O'Grady v Interactive Community Care Pty Ltd

DETERMINATION OF APPEAL PANEL
CITATION:	O’Grady v Interactive Community Care Pty Ltd [2021] NSWPICMP 119
APPELLANT:	Donna O’Grady
RESPONDENT:	Interactive Community Care Pty Ltd
APPEAL PANEL:	Member Deborah Moore Dr Julian Parmegiani Dr Michael Hong
DATE OF DECISION:	12 July 2021
CATCHWORDS:	WORKERS COMPENSATION- The appellant submitted that the Medical Assessor (MA) erred in finding a diagnosis of schizophrenia ‘inconsistent with opinions expressed by other clinicians’; The MA assessed 0% WPI on the basis of this diagnosis which was unrelated to the acknowledged incidents at work which led initially to other diagnoses; Held- Panel found that the appellant presented with a clear history of schizophrenia which is a biological condition and does not occur as a result of life events; MAC confirmed.

STATEMENT OF REASONS FOR DECISION OF THE APPEAL PANEL IN RELATION TO A MEDICAL DISPUTE

BACKGROUND TO THE APPLICATION TO APPEAL

On 19 March 2021 Donna O’Grady lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Samson Roberts, a Medical Assessor (MA) who issued a Medical Assessment Certificate (MAC) on 19 February 2021.
The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (1998 Act):
· the assessment was made on the basis of incorrect criteria,
· the MAC contains a demonstrable error.
The delegate is satisfied that, on the face of the application, at least one ground of appeal has been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the ground(s) of appeal on which the appeal is made.
The WorkCover Medical Assessment Guidelines 2006 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 the WorkCover Medical Assessment Guidelines 2006.
The assessment of permanent impairment is conducted in accordance with the NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4^th ed 1 April 2016 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5^th ed (AMA 5).

PRELIMINARY REVIEW

The Appeal Panel conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the WorkCover Medical Assessment Guidelines 2006.
As a result of that preliminary review, the Appeal Panel determined that it was not necessary for the worker to undergo a further medical examination because although one was requested, no reasons were provided as to why it was necessary, and in any event, we consider that we have sufficient evidence before us to enable us to determine the appeal.

EVIDENCE

Documentary evidence

The Appeal Panel has before it all the documents that were sent to the Medical Assessor for the original medical assessment and has taken them into account in making this determination.

SUBMISSIONS

Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.
The appellant submits that the MA erred “by determining that the appellant has a diagnosis of schizophrenia… inconsistent with opinions expressed by other clinicians.”
In reply, the respondent submits that no errors were made.

