Q v Accident Compensation Corporation

Case

[2017] NZHC 3024

7 December 2017

No judgment structure available for this case.

REMINDER: PURSUANT TO S 160(1)(B) ACCIDENT COMPENSATION ACT 2001 THERE IS A SUPPRESSION ORDER FORBIDDING PUBLICATION OF THE APPELLANT’S NAME AND ANY DETAILS THAT MIGHT IDENTIFY THE APPELLANT

IN THE HIGH COURT OF NEW ZEALAND WELLINGTON REGISTRY

I TE KŌTI MATUA O AOTEAROA TE WHANGANUI-Ā-TARA ROHE

CIV-2017-485-628 [2017] NZHC 3024

BETWEEN

Q

Applicant

AND

ACCIDENT COMPENSATION CORPORATION

Respondent

Hearing: 29 November 2017

Appearances:

J P Miller for Applicant
A K Miller for Respondent

Judgment:

7 December 2017

JUDGMENT OF CHURCHMAN J

[1]      The applicant in these proceedings has cerebral palsy.  This is a debilitating condition caused by abnormal development or damage to parts of the brain that control movement, balance and posture.

[2]      There is agreement among the medical specialists who have considered this case that the applicant’s cerebral palsy resulted from events that occurred either prior to or shortly after his birth.  The applicant was born by emergency caesarean section at 31 weeks’ gestation on 25 May 2000. The reason for the emergency caesarean was

placental abruption (the  separation of the placenta from the uterine wall during

Q v ACCIDENT COMPENSATION CORPORATION [2017] NZHC 3024 [7 December 2017]

pregnancy, depriving the baby of oxygen and nutrients and causing heavy bleeding in the mother).

[3]      The legal issue for this Court to determine is whether the applicant sustained a personal injury caused by medical error or medical mishap as those terms were defined under the Accident Compensation Act 2001 (the Act).

[4]      This  Court  is  now  the  third  court  to  have  considered  these  issues,  with

Judge Powell having delivered a decision on the substantive matter on 30 September

2015 and Judge Sinclair having dismissed under s 162 of the Act an application for leave to appeal Judge Powell’s decision on 26 June 2017.

[5]      In the situation where the Court appealed from has refused leave under s 162 an applicant applying for special leave will normally need to demonstrate both that there is an issue of principle at stake and a question of law capable of bona fide argument, but also that there is some “extraordinary factor” that has not been taken into account by the Court below.1

[6]      Judge Powell made an order permanently suppressing the applicant’s name on

30 September 2015 and for that reason I will refer to the applicant either as the applicant or Master Q.

[7]      Aware of the high legal threshold for the granting of special leave in this case the applicant’s counsel has proposed what are said to be three questions of law that arise in this case:2

(a)       Whether his Honour rejected the specialist medical evidence of the appellant without a clearly articulated and rational basis for doing so;

(b)Whether  his  Honour  engaged  in  unqualified  independent  medical conclusion that was not the subject of specialist medical opinion in the

appeal; and

1      Farrelly v Accident Compensation Corporation [2006] NZHC 3153 at [2].

2      Notice of application for special leave to appeal, 14 July 2017 at [2.2].

(c)      Whether the District Court, in addressing material matters not raised by the parties that materially affect the decision under challenge, should in complex cases involving seriously-injured infants at birth adjourn the hearing and use the Court’s own jurisdiction to engage an independent specialist witness or for existing specialists to give further evidence.

[8]      The substantive relief sought by the applicant is:

Approving cover for the personal injury and the costs associated with the bringing of the appeal.

[9]      The respondent opposes the application for special leave and says that the questions  raised  are not  bona fide  questions  of  law that  are  capable of serious argument, nor is there any extraordinary factor warranting the cost and delay of a further appeal and finally that it is in not in the interests of justice for special leave to be granted.

Facts

[10]     The facts are set out at length in Judge Powell’s decision and are well-known to the parties.  They were also dealt with at length at Judge Sinclair’s decision.  I will do no more than summarise them.

[11]     In brief, Master Q was born eight weeks premature on 25 May 2000, by an emergency caesarean.  Master Q began to have respiratory problems and in his first day signs of neurological damage were recorded.   The standard treatment for the respiratory problems suffered by Master Q had a potential side effect of a pneumothorax (a leak in the lung surface which builds up pressure in the lung cavity and can cause lung collapse) occurring.  Master Q formed two pneumothoraces, one in each lung, in the week following his birth.  Cerebral ultrasounds taken during this period began to show cerebral haemorrhaging in the applicant.

