Olds and Comcare (Compensation)

[2019] AATA 1477

Olds and Comcare (Compensation) [2019] AATA 1477 (27 June 2019)

Division:                  GENERAL DIVISION

File Number(s):      2017/3828; 2017/4361; 2017/5718; 2018/0294

Re:Christopher Olds

APPLICANT

AndComcare

RESPONDENT

DECISION

Tribunal:Senior Member A Poljak

Date:27 June 2019

Place:Sydney

2017/3828

The decision under review is set aside and in substitution for that decision, it is decided that the Respondent is liable under section 16 of the Safety, Rehabilitation and Compensation Act 1988 (Cth) for the cost of the total right hip replacement as recommended and performed by Dr Lyons.

2017/5718

The decision under review is set aside and in substitution for that decision, it is decided that Comcare is liable for medical treatment and incapacity for ‘right hip sprain (labrum tear)’ under sections 16 and 19 of the Safety, Rehabilitation and Compensation Act 1988 (Cth).

2018/0294

Plasma Rich Platelet (PRP) injections are not reasonable medical treatment and accordingly the decision under review is affirmed.

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

Senior Member A Poljak

CATCHWORDS

COMPENSATION – workers compensation – right hip – claim for medical treatment and incapacity – surgery – whether total hip replacement reasonable medical treatment – applicant continued to experience symptoms – other medical treatment options exhausted – evidence of improvement following surgery – decision under review set aside and substituted – Achilles tendon – Plasma Rich Platelet (PRP) injections not appropriate treatment – decision under review affirmed

LEGISLATION

Safety, Rehabilitation and Compensation Act 1988 (Cth) ss 14, 16, 19

REASONS FOR DECISION

Senior Member A Poljak

27 June 2019

1. Christopher Olds, the applicant, has been employed with the Australian Federal Police (“AFP”) since 2 July 2007. He was employed in the Close Operations Support Division, either as a member of the Protection or Intelligence Portfolios until 10 January 2014. The applicant was due to commence working in Operations on 13 January 2014.

2. On 21 January 2014, the applicant submitted a claim for compensation for a right hip injury sustained whilst ‘lifting a box’ in the course of moving offices in his employment with the AFP. The injury was said to have occurred on 10 January 2014. On 18 February 2014, Comcare accepted liability to pay compensation in respect of ‘sprain of unspecified site of hip & thigh (right hip only)’ (“right hip injury”) pursuant to section 14 of the Safety, Rehabilitation and Compensation Act 1988 (Cth) (“SRC Act”). On 20 March 2015, Comcare accepted liability for the applicant’s secondary conditions of ‘rupture of Achilles tendon (left)’ and ‘aggravation of bursitis/tendonitis Achilles tendon (left)’ pursuant to section 14 of the SRC Act (“Achilles tendon injury”).

3. There are a number of decisions under review in these proceedings. They are:

   2017/3828

   The decision under review is a decision made on behalf of Comcare by a delegated review officer dated 20 June 2017. The review officer affirmed a determination dated 7 April 2017, which denied liability to pay compensation under section 16 of the SRC Act for ‘total hip replacement’.

   2017/4361

   The decision under review is a decision made on behalf of Comcare by a delegated review officer dated 27 June 2017. The review officer affirmed a determination dated 31 May 2017, which denied liability to pay compensation under section 14 of the SRC Act for ‘aggravation of sprain of unspecified site of hip and thigh (right)’, claimed to have been sustained on 21 April 2017.

   2017/5718 and 2018/0294

   The decision under review is a decision made on behalf of Comcare by a delegated review officer dated 27 June 2017. The review officer affirmed two determinations both dated 30 May 2017, which determined that Comcare had no present liability for medical treatment and incapacity for ‘right hip sprain (labrum tear)’ under sections 16 and 19 of the SRC Act for the applicant’s accepted conditions and denied liability for a Plasma Rich Platelet (“PRP”) injection into the applicant’s left Achilles tendon split under section 16 of the SRC Act.

4. At hearing, the applicant advised that he no longer pressed his claim in regards to matter number 2017/4361. As such, the issues for determination in these proceedings are as follows:

   a)whether the applicant’s right hip injury continues to be contributed, to a significant degree, by his employment with the AFP, and if so:

   a.whether the applicant is entitled to compensation for a total hip replacement surgery;

   b.whether he suffers incapacity as result of that injury and/or requires medical treatment in relation to that injury.

   b)whether the applicant continues to suffer an Achilles tendon injury that was significantly contributed to by his employment with the AFP; and if so:

   c)whether a PRP injection is reasonable medical treatment obtained in relation to that injury.