FINDINGS AND REASONS

The procedures on appeal are contained in s 328 of the 1998 Act. The appeal is to be 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 [2006] NSWCA 284 the Court of Appeal held that the 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.
The appellant was referred to the MA for assessment of whole person impairment (WPI) in respect of a psychiatric/psychological injury resulting from a deemed date of injury of “in or about August 2012.”
The MA obtained a lengthy and comprehensive history. Given the nature of the grounds of appeal, it is appropriate to set this out in some detail. He said:
“Ms O'Grady could not recall when she started work at Interactive Community Care. She explained that her role entailed supporting clients in their own homes. She worked with various clients at different locations. Many of the clients had challenging behaviours, some were verbally violent and others were physically violent. She explained that she always loved her work. Sometimes it was stressful.
Ms O'Grady explained that one of her clients had high needs and was violent. In order to be involved in his care she had to undertake specific training. She was told that she would not be sent to work there alone but one night she was sent there alone. She recalled feeling sick...it was a very anxious night. She was so anxious that on her way home she pulled over and vomited. She rang her boss and said that she could not return to the home and was never sent back.
Ms O'Grady recalled that there were a few incidents thereafter in which she was involved. Ultimately she was involved in the care of a young client at Kincumber. Sometimes while she was working there, no one would attend to replace her. Ultimately he threw a rock at her face following which she had one day off work. She sustained a lump and a bruise. She never returned to his home.
Ms O'Grady's next client, Adam, was a 26-year-old man of large build. He had previously killed someone by accident. He was a high-needs client and it was always necessary to have two staff present on the shift. Ms O'Grady had a good rapport with him but he could still lash out. She explained that on one occasion he struck her between the eyes…She explained that he knocked her back and she was a bit ‘giddy’…She did not have to cease work but her colleagues took over temporarily while she ‘regrouped’ and she thereafter got ‘back into it’…She continued working a few shifts with Adam and about a week later went on holidays… She was away for four weeks.
On her return…she was re-booked to work a couple of days later. From that time, she worked a couple of shifts per week for only two weeks before ceasing employment.
When asked regarding the advent of psychiatric symptoms, Ms O'Grady replied that she found that everyone was acting ‘a bit strange’ after her return from holidays. She explained that she did not feel right but she could not explain in what way she did not feel right. She recalled that a colleague with whom she was working started yelling at a client. He intended to take the client on an outing without her. She stated that this represented an unplanned activity.
Ms O'Grady developed a severe headache. She had to stop at a chemist on the way home and on her return home she felt ‘stressed out’. She rang her employer stating that she could not work with Adam anymore and that she had ‘lost (her) nerve’. She stated that that night she felt ‘quite manic’. When asked to further explain how she felt, she replied that she had the thought that ‘they’ were trying to hurt him. On being asked to explain further what she meant by this, she stated her belief that colleagues were seeking to hurt Adam. In this context she spoke to the police. She was unable to sleep. She was restless and could not concentrate. She recalled that on attending the police station, she was asked if she wanted to see mental health. A police officer then told her to go home and to discuss the matter with her employer.
Ms O'Grady recalled that her cousin subsequently took her to a general practitioner. She had a headache. She did not feel good. She could not describe further symptoms. She was prescribed the antipsychotic Seroquel (quetiapine).
Subsequently, Ms O'Grady's boss came to her home. He took a statement and then handed her a separation certificate.
Ms O'Grady explained that the Seroquel that was prescribed to her….caused her to sleep excessively. She stated however that she was scared to sleep because she feared that someone would come and get her because she had said that her colleagues were hurting the client. After six months she felt better. By then she had seen staff at Centrelink and it was suggested that she should apply for a Disability Support Pension. She started seeing a counsellor at Wyong prior to being hospitalised for two weeks with pulmonary emboli.
