LESZKIEWICZ vy NEW SOUTH WALES INSURANCE MINISTERIAL CORPORATION (formerly GOVERNMENT INSURANCE OFFICE OF NEW SOUTH WALES SUPREME COURT OF NEW SOUTH WALES COURT OF APPEAL MAHONEY, MEAGHER and SHELLER JJA 22 November 1994, 7 December 1994 [1994] NSWCA 182 DAMAGES — motor vehicle accident — previous accident — cause or aggravating factor of disability INTEREST — Motor Vehicles (Third Party Insurance) Act 1942 — no award of interest on general damages — award of interest intended as part of general damages The appellant was injured whilst riding as a passenger in a motor vehicle in 1984. The driver was insured by the respondent and liability was admitted. The appellant had previously been injured in another motor vehicle accident in 1982, and there was a question of whether the 1984 accident was the cause of or merely a factor aggravating her injuries. The trial judge considered the appellant's testimony unreliable and relied on medical evidence. The appellant challenged, inter alia, the amount of the damages awarded and the trial judge's acceptance of one doctor's evidence in preference to that of other doctors. Held: 1. It was open to the trial judge to act on the doctor's opinion and his conclusions based thereon must stand. 2. The amount awarded for general damages was not manifestly inadequate. ORDERS 1. Leave to the respondent to file a cross appeal refused; 2. Appeal dismissed with costs. Mahoney JA I agree with the judgment of Sheller JA and with his Honour's reasons. The decision of Freeman DCJ was a practical judgment in which his Honour, inter alia, saw interest and general damages as to a degree overlapping. In argument, counsel for the parties sensibly indicated that the award of interest, if otherwise not warranted, could properly be dealt with in the manner indicated by Sheller JA. The accident happened on 27 October 1984. To direct a re-trial of liability would hardly have been in accordance with the dictates of justice. Meagher JA I agree with Sheller JA. Sheller Jajudgment Introduction The appellant, Danuta Leszkiewicz, who was born in Poland on 27 March 1934, was injured on 27 October 1984 while a passenger in a motor vehicle, the driver of which was insured by the respondent. She commenced proceedings in the District Court against the respondent. During the course of the proceedings liability was admitted. She appeals from the decision of his Honour Judge Freeman, delivered on 30 March 1990, awarding her a verdict of $15,500. As transcribed the verdict was made up as follows: Wage loss for 9-10 weeks at agreed rate of $217.42 2,000.00 2 UNREPORTED JUDGMENTS Interest thereon for 6 1/2 years at average 17 per 2,210.00 cent Out of pocket expenses as agreed 1,711.98 5 Interest thereon for 6 1/2 years at 8.5 per cent 940.00 there being evidence establishing the dates upon which these were incurred and these cover the whole period since the accident General damages 5,000.00 10 | Interest for 6 years at 12 per cent 5,600.00 $15,461.98 His Honour rounded this out to $15,500. The items that went to make up the 15 verdict exceeded the sum of them shown in the calculation but the appellant accepted that the amount of $5,600 interest on general damages was a typographical error. It should have been $3,600. This explains the sum arrived at. The assessment of damages involved a dispute about the nature and extent of the injuries sustained by the appellant as the result of the accident. The 20 complicating factor was that the appellant had commenced other proceedings in the District Court in respect of an earlier motor vehicle accident which had occurred on 23 February 1982. The other proceedings were on foot when Judge Freeman was hearing the present proceedings. The respondent was the insurer of the defendant in the other proceedings. It was unfortunate, as his Honour 25 observed, that neither party took steps to have the two proceedings heard together. Another complicating factor was that the evidence disclosed other possible causes for the appellant's physical condition at the date of the trial. APPELLANT'S DISABILITIES At the date of trial the appellant complained of a low back problem and of pain 30 in her cervical spine and both arms, the right much more than the left, and in her right hand. This she alleged was the result of the 1984 accident. His Honour concluded, on the basis of medical evidence to which he referred, that there was not much wrong with the appellant's low back and that this problem was not related to the 1984 accident. The appellant did not seek to disturb this conclusion. 35 His Honour said that it was clear, on any view, that the appellant suffered from advanced degenerative changes in her cervical spine which long pre-dated the 1984 accident. He said that these changes were certainly not initiated by the 1984 accident although there was some support for the proposition that they were aggravated by it. He referred to reports made by Dr Bornstein, an orthopaedic 40 surgeon. On 12 September 1985 Dr Bornstein reported that in the cervical spine there was quite gross degeneration and narrowing of the C,5,6 interspace. He regarded it as quite possible that the degeneration changes at the interspace could have been initiated in the 1982 motor vehicle accident with progression up to the time he was writing. He referred to x-rays taken after the 1984 accident and said 45 it was almost certain that the pain the appellant got in her arms arose from the cervical