[12]     Master Q then became infected with neonatal sepsis, which was eventually treated successfully.

[13]     The cumulative effect of these medical issues was that Master Q developed severe cerebral palsy, which has led to a long list of ongoing medical issues and care requirements. The applicant’s parents made a claim for a personal injury to Master Q, caused by either medical error and/or medical mishap under the Act as it stood then. The 2001 Act remains the applicable law the Court must consider.

[14]     Under the Act, the claimant was required to prove either:

(a)      that there was a failure on the part of those treating the appellant to “observe a standard of care reasonably to be expected in the circumstances” which caused the personal injury (medical error); or

(b)that in the event that the treatment received by the appellant was properly given, the personal injury received by the appellant was a rare and severe adverse consequence of that treatment (medical mishap).

[15]     The initial focus of the personal injury claim brought was that there had been a failure to provide Master Q with steroids prior to his birth which would have aided his lung development.   The experts and the Accident Compensation Corporation (ACC) were unanimous in rejecting this claim.

[16]     The second claim involved whether or not the infection Master Q contracted was the result of the neonatal care administered to him. A review by ACC concluded that even if the infection was a medical mishap, the causation between the infection and the applicant’s cerebral palsy did not reach the civil standard of “balance of probabilities”.

[17]     The third claim raised by a medical expert in 2014 was that the treatment of the first and most severe pneumothorax on the night of 27 and 28 May 2000 (the first pneumothorax) involved a medical error. There was a general consensus that this first pneumothorax, occurring when the applicant was barely two days old, was “significant and destructive, and led directly to a significant intravenous haemorrhage (IVH) which

in turn was a primary factor in the development of the appellant’s cerebral palsy”.3

3      Q v ACC [2015] NZACC 288 at [18].

[18]     It was generally agreed that the respiratory aid treatment administered to Master Q was appropriate at the time, even with the potential pneumothorax side effects, and that no claim of medical error could be sustained in relation to the treatment.  Similarly, it was agreed that the development of a pneumothorax was not a rare adverse consequence, and could not qualify as a medical mishap.

[19]     The allegation of medical error therefore turned upon the speed with which the first pneumothorax was treated, and whether any delay in treatment amounted to a medical error.  If there was a delay, the causative question was to what degree that delay affected the development of the IVH, which in turn was the proximal cause of the applicant’s cerebral palsy.

District Court decision

[20]     The question thus turned on Judge Powell’s interpretation of the varied medical evidence given across a 12-year period. The latest claim for medical error which Judge Powell addressed was contingent on the evidence of Dr Broadbent’s February 2014 report, which differed from Dr Broadbent’s previous reports.  Judge Powell held:

(a)      Dr Broadbent’s view of the circumstances surrounding the applicant’s treatment had “undergone a significant change” from his first report in

2002, when he identified no issue with the treatment received by the appellant at the time of the first pneumothorax.4

(b)Dr Broadbent’s conclusions as to the quality of treatment of the pneumothorax had changed in both his 2011 and 2012 reports, but still at that stage had not reached the threshold for medical error.   Dr Broadbent expressed disappointment with the outcome of the treatment, but identified no specific issue with the treatment, nor that it failed  to  meet  the  standard  of  care  reasonably  expected  in  the

circumstances.5

4 At [35].

5 At [35].

(c)      In his 2014 report, Dr Broadbent identified for the first time specific and severe issues with the treatment of the pneumothorax, the skills and experience of the junior frontline staff, and the lack of availability of consultants who should have been on call.   He made no effort to reconcile these criticisms with his earlier conclusion that there was no error in the standard of care.6

(d)Dr Broadbent’s 2014 conclusions were not based on new evidence recently in his possession, but rather from his reflections on investigations he did at the time of the treatment and in the period between 2000 and his 2002 report.7

(e)       Dr Broadbent’s 2014 conclusions did not acknowledge the significant

improvements and expectations surrounding treatment of premature births which have occurred in the intervening period.8

(f)      Dr  Broadbent’s  “belated  allegations”  raised  a  number  of  issues, primarily that he did not attempt to reconcile his two opposing positions for the Court.  In the absence of an explanation, the Judge was unable to give Dr Broadbent’s 2014 report’s assertions much weight.

(g)The initial specialist reports of Dr Brooks, Dr Smales, Dr Richardson and Dr Broadbent better reflected the available evidence in that no medical error was proven on the balance of probabilities.  The appeal was dismissed on this basis.