   Relevant Lay Evidence

5. The applicant has provided a written statement in these proceedings dated 31 October 2018 and gave oral evidence at hearing. It is his evidence that prior to the injury on 10 January 2014, he was very physically active. He said that he would engage in activities such as martial arts, surfing, soccer, orienteering/bushwalking and gym activities.

6. The applicant’s evidence is that following the incident in January 2014, he tried to play down his injury by sending SMS text messages to his team leader which contained remarks that included that he was due to have a “right hip replacement” and that “his body was falling apart”. The applicant’s evidence is that he made these remarks because he had heard that “once one hip goes the other follows”. He also clarified in his written statement that his comments were not based on any medical evidence but rather on conversations that he had generally with some older people who had had hip replacements and who he would see at the hydrotherapy pool at Bondi following his left hip resurfacing surgery.

7. The applicant states that following the surgeries performed on his right hip in July 2014 and 22 July 2015, his hip did not respond well. His recovery and response to the surgeries was not improved by post-operative rehabilitation.

8. In relation to the applicant’s left Achilles condition, he sought treatment from a Dr David Carmody in about June 2014 who recommended a PRP injection. This was undertaken in late July 2014. The applicant’s evidence is that he found the PRP treatment helpful in reducing his pain and that he understood that a scan in late 2014 showed that the tear in his Achilles was no longer visible.

   Relevant Medical Evidence - right hip injury

9. The applicant underwent an MRI of his right hip on 15 January 2014. The findings revealed, inter alia, “The labrum demonstrates a subtle degenerative linear signal without significant separation. This is likely to represent a very subtle degenerative tear-fraying without significant separation of the labral component…mixed-form of impingement may well be present”.

10. On 30 July 2014, Dr Matthew Lyons, the applicant’s treating orthopaedic surgeon, performed an arthroscopy right hip, labral repair and femoral osteochondroplasty. The surgery was approved by Comcare. The Operating Report of the same date records a preoperative diagnosis of “labral tear right hip” and “CAM femoroacetabular impingement”.  The operative findings in the central compartment were recorded as:

    “Labral Tear

    a.Degenerative

    b.Full thickness

    c.Chondrolabral junction

    d.12 to 3 o’clock

    Femoral Articular cartilage

    a.Moderate CAM impingement

    Acetabular articular cartilage Grade IV changes adjacent to labral tear”

11. On 22 June 2015, Dr John O’Donnell, orthopaedic surgeon, reported that the applicant “had persisting problems with the right hip which have never resolved either before this surgery or subsequently. He has increasing pain, particularly when sitting”. Dr O’Donnell reported that the applicant had “evidence of persisting bony impingement in the right hip and most probably some intra-articular scarring following previous labral repair”. He advised the applicant required “further arthroscopy of the right hip, removal of the irritating stitches which have been placed around the labrum, removal of persisting excessive bone on the femoral head and neck junction, and correction of any other pathology identified at that time”. The surgery was approved by Comcare and was performed on 22 July 2015.

12. At the request of Dr Michael Solomon, orthopaedic surgeon, the applicant underwent an MRI of his right hip to see whether he was “developing arthritic changes”. Likewise, in a letter dated 22 March 2016, Dr O’Donnell requested an MRI scan be performed on the applicant’s right hip, and advised that the applicant had some ongoing problems with his right hip pain which had not settled following his surgery.

13. The MRI report dated 20 March 2016 concluded:

    “1. Mild degree of femoroacetabular dysplasia.

    2. Both scarring in keeping with previous repair of the acetabular labrum as well as what appears to be a tear.

    Abnormal stress response in the subchondral bone of the acetabulum”.

