.
As assessor Giles observes, distinction between Class I and Class II impairments can be difficult to determine, but the opinion of this assessor is that the impairment of Mr Johnston does fall into the Class II category, because all three criteria for that class were satisfied. Signs and symptoms of skin disorder were present - criterion (a). Performance of some activities of daily living was limited, as indicated above in this report - criterion (b). For the reasons expressed earlier in this decision, there was a need for constant treatment - criterion (c). Having regard to the frequency of his ongoing treatment requirements, it would be reasonable to place his impairment in the upper part of the impairment range available in the Class II category, and 18% WPI is appropriate .
Combining the impairments results in a total of 21% WPI.”
Conclusion
The Panel accepts and adopts Dr Curtin’s report and assessment of 21 whole person impairment.
The appeal is allowed. The Medical Assessment Certificate of Dr Giles is set aside and replaced by the attached Medical Assessment Certificate.
PERSONAL INJURY COMMISSION
APPEAL PANEL
MEDICAL ASSESSMENT CERTIFICATE
Injuries received after 1 January 2002
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 Dr Giles and issues this new Medical Assessment Certificate as to the matters set out in the Table below:
| 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 AMA5 Guides | % WPI | WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed as a fraction) | Sub-total/s % WPI |
| The face | 28.10.10 | Chapter 6 | Chapter 11.3 pages 255, 256 Table 11-5 | 4 | Nil | 4 |
| The skin | 28.10.10 | Chapter 14 | Chapter 8.7 page 178 Table 8-2 | 18 | Nil | 18 |
| Total % WPI (the Combined Table values of all sub-totals) | 21% | |||||
R J Perrignon
Member
Dr Paul Curtin
Medical Assessor
Dr Tommasino Mastroianni
Medical Assessor
0
1
1