Submissions

[21]     The applicant submitted:

(a)      Judge Powell set too high a bar for a medical specialist to review his or her earlier opinion through ongoing reflection and experience.

6      At [36]–[37].

7      At [38(a)].

8      At [38(b)].

(b)The key question was whether there had been a hypoxic episode of two and a half hours, and the effect of such a hypoxic episode on IVH occurrence rates.   It is irrelevant whether or not these events were emphasised in earlier reports.

(c)      Dr Broadbent, in relation to the divergent focus between his initial 2002 report and his later 2014 report, said “[it] is preferable to look at the overall conduct and outcome of the pneumothorax treatment”.  This is indicative that he had regard to his earlier findings but had re-evaluated his overall finding on a holistic basis to find that the care provided was below standard.

(d)Mr Smales in 2002 communicated lingering concerns about “how [the pneumothorax] was handled and how quickly treatment was arranged

… any delay can result in very substantial deterioration in the baby … This period of hypoxia may therefore be of significance”.  Mr Smales concerns lead to the commissioning of a further specialist report.

(e)      Judge Powell’s analysis at [38(iii)] as to the oxygen levels during the period of hypoxia was not based on existing medical analysis of the experts in the case.

(f)      Judge Powell’s focus on rejecting Dr Broadbent’s latest report did not address the key question posed (was the two and a half hour hypoxic delay a contributory cause of an IVH event?).

(g)The Court rejected evidence without a rational basis for doing so. Here the evidence clearly sets out a two and a half hour hypoxic event.

(h)The  Judge  should  not  have,  and  was  not  allowed  to  draw  any independent medical conclusions.   Here, Judge Powell concluded at [38(iii)] that the hypoxic episode wasn’t as severe or enduring as indicated in the 2014 report, because of oxygen saturations around 90 per cent at one point.

(i)The  Judge  did  not  voice  his  concerns  with  the  inconsistencies  in evidence between Dr Broadbent’s initial and later reports; it would have been more appropriate for the judge to require Dr Broadbent to give evidence, or to obtain a medical expert witness to aid the Court.

(j)The  Court  should  adopt  a  generous  approach  to  seriously-injured infants.

[22]     The respondent submitted:

(a)      Dr Broadbent was involved in Master Q’s treatment from when he was four days old (after the treatment complained of had occurred) and provided the medical reports on Master Q’s condition in July 2002, September 2011, July 2012 and February 2014.

(b)Judge Powell was entitled to make credibility findings in relation to Dr Broadbent’s  various  opinions  over the  years  and  to  determine the weight he would ascribe to different opinions in evidence.

(c)       The Judge’s reasoning was logical and rational.

(d)The onus was on Dr Broadbent to articulate how and why his opinion changed between 2002 and 2014.   Failure to do so impacts on the weight that can be ascribed to the evidence in the proceeding.

(e)      Judge Powell’s decision was comprehensive, clearly articulated and rational.  His findings were not inconsistent with facts, and there was no error of law.

Approach on appeal

[23]     Special leave can be obtained only in relation to questions of law.  Doogue J

classified what was meant by “a point of law” in relation to ACC appeals:9

Whether or not a statutory provision has been properly construed or interpreted and applied to the facts is a question of law … a mixed question of law and fact is assailable as a matter of law … a decision-maker’s treatment of facts can amount to an error of law.  There will be an error of law where there is not evidence to support the decision, the evidence is inconsistent with, and contradictory of the decision, or the true and only reasonable conclusion on the evidence contradicts the decision. … Whether or not particular evidence is relevant to a particular issue is a question of law.

[24]     In Ellwood v ACC part of the appeal concerned the manner in which the District Court Judge dealt with conflicting medical opinion.10   It was held that the Judge had failed to give rational reasons consistent with the fact held for preferring the opinions of the ACC experts over those for the appellant. This was held to be wrong in law.11

Law

[25]     Dunningham J in Gilmore v ACC summarised the criteria to be applied in relation to special leaves applications under s 162 of the Act (footnotes omitted):12

(a)   the purpose of acquiring leave for certain appeals is to ensure that scarce judicial time is allocated sensibly;

(b)   although it is ultimately a matter for the discretion of the Court, it will normally be necessary to show that there is an issue of principle at stake or that a considerable amount hinges on the decision and that there is a reasonable prospect of success;

(c)   the fact that special leave is required is significant and suggests that leave ought not to be granted as a matter of course;

(d)   it is for the applicant to show that leave is required in the interests of justice;

10     Ellwood v ACC [2007] NZAR 205 (HC).

11     At 215.

12     Gilmore v ACC [2016] NZHC 1594 at [27].

(e)   as leave has already been refused by the District Court, however, there will normally have to be some extraordinary factor which has not been properly taken into account.