14. In a report dated 6 May 2016, Professor Frederick Ehrlich, orthopaedics and rehabilitation specialist, advised that the applicant sustained “labral injuries superimposed on impingement of his right hip, a condition of constitutional origin”. He accepted that since the applicant had no symptoms before January 2014, then his condition should be attributed to that event. In summary Professor Ehrlich advised:

    “[The applicant] sustained a right hip sprain two years ago and this continues to trouble him. He is still involved in active treatment which may culminate in major surgery but this remains uncertain at this stage…” [Emphasis added]

15. In a report dated 28 June 2016, Dr Lyons stated:

    “We spent some time examining his imaging which unfortunately shows that the chondral surfaces, particularly of the right hip, have deteriorated. When [the applicant] first had labral pathology and femoroacetabular impingement, and this has now progressed through to osteoarthritis. In this regard he should be treated non-operatively for as long as possible and when he feels that he has reached the end of his tether with regards to functional incapacity and pain, he would be an excellent candidate for some form of replacement surgery, either a resurfacing as Dr Solomon has successfully performed, or a total hip replacement”. [Emphasis added]

16. The applicant underwent a repeat MRI on 16 January 2017. On 24 January 2017, Dr Lyons advised:

    “Despite the appearance of healing of the labrum, [the applicant] has unfortunately succumbed to the sequelae of femoroacetabular impingement in the form of arthritis. He is quickly approaching the point where he feels that he would like to proceed to definitive care in the form of a total hip replacement…I have recommended he undergo an ultrasound guided injection of his trochanteric bursa”.

17. On 24 March 2017, Dr Lyons reported that he recommended a “total hip replacement with a hard on hard bearing surface such as a ceramic on ceramic”. Approval for the surgery was sought from Comcare by Dr Lyons on 29 March 2017.

18. On 11 April 2017, following Comcare’s denial of the applicant’s total right hip replacement, Dr Lyons reported to Comcare that:

    “I believe your reasoning to be lacking in judgement and is simply incorrect. Femoroacetabular impingement is not a condition present at birth and it does not develop an early childhood. Osteoarthritis and the predisposing conditions for this development are well documented. This includes a labral tear and femoroacetabular impingement. This is the injury that [the applicant] sustained back in 2014. Despite best efforts with myself, Dr Michael Solomon and Dr John O’Donnell, having undergone two hip arthroscopies and labral reconstructions, [the applicant] has ultimately developed arthritis of his hip joint. This can still occur despite the labrum having healed.

    As [the applicant] did not have a labral tear of FAI prior to his injury in 2014, it leads me to my educated opinion that that was the beginning of his arthritic change”. [Emphasis added]

19. Similarly, on 1 May 2017, Dr Solomon opined:

    “[The applicant] was always going to develop osteoarthritis in the right hip. His work-related injury did not cause the arthritis but rendered him symptomatic to the point that he likely had further tearing of his labrum requiring arthroscopic surgery and an attempt to relieve the impingement. Unfortunately his result has been suboptimal and now he needs a hip replacement.

    Had he not injured himself at work, he would eventually have needed a hip replacement but I believe the sequence of events following the injury has led him to needing the surgery sooner rather than later”. [Emphasis added]

20. On 21 August 2017, the applicant underwent a total right hip replacement under the care of Dr Lyons at the applicant’s own expense.

21. In a report dated 16 November 2017, Professor Peter Youssef, a consultant rheumatologist, stated:

    “I agree with Dr Solomon’s opinion of 1 May 2017 that [the applicant] has an arthritic hip and that [the applicant] was always going to develop osteoarthritis of the right hip and that the work-related injury of January 2014 did not cause the arthritis of the hip. However, I disagree with both Dr Solomon’s and Dr Lyons’ opinions…that the injury in January caused further tearing of the labrum because there is no documentation of significant tearing of the labrum on MRI scan performed on 15 January 2014 and thus there was no evidence of a significant level tear following the incident on 10 January 2014”. [Emphasis added]

22. Professor Youssef opined:

    “He suffers from bilateral femoroacetabular impingement which is a constitutional disorder that predisposes to the premature development of hip degenerative disease”. [Emphasis added]

23. In regards to injuries suffered by the applicant in the course of his employment, Professor Youssef stated:

    “He exacerbated the underlying degenerative disease in the right hip on 10 January 2014. There was no other documented exacerbation during the course of his employment. I would have expected such an exacerbation to be transient because there was no evidence of an acute structural injury to the hip as demonstrated by the absence of a labral tear or bone oedema on the MRI of 15 January 2014”. [Emphasis added]

24. In regards to the right hip replacement surgery, Professor Youssef opined that the applicant would have required surgery independent of the incident on 10 January 2014. He also noted:

    “…his treating general practitioners and specialists had documented significant right hip symptoms prior to January 2014 and [the applicant] also texted soon after the incident on of January 2014 that he was aware that he had right hip disease requiring hip replacement prior to this incident. Furthermore, there was radiological evidence of degenerative disease of the right hip prior to January 2014”.