spine and was, therefore, unrelated to work, other than for the fact that sitting in one position was likely to cause some aggravation to her neck and consequent pinching. He felt that the aggravation,suffered at work would have only lasted while actually at her place of employment. Once she ceased working 50 in that employment, it would have settled down. "Her major problem, therefore, I feel is initiation of degenerative changes in 1982 followed by re-aggravation in WESZKIEWICZ v NEW SOUTH WALES INSURANCE MINISTERIAL CORPORATION (formerly GOVERNMENT INSURANCE OFFICE OF NEW SOUTH WALES (Sheller Jajudgment Introduction) the motor vehicle accident in 1984." He thought it likely that the appellant was going to be left with discomfort in the neck and in the arms indefinitely. On 14 February 1986 Dr Bornstein reported that the appellant had come to the point where nothing further could be done for her. On 20 September 1989 he reported: "T reviewed her x-rays taken in 1989. Those of the cervical spine show grossed narrowing, a degeneration of the C5-6, C6-7 levels and to a lesser extent the C7, T1 level as well. There is marked foraminal encroachment particularly at the C6-7 level which is confirmed on the CT scan which shows marked osteophytes projecting backwards at this level without any disc protrusion. OPINION This patient has suffered significant aggravation to her cervical spine during the course of her motor vehicle accident as detailed previously. She has ongoing problems related to the degenerative disease in the cervical spine and nerve compression on the two sides. The discomforts she experiences are reasonable in view of the radiological changes noted. It is likely that she will be left with residual discomfort permanently and also the weakness in the right hand due to compression on nerve roots." The respondent tendered a report dated 20 June 1989 by Dr Ganora, a physician specialising in physical and rehabilitation medicine, and a report dated 13 December 1988 by Dr O'Donovan. His Honour summarised these reports by saying that Dr Ganora had obtained the history of no neck pain until after the second motor vehicle accident and on the basis of that believed that it was the second accident which was to blame for the symptom complex then present. Dr O'Donovan did not obtain a history of neck pain following the first accident in 1982 but was told of the onset of tingling in the fingers of the right hand and, to a lesser extent, of the left hand as well, sometime between the two motor vehicle accidents. He attributed this syndrome to the gradual evolution of cervical spondylosis due either to constitutional factors or the 1982 injury. Dr O'Donovan found that the 1984 injury had had an effect upon the appellant's cervical spine but that this had passed off within a matter of a few weeks or months and that thereafter her continuing complaints were referable to the inexorable progression of the changes which had first symptomatically made their presence felt in 1983 or thereabouts. THE APPELLANT'S CREDIT His Honour said that a great deal depended "'in these circumstances" upon just what the appellant's history was and the extent to which she was a reliable witness. Earlier in his judgment after referring to the other proceedings in Court and the other possible causes for her physical condition his Honour said: "It may even be that the [appellant], being herself aware of the other proceedings on foot, has been somewhat equivocal in the responses that she gave to questions directed to this issue and that she has done herself something of a disservice by appearing to me to be vague, at times contradictory and, withal, given to prevarication. Whatever the reasons for this performance may be, certainly the [appellant] has not impressed me as a witness upon whose testimony I could wholly rely. By way of an example only and without exhaustively analysing the [appellant's] testimony on this aspect, I should observe that she said that she had had pain in her lower back between the incident in 1982 and the incident in 1984 then she described how working in a particular section of her employment she had found her back became very stiff and that she couldn't walk 4 UNREPORTED JUDGMENTS properly in the mornings after working a night shift in that section; then she said that there was nothing wrong with her back before the second injury then she said that the condition of her back depends on what she was doing during the period before the second motor vehicle collision and likewise a similar situation obtained in that her condition varied according to her activities since the second motor vehicle accident. In cross examination it was put to her that she had had time off work in May 1983 because of low back pain, she replied that she had not, although she agreed that she had had trouble with her back and that she had told Dr Silva that the job she was then doing required a lot of sitting which gave rise to the pain." When he came to deal with the appellant's history his Honour said that she had told him that she noticed nothing about herself following the 1982 collision but that some weeks afterwards because of a particular function she was performing at work holding certain cups up to the light she began getting pain in her fingers and hands. This pain was very bad and extended from her fingers to her shoulders: She was transferred to another work section. Her problems were sufficiently bad for her