Analysis

Did the Court reject evidence without a clearly articulated and rational basis for doing so?

[26]     Judge Powell in the District Court was acting as a fact finder.  He was forced to balance the facts and expert opinions as set out in the initial 2002 reports, against those communicated in 2011, 2012 and then in 2014. Judge Powell did not undertake to determine the actual cause of the appellant’s personal injury, however it was appropriate for him to engage in an assessment of the quality of evidence and to try and reconcile the differences in it.

[27]     Judge Powell did not find it was not credible for Dr Broadbent to revise his medical opinion on further reflection.   Rather he found that the factual allegations raised by Dr Broadbent in 2014 were not supported by any of Dr Broadbent’s previous factual evidence, nor by the evidence of contemporary experts.  In the face of such conflicting evidence, it was appropriate for the Judge to engage in seven paragraphs of close analysis of the weight he could ascribe the key evidence underpinning the claim of medical error.

[28]     I accept that a medical specialist must always be permitted the opportunity for reflection and revised opinion, particularly with medical knowledge continually advancing.  If the case had involved Dr Broadbent setting out in detail the fact there was a two-and-a-half-hour hypoxic episode in 2002 and 12 years later returning to that fact and giving his updated opinion that such an episode was likely causative of the IVH which was causative of the personal injury that would be relevant.   In such circumstances the Court would need to engage in how much later and advanced medical opinions are to be treated as evidence.13  Here, Dr Broadbent not only changed his opinion as for the existence of a medical error, he changed the factual basis for the opinion, without adducing any new evidence or supporting material, or an explanation

as to why his medical focus has shifted, beyond that in his later opinions he was taking a more holistic approach.

[29]     Judge Powell noted that even in his 2011 and 2012 reports, Dr Broadbent identified “no specific issue with the treatment provided to the [applicant]”.14    He noted that Dr Broadbent  had used  words such  as that the treatment of the first pneumothorax had not gone “smoothly” and said that:15

… Dr Broadbent did not identify any error as being the reason the outcome sought was not achieved as opposed to the inherent difficulty of treating the [applicant] and, in particular, did not identify any lack of care and skill on the part of those treating the [applicant] as being the reason the treatment did not go smoothly.

[30]     Judge Powell dealt in detail with what he described as Dr Broadbent’s “belated allegations”.16  At [38(c)] Judge Powell addressed in detail the inconsistencies between Dr Broadbent’s 2014 report and his prior reports (in particular his first report of 2002). He   specifically   noted   that   in   2002   Dr Broadbent   had   said   of   the   second transillumination “it was positive on the wrong side so in needling the chest at that

stage would not have been helpful”.17

[31]     He noted that this statement was:

… in direct contrast to Dr Broadbent’s more recent assertions that needling should have been undertake immediately … .18

[32]     Dr Broadbent’s later report was prepared some 12 years after his first report but was not based on any new evidence.  I find there was no error in Judge Powell pointing out the irreconcilable conclusions reached by the doctor in his evidence.  In the circumstances it was incumbent upon Dr Broadbent to explain how and why his original conclusions were no longer valid.  He did not do that.

[33]     The conclusion reached on this point by Judge Powell was entirely rational:19

14     Q v ACC [2015] NZACC 288 at [36].

15 At [39].

16 At [38].

17     At [35(c)(ii)].

18     At [38(c)(i)].

19 At [39].

In the absence of any explanation as to why these matters were no longer relevant I conclude that I am unable to place weight on Dr Broadbent’s post-

2011 reports and in particular the new matters raised in this 2014 report.  In particular I am not satisfied on the basis of Dr Broadbent’s evidence as a whole

that there was in fact a failure of the team treating the appellant to bring the first pneumothorax under control.

[34]     As a separate ground for not finding the conclusions in Dr Broadbent’s post-

2011 reports to be credible, Judge Powell also noted that they were inconsistent with the conclusions reached in other reports prepared at the time and he particularly referred to the reports of Dr Brooks, Dr Smales and Dr Richardson.  When one looks at the reports of the other specialists Judge Powell’s comments are appropriate.  For example, Dr Smales in his report of 4 November 2002 stated:20

Dr Broadbent acknowledges that there were some delays in the treatment of the initial pneumothorax but there do not appear to be any indications that this represented a medical error.