25. In a report dated 19 December 2017, Dr James Bodel, orthopaedic surgeon, provided the following diagnosis:

    “… The diagnosis of injury firstly is a probable tear of a degenerate labrum in the region of the right hip caused by the event that occurred at work on 10 January 2014 when he was lifting a box of personal items while moving his office.

    An underlying pathological diagnosis is post-traumatic osteoarthritis in the region of the right hip, a femoro-acetabular impingement syndrome and possible tendinitis or enthesopathy involving the gluteus medius and minimus in the region of the right hip. I agree with Dr Lyons in regard to causation in this issue. He indicates that the event at work has caused the labral tear and that has caused the aggravation of the underlying degenerative process and I agree with that…” [Emphasis added]

26. In regards to causation, Dr Bodel stated:

    “The event on 10 January 2014 when he was lifting a box while moving his office has caused aggravation by way of a significant degree and has caused the tear of the labrum which has accelerated the degenerative process referred to by Dr Lyons”. [Emphasis added]

27. In regards to reasonable medical treatment in relation to the right hip injury, Dr Bodel opined:

    “I am satisfied that the right hip replacement on the right hand side has been reasonable medical treatment in relation to the aggravated arthritic change in the region of the right hip and the aggravation was caused by the labral tear in the injury that occurred at work. A total hip replacement was inevitable had that injury not occurred on 10 January 2014 but the timing of this has been brought forward by that event at work which is caused a material aggravation to the underlying pathology”. [Emphasis added]

28. In a further report dated 19 March 2018, Dr Bodel notes that he received clarification about the date of an arthroscopy performed on the applicant in the region of the right hip. The clarification specified that the surgery occurred on 22 July 2015, well after the accepted right hip injury, and not on 9 December 2013 as previously advised. In light of this evidence, Dr Bodel stated:

    “I confirm that with this clarification of the dates that I am satisfied that hip pathology did occur in the region of the right hip in January 2014. I agree with the original treating orthopaedic specialist, Dr Matthew Lyons that the likely diagnosis is that “in regard to causation he indicates that the event at work has caused the labral tear and that has caused the aggravation of the underlying degenerative process” and as I said in my report I agree with that. The spurious date of the possible previous arthroscopy does not affect that statement. The need for the treatment that flowed from that injury in January 2014 has arisen as a consequence of that tear in the degenerative labrum”. [Emphasis added]

29. Professor Youssef provided a supplementary report dated 20 April 2018, following receipt of the two medical reports of Dr Bodel. He ultimately stated that Dr Bodel’s reports did not alter his opinions expressed in his earlier report dated 16 November 2017. However, he did note that “the fact that surgery was not undertaken on 9 December 2013 suggests that the incident on 10 January 2014 made [the applicant] more symptomatic” but opined that “it is unlikely that such a subtle tear or degenerative fraying (as recorded in the MRI of 15 January 2014) would cause the pain that [the applicant] was experiencing but rather that the activities that he was doing on 14 January 2014 made the degenerative disease more symptomatic”.

30. At hearing, Dr Lyons confirmed his opinion that as a result of the incident in January 2014, the applicant suffered a labral tear. He explained that this view was formed by the symptoms presented, pain in the applicant’s groin and hip flexion and extension issues. He said that he could see the labral tear clearly during arthroscopy surgery in the applicant’s right hip (as outlined in his Operating Report dated 30 July 2014). Dr Lyons stated that arthritis and femoroacetabular impingement was not congenital but was a developmental condition resulting from activity. In regards to whether there was a connection between the labral tear seen during arthroscopy and the applicant’s grade four arthritis, Dr Lyons stated that it was a spectrum of disease and well-known that the natural history of arthritis usually resulted in labral symptomatology; it was a progressive disease. He did not agree with Professor Youssef that the applicant’s changes in his right hip were due to degeneration but stated that the labral tear was the main factor. He stated that a labral tear and femoroacetabular impingement ultimately lead to arthritis. Dr Lyons did not fully accept that arthritis was “likely” to have occurred absent the labral tear but said that it was “probable” and that the tear “accelerated the change” and “kick-started the decline for the applicant”. In regards to the most significant contribution to the applicant’s osteoarthritis in his right hip, Dr Lyons stated that the injury suffered by the applicant in 2014 resulted in the labral tear with a background of femoroacetabular impingement. In cross-examination Dr Lyons said that someone can have arthritis and be asymptomatic. In the applicant’s case, the labral tear and femoroacetabular impingement precipitated the cascade of events and rendered the applicant symptomatic. He said that he based this opinion on his own examinations and on viewing the radiological images. Dr Lyons was asked about whether the problems suffered by the applicant in his left hip were indicative of issues with the right hip to which he responded in the negative. He stated that it was common to have both hips involved but it was also common to have isolated disease in one hip.