Ms O'Grady explained that for a long time doctors sought to prescribe medication but she was ‘non-compliant’. It was at least twelve months ago that she suffered what she referred to as her ‘last breakdown’. She could not recall what happened. She did recall however that she was sleeping excessively. She recalled that she wet her bed and lay in it. She could not cook or clean. She experienced voices telling her that by washing her hair or washing dishes she was hurting someone. She did not recognise the voices which were both male and female. She recalled that they would say her name in a reprimanding tone. One of the voices interacted with her laptop computer and indicated to her that it was God. She also recalled that the television was interacting with her. She therefore no longer uses the television or the laptop. She described feeling unsafe. She could not however state who it was whom she perceived was seeking to harm her. She also reported that she was seeing things. For example she recalled seeing a flat mate standing in her doorway and she recalled seeing a body in her son's room. In addition she experienced what she referred to as "sensations". On being asked to explain this further, she replied that one night a voice said, "She is hooking." Ms O'Grady acknowledged that she had no idea what this meant. She went on to explain that she felt as if she were on a boat. She was unable to walk straight.
In the context of her psychiatric decline described above, Ms O'Grady's mother took her to Wyong Hospital. She was assessed and underwent blood tests. She was discharged with mental health follow-ups. She was prescribed the antipsychotic Zyprexa. Her sleep improved and the voices diminished. She subsequently saw a psychiatrist at Brisbane Waters Private Hospital on one occasion only.
Ms O'Grady explained that she reflects on what happened at work and what went wrong. She has nightmares about high needs violent clients. She has had no further contact with any of her former clients but she has bumped into her former colleague at Bateau Bay. She found this uncomfortable because she continues to harbour the thought that her colleagues were hurting Adam. Sometimes the assault by Adam plays on her mind. She also has a memory of him biting a co-worker. She stated that she has ‘issues’ with Muslim people because Adam was a Muslim. She avoids Muslims and when exposed to them feels sick. She stated that she cannot explain the way she feels in this regard.”
Present treatment was noted as follows:
“Ms O'Grady committed to emailing a list of medications. She did not know her medications off hand to recount her regime at interview. She explained that six months prior to the assessment she ceased taking psychiatric medication explaining that she was grinding her teeth. Auditory hallucinations returned and she resumed taking the medication at an increased dose.
Ms O'Grady has a mental health worker named Pip through the local community mental health team. She has not seen a psychiatrist since her discharge from hospital.”
Present symptoms were noted as follows:
“Ms O'Grady explained that when she goes out she feels unsafe. Sometimes she also feels unsafe in her home. With respect to the voices, she explained that one of them is particularly persistent. It continues to say her name in a reprimanding tone. The other voices are only present sometimes. She continues to worry about the safety of her friends and family. She stated that she has been unable to identify the people whom she perceives intend to harm her friends and family. She continues to believe that the devil is still after her and she spoke of having felt a fingernail scrape across her back.”
After documenting her past and general health issues, the MA then documented her psychosocial history. The MA said:
“In terms of other family circumstances, Ms O’Grady reported that her paternal aunt has schizophrenia. Her sister died two years ago from an infection following a surgery to her back. She has a brother who is unwell having been traumatised by an incident at work in his role as a prison guard…”
As regards social activities and activities of daily living, the MA said:
“Ms O'Grady confirmed that she has not been in a relationship since her relationship with John ended following her pulmonary emboli. She resides with her 32-year-old son. Her cousin also lives with her and they have lived together for approximately 15 years.
Ms O'Grady stated that twelve months ago her psychiatric condition was much worse and her mother took her to hospital at that time and treatment was altered. Ms O'Grady was not working at the time of the assessment and explained that she spends her time cleaning and painting. She does not watch television because the television was talking to her, making fun of her, ‘testing’ her and sending her messages.
Ms O'Grady drives herself to doctors' appointments sometimes but is generally driven there by others. Her doctors are in Bateau Bay, a 15 to 20-minute drive.
Ms O'Grady does not read. She tends to her hoya plants.
Ms O'Grady stated that her relationship with her son is satisfactory. He is a gamer and spends a lot of time playing on computers. She finds it frustrating. She referred to her mother as her "hero". Her mother attends weekly and helps with cleaning. Her relationship with her cousin is pretty good. He is an older man who works. He is helpful. Her friends have been supportive but she has distanced herself from them because she worried about how she would save everyone. On being asked about this, she explained that she ‘sort of went into protective mode’ thinking that people were trying to hurt them. She spoke to God. She stated that the devil was after them. She heard voices. She was of the belief that she was hurting people just by doing the housework, cooking and cleaning and she therefore stopped doing any of these tasks. She has recently started reconnecting with friends some of whom she has known for in excess of 20 years. She stated that her condition had not caused any harm to her friendships.