[35]     Dr Smales concluded that report by saying:21

I do not think that it is possible to establish that any physical injury has occurred as a result of any specific medical treatment as there are too many intermediate and hypothetical linkages.

[36]     Counsel for the applicant, Mr Miller, referred the Court to the slightly different wording used by Dr Smales in his 27 November 2002 further report where he said:22

If junior staff were unable to perform either of the procedures mentioned [the chest needle or insertion of a tube drain] there may have been an unacceptable delay before a senior member of staff was able to assist.

[37]     However, there is no evidence that these comments were anything more than hypothetical.

[38]     Another expert, Dr Richardson, in his report of 28 April 2013 said:23

At 2345 hours on 27 May 2000 [Master Q] had a sudden deterioration in his respiratory status with increased work of breathing and increased oxygen requirements.   The cause of this was clearly a pneumothorax, which was recognised and treated appropriately.

20     Joint Bundle of Documents [JBD] at 18.

[39]     Later on, in the same document he concluded:24

There is no evidence before me that there was error or mishap here.

[40]     In 2012 Dr Richardson was engaged to respond to two reports prepared by Dr Broadbent dated 18 September 2011 and 28 July 2012.  His specific conclusion was “I believe that the pneumothorax was looked for promptly and identified and treated in a timely manner”.25    He further says that he had identified no failure to observe a standard of care as skill reasonably expected in the circumstances.   He specifically said “the level of expertise displayed is entirely as expected.  I have seen no evidence that the hospital systems led to any delays in treatment”.26

[41]     On 16 February 2014 Dr Broadbent provided a further report that included the statements:27

… the management of the pneumothorax was suboptimal. … Insertion of the chest drain an hour after Master [Q’s] deterioration is an unacceptable delay, regardless of the time of day.

[42]     The report also specifically refers to the x-ray taken at 1:20 am showing a “continuing tension pneumothorax … due to the tube being inserted too far”.28    He then concludes that:29

It must be stressed that considering the severity of symptoms the delays in treatment were very much outside the expected or acceptable range in this

case.

[43]     Mr Richardson responded to these claims in his report of 26 August 2014. That report comments on the allegations made by Dr Broadbent:30

It appears there may have been local issues around the early management of the first pneumothorax which would be better known to Dr Broadbent, but from the information that I have seen there the management of this was satisfactory, although a slightly better outcome was possible if the drain had been inserted sooner.  I cannot stress enough that the important thing for the

24     JBD at 22.

25     JBD at 45.

26     JBD at 46.

27     JBD at 49 and 50.

future in this situation is to avoid a pneumothorax in the first place – and there is no contention about that.

[44]     The reason that Dr Richardson referred to there possibly being “local issues” known to Dr Broadbent is because the factual basis for Dr Broadbent’s opinion does not appear in his written report.  There is no evidence that there were such “local issues” known to Dr Broadbent or anyone else. In this context it is important to record that he was not involved in Master Q’s treatment until four days after his birth.

[45]     Dr Richardson referred to Dr Broadbent’s claims as not being supported by the notes:31

While Dr Broadbent appears privy to information about this event that is not clear from the notes, it appears to me that the junior doctor looked for the presence of a pneumothorax quite early after the oxygen requirements increased and did make this diagnosis.

[46]     Mr  Miller  argued  that  the  absence  of  information  in  the  notes  was  not Master Q’s fault and should not be held against him.  He also said that the case law indicated that a lenient approach should be taken in relation to a very young claimant who had sustained severe injury.  However, the case law being referred to related to interpretation of the Act, not interpretation of the facts. Here, as Dr Richardson noted, there  are  simply  no  facts  available  to  the  Court  that  support  Dr Broadbent’s conclusion.

[47]     In  relation  to  Dr Broadbent’s  claims  about  insertion  of  the  tube  drain, Dr Richardson noted:32

An inter-costal tube that is “in too far” commonly is still effective at draining the air and in this case it was reported that “bubbling” was noted at the time of insertion – a sign that the tension was relieved at that point.

[48]     On the issue of the time taken to address the pneumothorax Dr Richardson said:33

If one could examine pneumothoraces in New Zealand that occurred in NICUs in 2000 one could find those that had been controlled faster than this and others that took the same time or longer to control.