1. At hearing Dr Bodel discussed the applicant’s pre-existing pathology in his left and right hip and said that the 2014 incident “materially aggravated the underlying pathology”. He said that since the 2012 pathology, the applicant was able to continue with work without issues but since the event in 2014, the applicant was then required to pursue treatment. Dr Bodel said that the normal gradual progression of the condition would demonstrate a gradual increase in treatment and complaints however the difference here is that the treatment pattern changed abruptly from 2014; which he described as a “sudden escalation”.

2. Professor Youssef said at hearing that labral tears were common in patients with osteoarthritis and also in patients without symptoms. He reiterated that it was degenerative and that if you have osteoarthritis you usually have some degeneration of the labrum. Professor Youssef further stated that he would expect the labrum to be abnormal in someone presenting with osteoarthritis. He said the loss of cartilage and changes in bone and forces are most important and a labral tear was secondary. He did accept that in the applicant’s case, the applicant’s reports of pain following the incident in 2014 were a rapid progression. He also accepted that the workplace incident in January 2014 rendered the applicant more symptomatic. However, Professor Youssef stated that the MRI scan after the incident did not show structural change that would result in a more rapid progression of the disease and as such he was unable to explain why the incident in 2014 suddenly resulted in a hip replacement a few years down the track. He said that the abnormalities reported in the MRI after the 2014 event were subtle. If a large labral tear had been present it would not have been missed.

   Relevant Medical Evidence - Achilles tendon injury

3. In a report dated 19 December 2017, Dr Bodel opined that the applicant’s left ankle condition had arisen as a consequence of deteriorating right hip function. He concluded that the applicant suffered from bursitis and tendinitis in the region of the left Achilles tendon and advised that since the applicant appeared to respond to a PRP injection a second one was recommended.

4. In his supplementary report dated 19 March 2018, Dr Bodel referred to a series of radiological reports and investigations undertaken in the applicant’s left ankle. The most recent being 15 December 2017. Dr Bodel reported that this confirmed the presence of a “localised area of tendonosis at the deep aspect of the medial portion of the left Achilles tendon including a small intrasubstance split extending over the length of approximately 16 mm, the majority of the tendon remains intact and has essentially a normal appearance”. He stated that the cause of the applicant’s pain was “associated tendonitis and the swelling seen clinically”.

5. In a report dated 16 November 2017, Professor Youssef stated “at present there is no clinical evidence of Achilles tendonitis or a significant ankle disorder”. In regards to PRP injections he stated:

   “Platelet rich plasma injections would not assist his symptoms in his Achilles tendon as he does not currently report symptoms in the Achilles tendon and there is no tenderness over the Achilles tendon. Also, there is no good data that platelet rich plasma injections are effective for Achilles tendonitis”.

6. In his supplementary report dated 20 April 2018, Professor Youssef advised that the ultrasound referred to by Dr Bodel in his reports does not change his opinion as the diagnosis was based on clinical examination. He stated “radiological changes may be present in tendons can occur in asymptomatic patients”.

7. At hearing, Professor Youssef confirmed his opinion and stated that he did not recommend PRP treatment as he was unaware of any data that it would be beneficial.

8. Dr Bodel also gave evidence orally at hearing and gave a different opinion to that contained in his medical reports. He stated that the literature indicated PRP was less likely to be of a long-term benefit although it was used routinely by practitioners who believed in it. He said that compared to 4 years ago, when the applicant had his first PRP injection, its use is now less favourable. He said he would not recommend the treatment now and suggest the applicant look to alternative treatments such as physiotherapy and surgery.