Ms O'Grady spoke of an isolative lifestyle. She drives to the local shops. She is anxious in the shops and often in a hurry to get home. She cannot explain why. Now she maintains her hygiene and her personal care and she is cooking for herself. She may lose her appetite sometimes. She also acknowledged ’a lot of medical issues.’ She purchases her groceries online or someone goes to the shops accompanied.”
Findings on mental state examination were reported as follows:
“The assessment was undertaken by Zoom but the audio failed and while the video operated we relied on the telephone to complete the assessment. Ms O'Grady presented with long wavy unruly hair. It was apparent that Ms O'Grady was missing a front tooth. She smoked during the interview. She was animated throughout the interview. She exhibited a restricted affect. She stated that she was depressed about her inability to work and expressed frustration with herself in this context. She acknowledged finding it difficult to "get happy" but her sense of humour was intact as was apparent at interview. She expressed anxiety in the context of delusional beliefs, auditory hallucinations and visual hallucinations. She retained a paranoid belief that her friends were in danger and that her former colleagues had sought to harm a client. She participated effectively in a lengthy assessment. Her memory was vague with respect to some matters. As described above, psychotic symptoms were prominent.”
In summarising the injuries and diagnoses, the MA said:
“The history presented by Ms O'Grady reflects her distress in the context of circumstances that arose in the workplace inclusive of assaults to which she was subjected. The description of the symptomatology that she experienced at that time was reflective of the development of an Adjustment Disorder with Mixed Anxiety and Depressed Mood of a nature sufficient to cause her to feel reticent about working with those clients who had conducted themselves in an aggressive manner. She nevertheless continued to work with Adam until she went on planned leave. At work, she was the subject of a physical assault to her head but it was not of sufficient severity to produce loss of consciousness or to compel her to cease work. She sustained bruising. She did not require medical intervention.
Ms O'Grady presented an account of the advent of psychotic symptoms when she returned to work after a holiday of several weeks' duration. She described beliefs of a delusional nature about her colleagues, namely she formed the belief that they were harming Adam. Her beliefs with respect to her colleagues persisted after she ceased work and came to include the belief that she and her friends were in danger and being targeted. It is evident that she has experienced enduring delusional beliefs that her friends and family may come to harm and over the subsequent years she has taken steps to ensure her personal safety. She had the locks on her home changed and she had security cameras installed. In addition to these delusional beliefs, she experienced auditory hallucinations of voices telling her that undertaking basic household tasks would cause her to harm others. In this context she felt compelled to neglect her home. The auditory hallucinations have persisted in speaking to her in a reprimanding tone. She also described experiencing visual hallucinations and somatic hallucinations.
It is evident that in the context of psychotic symptomatology, Ms O'Grady has come to the attention of mental health services having been under the care of her general practitioner previously. She has been prescribed antipsychotic medication but the treatment that has been prescribed to her has been insufficient to satisfactorily moderate her symptomatology although some diminution of severity has been achieved.
Diagnostically, Ms O'Grady's symptomatology reflects the advent of Schizophrenia. The enduring psychotic symptoms are inevitably associated with anxiety. While she continues to reflect on experiences in the workplace, her account indicated that her ruminations and concerns about work and her former colleagues are delusional-based and represent a manifestation of her psychotic illness, Schizophrenia. The symptomatology described by her does not support the conclusion that the Adjustment Disorder with Mixed Anxiety and Depressed Mood has endured. The enduring psychiatric presentation is reflective of Schizophrenia which continues to impact on her day-to-day functioning and the treatment of which has been suboptimal.
In conclusion, the work-related diagnosis of Adjustment Disorder with mixed anxiety and depressed mood has remitted and it is the non-work-related psychiatric diagnosis of Schizophrenia which persists and which remains the target of treatment and the source of impairment…
As stated above, consistent with the natural course of an Adjustment Disorder with Mixed Anxiety and Depressed Mood, this condition has remitted however Ms O'Grady developed Schizophrenia, a psychiatric abnormality, which accounts for the symptomatology with which she presented at interview and which accounts for the entirety of her impairment. This does not represent a condition caused by work. It is accepted by the overwhelming body of psychiatric opinion and well documented in the psychiatric literature that this represents a neurodegenerative biological condition and cannot arise as an effect of circumstances in the workplace.”