to lose time from work. From the time of the second motor vehicle accident in October 1984 the appellant said that she felt frank neck pain for the first time and the upper limb problems became worse. She was off work for two weeks and then returned for one week but was unable to continue. She was off work for the following three weeks and then took the Christmas holidays of four more weeks. On her return to work she said she felt "OK" and remained at work until the following Easter. During that time, however, she said that her symptoms again became increasingly significant and she needed the assistance of work mates. She was waiting to see whether her condition would improve but finally saw another doctor who put her off work because of both her neck and her back. The appellant has never returned to work and regarded herself as being unfit for any form of employment. His Honour said: "An offer of light work was made by her former employer but she did not take this up. In cross examination the lighter the activity supplied to her the more pronounced her disability was claimed to be. I am satisfied there is considerable exaggeration in the [appellant's] claims." TRIAL JUDGE'S CONCLUSION ON NECK COMPLAINT His Honour said that it was clear that the only doctor who was opining on the basis of the exact history to which the appellant deposed was Dr O'Donovan. His views, accordingly, had a validity not to be accorded the others. His Honour said: "T accept his opinion that this accident produced a temporary aggravation of the [appellant's] cervical spine condition and that this had, for all practical purposes ended when she returned to work at about the end of January 1985. Her incapacitating symptoms thereafter at whatever level one accepts them are to be related to other factors such as the 1982 incident or the work she was doing or active progression of her condition etc. They are not all symptoms for which she is entitled to be compensated by this Defendant. There may well be some continuing element of discomfort referable to this incident but nothing of any incapacitating nature. I have endeavoured to deal with this aspect by allowing an interest rate which reflects my belief that nearly all of the [appellant's] suffering resulting from this accident was over by early 1985 but that some minor continuing element may have persisted for a time after that. WESZKIEWICZ v NEW SOUTH WALES INSURANCE MINISTERIAL CORPORATIONS (formerly GOVERNMENT INSURANCE OFFICE OF NEW SOUTH WALES (Sheller Jajudgment Introduction) The symptoms in her upper limbs, likewise, appear to be established as being related to her cervical spine and as such, subject only to a similarly temporary aggravation. I believe she suffered a nasty experience and underwent considerable pain, treatment and disruption of lifestyle for the period of the aggravation. I include in the verdict an amount of $5,000 by way of general damages." CROSS APPEAL Before coming to the grounds of appeal on which the appellant relied I should refer to an application by the respondent to file in Court a notice of cross appeal from his Honour's award of interest on general damages in the amount of $3,600. The ground of the cross appeal is that s35D(1) of the Motor Vehicles (Third Party Insurance) Act 1942, which came into force in 1984 and which applied to this award of damages, provided that a Court should not order the payment of interest and that no interest should be payable on an amount of general damages in respect of the period from the date of injury to the date of award. On its face this submission seems to be correct. Accordingly when he made his award on 30 March 1990, Judge Freeman should not have ordered the payment of interest in the amount of $3,600 or any amount on general damages for the period up to the date of judgment. However the respondent conceded that the award of interest was intended to reflect, in part at least, an award for general damages for the period from early 1985 to the date of judgment. To that extent it was not in substance, even if in form, an award of interest. Very fairly counsel for the respondent accepted that any amount excised from the figure of interest awarded should properly be added to the amount of general damages. The consequence of this is that the total amount of the verdict would remain as it is. Since the respondent does not appeal against the amount of the verdict awarded the notice of cross appeal would serve no purpose. Accordingly I think the respondent's application to file a notice of cross appeal and rely upon it should be rejected. GROUNDS OF APPEAL Counsel for the appellant disputed his Honour's finding that the appellant was not a witness upon whose testimony he could wholly rely or had considerably exaggerated her claims. Principally this challenge was mounted by referring to his Honour's summary of the evidence at those points in his judgment where he reached these conclusions. I have quoted both passages from the judgment. In the first his Honour made an observation about the appellant's complaints concerning her lower back "(b)y way of an example only and without exhaustively analysing the [appellant's] testimony on this aspect." In this example he said: "\... then she said that there was nothing wrong with her back before the second injury." During the course of her evidence in chief the appellant was asked: "Q. In the period you were working in the printing section just before the second accident, did you have any trouble with your back in that period: A. No. Q. At the time of your second accident or immediately after it, did you notice anything about your back? A. When I was bending, depends what I was doing when I was bending but just taking up containers, because everything was coming to me on machines, all the containers, and putting them in the boxes on the side and when I had to bend and close boxes, that is when my back was hurting. Q. When did you first feel the pain in your back after the second accident? A. I had pain in my back after first accident, was getting worse after second. 