   Consideration

9. Having carefully considered all of the available medical evidence, I am satisfied that the incident on 10 January 2014 caused a labral tear in the applicant’s right hip and this has caused an aggravation of an underlying degenerative process, accelerating the applicant’s need for a total right hip replacement. This is primarily supported by the evidence of Dr Lyons and Dr Bodel; which I accept. Dr Lyons is the applicant’s primary treating orthopaedic surgeon. While Professor Youssef contends that based on an MRI report taken contemporaneous to the incident on 10 January 2014, the applicant did not suffer a significant labral tear, it was Dr Lyons who treated the applicant at the time and undertook an arthroscopy on his right hip. It is Dr Lyons’ evidence that he visibly saw a tear in the applicant’s labrum while performing the arthroscopy in July 2014. I find this evidence most compelling.

10. The applicant accepts that osteoarthritic symptoms were present in his right hip prior to the incident on 10 January 2014. It is accepted by all of the medical experts that the applicant would have likely required a total right hip replacement at some stage. This would have been the normal progression of his condition. However, all the medical experts are in agreement that in this case, the applicant’s condition based on symptomology and reports of pain following the incident in 2014 was a rapid progression. Dr Lyons, Dr Bodel and Dr Solomon are all of the opinion that following the incident in 2014, the applicant became symptomatic and had not been symptom-free since then until he underwent a total right hip replacement in August 2017. Prior to undergoing the total right hip replacement in August 2017, the applicant had plainly exhausted other available medical treatment by undergoing two arthroscopies and the recommended post-operative rehabilitation. All to no avail. It is plain on the medical evidence of Dr Lyons, Dr Solomon and Dr Bodel that a total right hip replacement was reasonable treatment. Dr Bodel noted in his report dated 19 December 2017, that when he examined him it had only been four months since the surgery and that “there had been a significant improvement”. He noted that he had been reviewed by Dr Lyons post operatively and that “he is happy with the outcome”. The applicant says he intends to return to physiotherapy and hydrotherapy as he improves his hip function following surgery.

11. The evidence clearly shows that the applicant has continued to suffer from the compensable injury since 10 January 2014. As already stated, I accept that incident caused the applicant to suffer a labral tear in his right hip and that this aggravated an underlying degenerative process. Since that time the applicant has not been symptom-free and his need for treatment rapidly escalated. He has undergone numerous surgeries and treatments leading ultimately to a total right hip replacement in August 2017. The bulk of the medical evidence supports a finding that the total right hip replacement was reasonable treatment in relation to the compensable injury.

12. In regards to the Achilles tendon, I am satisfied that the applicant suffers from Achilles tendonitis in his left ankle and that this condition has arisen as a consequence of his deteriorating right hip function. Dr Bodel clinically examined the applicant’s left ankle in December 2017. In his report dated 19 December 2017, he noted that the applicant suffered some pain in the Achilles tendon caused by associated tendonitis and swelling. This is supported by radiology.

13. There is no dispute amongst the experts that PRP is not appropriate treatment for the applicant.

    Decision

14. In application 2017/3828, the decision under review is set aside and in substitution for that decision, it is decided that the Respondent is liable under section 16 of the Safety, Rehabilitation and Compensation Act 1988 (Cth) for the cost of the total right hip replacement as recommended and performed by Dr Lyons.

15. In application 2017/5718, the decision under review is set aside and in substitution for that decision, it is decided that Comcare is liable for medical treatment and incapacity for ‘right hip sprain (labrum tear)’ under sections 16 and 19 of the Safety, Rehabilitation and Compensation Act 1988 (Cth).

16. In application 2018/0294, I find that PRP injections are not reasonable medical treatment and accordingly the decision under review is affirmed.

I certify that the preceding 46 (forty-six) paragraphs are a true copy of the reasons for the decision herein of Senior Member A Poljak

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

Associate

Dated: 27 June 2019

Date(s) of hearing:	5, 6 & 7 November 2018
Counsel for the Applicant:	Mr A Coombes
Solicitors for the Applicant:	Slater & Gordon Lawyers
Counsel for the Respondent:	Mr M Snell
Solicitors for the Respondent:	Lehmann Snell Lawyers