The MA assessed 0% WPI.
The MA then summarised the other medical opinions and other material before him as follows:
“The application is noted to refer to the diagnosis of Post-traumatic Stress Disorder ascribed to the incident associated with engaging with violent and abusive clients and from being assaulted in the course of her employment.
The statement of Ms O'Grady refers to the assault described at interview…Consistent with the account presented at interview, she documents that the voices were telling her that she was hurting people by cooking and by doing housework. This is dated to early 2019 while the events to which she ascribed her initial psychiatric decline are dated to December 2012…
The psychiatric report of Dr Thomas Oldtree Clark dated 23 October 2019 was reviewed. He documented the advent of psychosis and documented that Ms O'Grady ‘had thoughts of God, complaining to the police that the client involved was in danger and she realised she herself was in danger’. He also documented the death of Ms O'Grady's sister. He documented the persistence of ‘transient psychotic episodes’ noting that she cannot watch television. He documented that she had ‘worked out a way of watching Netflix on her laptop’. On being asked about this, Ms O'Grady replied that Netflix does not communicate with her like the television does and she has more control over what she watches. She can therefore turn the volume down or have a break if she perceives there to be some communication from the device. Dr Clark also noted that she had been walking on a treadmill. On being asked about this, Ms O'Grady made reference to lung problems. Dr Clark concluded upon a diagnosis of Post-traumatic Stress Disorder and identified the absence of any pre-existing psychiatric impairment. He undertook an assessment of whole person impairment. It is not clear from his assessment that physical factors were excluded. He concluded upon a whole person impairment of 26% adding 1% for effects of treatment, namely the antipsychotic medication and calculated a total whole person impairment of 27%.
Clinical correspondence of Dr Ranasinghe dated 11 September 2018 documents anxiety symptoms. It documents that Ms O'Grady had witnessed domestic violence as a child. No diagnosis is documented. Dr Ranasinghe recommended an increase in the antidepressant sertraline which was at the time prescribed at the subtherapeutic dose of 25mg daily and a trial of the antipsychotic lurasidone at a dose of 40mg daily instead of olanzapine which Ms O'Grady was evidently taking at the time. She confirmed that she never saw Dr Ranasinghe again...
A clinical entry in the general practice notes of Dr Pravesh Shah dated 30 November 2012 documents that Ms O'Grady attended in the company of her partner stating that she had been feeling odd and that something was going on at work. Her partner reported that she had been behaving strangely for a few days and was "very suspicious and scared". She was prescribed Seroquel 25mg at that time. The entry of 3 December 2012 documents that Ms O'Grady was distressed and frightened. A diagnosis "of acute/transient psychotic disorder" was made and it was recommended that the Seroquel dose be increased. The death of Ms O'Grady's sister is documented in an entry of 30 June 2014. The presence of auditory hallucinations is documented in an entry of 15 July 2015. The clinical entry two days later refers to a "meltdown" and the ingestion of Pristiq tablets. On being asked about this, Ms O'Grady reported that God was telling her that the devil wanted her and that he wanted her asleep. She interpreted this to mean that she should take all the tablets. The entry of 28 August 2015 documents that Ms O'Grady was spending time in her garden and going out for drives but still crying occasionally and requiring Seroquel regularly. Pristiq was said to be beneficial in an entry of 12 October 2015. Type 2 diabetes was diagnosed on 19 February 2016 in response to which Ms O'Grady became upset. The entry of 26 July 2017 documents the presence of paranoia and depression.
Centrelink medical certificates refer to acute stress reaction. They also refer to psychosis.
Further general practice records include reference to a diagnosis of Bipolar 1 Disorder. Ms O'Grady stated that she had never been given that diagnosis. The assault by Adam is documented in an entry of 6 January 2012. The entry of 3 November 2012 refers to Ms O'Grady's presentation with her partner, John. She stated the relationship ended after she had the pulmonary embolus and it had been in an intermittent relationship. It is documented that she was suspicious and scared and asked him to change the locks in the house to prevent someone entering. On being asked about this she confirmed that she still locks the house but is not as vigilant as she was. This has changed because her brother purchased cameras for her. She explained that she would hear things on the roof and, when there was an intrusion into her neighbour's property, she thought that it could be because of her. She further explained that when there were arborists working in the street, she had the feeling that her own arms were being ripped off.
The clinical entry of 25 November 2013 documents Ms O'Grady's intention to travel to the Northern Territory. The entry of 24 December 2013 documents that her son had been ‘troubling her’ and that he was remaining in his room playing games. It is documented that he was sometimes abusive to her. The entry of 19 June 2014 refers to Ms O'Grady not doing well mentally. The entry of 22 October 2014 documents an account that the coroner identified that her sister had high levels of carbon monoxide in her and documents the council’s intention to check her mother’s house for possible sources of carbon monoxide. In this context Ms O'Grady expressed the worry that she too might have high levels of carbon monoxide. The entry of 30 October 2014 documents that she has ceased drinking water from her taps at home because someone had told her that copper could be making her feel ill. The entry of 16 January 2015 documents Ms O'Grady's belief that someone was trying to harm her and her family and that she perceived she was being exposed to carbon monoxide. The entry of 17 July 2015 documents a diagnosis of Schizophrenia and the entry of 30 August 2018 documents a diagnosis of ‘Posttraumatic Stress Disorder with work exacerbating her bipolar episode.’