[49]     Dr  Richardson  concluded  his  report  by  noting  that  the  main  cause  of

Master Q’s “bad outcome was that the pneumothorax occurring in the first place”.34

[50]     I find that there is no basis for the suggestion that Judge Powell rejected the specialist medical evidence without a clearly articulated and rational basis for doing so. He clearly explained why he didn’t accept Dr Broadbent’s later observations which were inconsistent with the conclusions he had expressed a decade earlier. No question of law arises on this point.

Unqualified independent medical conclusion

[51]     Although  covered in  Mr Miller’s  written submissions  this  point  was  not addressed in any detail in his oral argument.

[52]     The argument on this point advanced in Mr Miller’s written submissions was that Judge Powell’s analysis of the oxygen levels was “not based on any existing medical interpretation among the specialists obtained”. He submitted the Court should be wary of determining exactly, without specialist input, what “oxygen obtaining O² saturations in the 90s in 90 per cent oxygen” refers to at a certain point in the course of treatment.35

[53]     In order to ascertain whether Judge Powell had embarked on an impermissible, unqualified, and independent medical conclusion, it is necessary to look at the context in which Judge Powell made the observation referred to.  The paragraph in which the impugned comments appear starts with the words:36

Although the oxygen saturations dropped at the beginning of the first pneumothorax   episode   the   contemporary   evidence   as   opposed   to Dr Broadbent’s 2014 report was that they did not in fact remain so for the whole period.

34     JBD at 55.

35 Applicant submissions for special leave to appeal, 9 October 2017, at [19].

36     Q v ACC, above n 3, at [38(c)(iii)].

[54]     It was common ground among the experts that Master Q’s blood oxygen saturation levels varied.  Indeed, in his report of 17 July 2002 Dr Broadbent himself had stated:37

For the initial 48 hours he ran a course of moderate RDS [respiratory distress syndrome] on CPAP not requiring large quantities of oxygen. The chest x-ray showed the usual signs of RDS.  Right through until 2300 hours on 27 May

2000, he was requiring no more than 30 per cent oxygen.

[55]     The point that Judge Powell was making in [38(c)(iii)] is that Dr Broadbent did not refer anywhere in his post-2011 reports to the initial favourable evidence about blood oxygen levels and that Master Q was not in fact hypoxic throughout the period he was being treated for the first pneumothorax. This is a conclusion that Judge Powell was able to draw from the evidence before him.

[56]     In any event, Mr Miller did not submit that Judge Powell’s comments were factually incorrect or that he had misunderstood the evidence. He merely claimed that the Court should be “wary” of it.

[57]     There is no error of law in this regard.

Failure to adjourn

[58]     The third error of law advanced by the appellant was the contention that Judge Powell should have adjourned the hearing and used the Court’s own jurisdiction to engage an independent specialist witness or to call the existing specialists to give further evidence.   In his oral submissions Mr Miller clarified that he was not suggesting that the Court should have commissioned its own report, but rather that it should have asked for clarification from Dr Broadbent.

[59]     The particular aspect of the evidence that it was suggested that Judge Powell needed clarification on were his observations about Master Q’s blood oxygen levels and the issue of whether or not Master Q had been hypoxic throughout the period he

was being treated for the first pneumothorax.

37     JBD at 8.

[60]     For the reasons set out above Judge Powell’s conclusions were supported by the  evidence  of  the  medical  specialists,  including  Dr Broadbent’s  own  initial comments.  There is no basis for pleading the need for an adjournment, nor was the Court obliged to provide Dr Broadbent with an opportunity to comment further on the issues Judge Powell raised in [38] of his decision.

[61]     This matter does not give rise to a question of law.

[62]     The applicant in this case has attempted to transform what are fundamentally questions of fact into issues of law. At the end of the day Judge Powell considered all of the evidence (including all of that of Dr Broadbent).   He preferred the initial specialist reports of Dr Brooks, Dr Smales, Dr Richardson and Dr Broadbent as to whether or not a medical error was made out.  He explained why he did so.  He did not overlook any relevant matter or take any irrelevant matter into account.  He has not made any error of law and this application does not raise any question of law capable of bona fide argument.

[63]     Accordingly, the application for special leave to appeal is dismissed.

[64]     If any application for costs is to be made these should be filed by the respondent by 15 December 2017 with any response by the applicant to be filed by 5 February

2018.

Churchman J

Solicitors:

John Miller Law, Wellington for Applicant

Claro, Wellington for Respondent

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