Emergency department documents of Wyong Hospital pertaining to an overnight admission from 16 July 2015 refers to Ms O'Grady ‘being persecuted on Facebook by a former patient’. The same documentation states that she admitted to daily marijuana use and was providing conflicting information pertaining to her marijuana use. On being asked about this, Ms O'Grady confirmed that she was smoking but only "dabbled". It is documented that she was hearing voices of people talking to her and that she was scared to leave the house. She reported that her thoughts were "going very fast" and that she was suffering insomnia and had been wetting the bed. It is documented that she had hypothyroidism which had been unstable. Ms O'Grady stated that her condition had in fact been stable over time.”
The appellant submits that the diagnosis of schizophrenia is “not supported by the evidence and is inconsistent with opinions expressed by other clinicians.”
The appellant commences her submissions with a detailed chronology of the events at her workplace and related matters which is generally consistent with those reported by the MA.
The appellant then goes on to set out details of the medical evidence, both reports and clinical notes, in support of her submission that her “psychosis is now well-managed and that it is her work-related psychiatric condition from which she continues to suffer (be it anxiety, and/or PTSD and/or adjustment disorder with mixed anxiety and depressed mood).”
The appellant added:
“Dr Clarke provides a diagnosis of PTSD despite taking a similar history to [the MA]…
The diagnosis of a psychological injury is a matter of clinical judgment based on the diagnostic guidelines. It is acknowledged that the exercise of clinical judgement may justify giving certain diagnoses to an individual, even though their clinical presentation falls just short of meeting the full criteria for the diagnosis as long as the symptoms that are present are persistent and severe.
The…chronology paints a picture of someone with multiple medical issues as referred to by Dr Ranasinghe. There have been various diagnoses and treatments in relation to her psychological condition which appear to be of a complex nature.
Competing diagnoses can be expected in complex matters and a difference in medical opinion is not something that in itself would disentitle an applicant to compensation so long as the opinion on diagnosis is given in a reasonable climate.
While a difference of medical opinion does not amount to the use of incorrect criteria or a demonstrable error, it is submitted that this is more than a mere difference of opinion…”
We do not cavil with the appellant’s summation of the consideration to be given to competing diagnoses, but the appellant’s submissions are misconceived.
The MA clearly acknowledged that:
“The history presented by Ms O'Grady reflects her distress in the context of circumstances that arose in the workplace inclusive of assaults to which she was subjected. The description of the symptomatology that she experienced at that time was reflective of the development of an Adjustment Disorder with Mixed Anxiety and Depressed Mood (our emphasis) of a nature sufficient to cause her to feel reticent about working with those clients who had conducted themselves in an aggressive manner…”
In other words, he accepted that the work-place events had led to the diagnosis referred to above, and as he said:
“the work-related diagnosis of Adjustment Disorder with mixed anxiety and depressed mood has remitted and it is the non-work-related psychiatric diagnosis of Schizophrenia which persists and which remains the target of treatment and the source of impairment…”
The appellant further submitted:
“The path of reasoning taken by Dr Samson ignores the evidence provided in the history taken from the worker, of symptoms that are indicative of a diagnosis of PTSD which she continues to suffer from as per Dr Clark’s view.
She presented to ED after overdosing on Pristiq in 2015 after running into a colleague from her work which brough up memories regarding the issues that she had at the time.
She continues to have nightmares (as reported by the MA).
This demonstrates an error on the face of the record of the Medical Assessment Certificate.
The [MA] fell into error in determining that any work-related psychiatric condition was in remission…
In support we repeat the above submissions regarding the history of continuing complaints about nightmares about traumatic incidents and rely on the diagnoses of Dr Rangasinghe and Dr Clarke…”
These submissions show that the appellant is doing no more than urging acceptance of the opinions of Dr Rangasinghe and Dr Clark.
It is perhaps timely at this point to set out the task of an Appeal panel as stated in Ferguson v Stateof New South Wales [2017] NSWSC 887 where Campbell J said:
“The Appeal Panel accepted that intervention was only justified… if it could be demonstrated that the AMS was unaware of significant factual matters; if a clear misunderstanding could be demonstrated; or if an unsupportable reasoning process could be made out. I understood that all of these matters were regarded by the Appeal Panel as interpretations of the statutory grounds of applying incorrect criteria or demonstrable error. One takes from this that the Appeal Panel understood that more than a mere difference of opinion on a subject about which reasonable minds may differ (our emphasis) is required to establish error in the statutory sense….”
The “difference of opinion” between the MA and Dr Clark is clearly explained by the MA. The appellant’s presentation and the weight of all the medical evidence summarised in considerable detail by the MA clearly supports the diagnosis he made.
A MA is required to make an assessment on the day of the examination.
In our view, the appellant presented with a clear history of schizophrenia which is a biological condition which does not occur as a result of life events.
The MA does not deny that the appellant had a psychological condition, whether it be Adjustment Disorder with mixed anxiety and depressed mood or as Dr Clark opined, Post-traumatic Stress Disorder. Whatever the nature of that condition, the MA concluded that any symptoms from that condition had abated.
The appellant’s presentation and the totality of the evidence supported that conclusion.
In our view, it was open to the MA to reach the conclusions he did. He prepared a thorough and comprehensive MAC clearly explaining his reasons for his assessment.
For these reasons, the Appeal Panel has determined that the MAC issued on 19 February 2021 should be confirmed.

[2021] NSWPICMP 119

12 July 2021