6 UNREPORTED JUDGMENTS Q. I thought you said in the period just before the second accident when working in the printing section you had no problem with your back? A. That is what I was doing." She had given evidence that she had been working for about six months in the printing section before the October 1984 accident. The respondent submitted that in the passage complained of his Honour meant to say that the appellant had said that there was nothing wrong with her back in the period of six months before the second injury. If this be right the example given by his Honour does not appear to involve contradiction or prevarication. It may be vague. However his Honour made it plain that the views he had formed about the appellant were derived from her evidence generally. The example is a bad one. Reference to it detracts from confidence in his Honour's conclusion. But I do not think it is enough to enable me to conclude that his Honour was wrong to treat the appellant as not a witness upon whose testimony he could wholly rely. In any event looking at the appeal as a whole this is not a matter of great significance. The appellant accepts his Honour's findings based on the medical evidence about the appellant's low back disability. The findings about the neck injury are also based on medical evidence and a history said to be consistent with the history given by the appellant. Before saying that he was satisfied that there was considerable exaggeration in the appellant's claims his Honour referred to her cross examination and said "the lighter the activity supplied to her the more pronounced her disability was claimed to be." We were taken to the following passage in the cross examination of the appellant: "Q. So in other words, your doctors told you in 1985 they did not think you were able to work and therefore you considered you have not been able to work since that time? A. Yes. Q. Is that right? A. Yes. Q. Without subsequently, at some other time since then discussing this matter with them, is that right? (No reply) Q. If you had a job, for instance, like checking containers and all you had to do was hold a clipboard for instance? A. Yes, but this was after first accident. Q. So what you were doing after the first accident was checking? A. I done some checking. Q. Not packing but checking? A. Packing, when I come back I have to check no more pack containers. Q. What about if you did not have to pack the containers and you only had to check, would you like to try that now? A. No. That is not good, I have to put myself out and that is no good. Q. You would not even try, you don't think you would be able to do it? A. My neck is so sore now I am sitting in this position and I am feeling very very bad right now. Q. You didn't always have this degree of problems with your neck did you? A. I'm sorry? Q. The feeling you have got in your neck now, you don't continually have that same feeling, do you? A. Not same feeling, no, sometimes I get better and sometimes worse. Q. Sometimes it's better and sometimes it's worse, is that right? A. Yes. Q. Simply what I'm going to put to you is this: at those times when it is better, you would be able to do some light clerical tasks which enabled you to sit down or to move around? A. No. WESZKIEWICZ v NEW SOUTH WALES INSURANCE MINISTERIAL CORPORATION (formerly GOVERNMENT INSURANCE OFFICE OF NEW SOUTH WALES (Sheller Jajudgment Introduction) Q. At your will? A. No, because my neck is sometimes better and my hands no good. I put pressure on my fingers, my fingers are numb and after I cannot hold things, I drop - many cups and food sort of things broken and my fingers numb. If my neck is better, my hands numb." I do not think that the comment made by his Honour was unjustified. What is more important, even if I thought it an unjustified comment on what the witness said, I do not think that forms a basis for saying that his Honour's conclusion that there was considerable exaggeration in the appellant's case was not open to him. Once again when one turns to the conclusion his Honour reached about neck injury this is not particularly significant. PAIN AND SUFFERING AND ONGOING DISABILITY The appellant does not dispute that Dr O' Donovan formed the opinion which his Honour accepted and summarised in that part of the judgment which I have quoted. The appellant submitted that his Honour was inaccurate when he said that Dr O'Donovan was the only doctor who based his opinion on the exact history to which the appellant had deposed. When referring to the appellant's condition after the October 1984 accident, Dr O'Donovan said she had "continued to experience symptoms of pain in the neck and pain and tingling in the fingers of both hands since that time. Of course, she had these symptoms prior to the accident which occurred in 1984." The appellant's evidence was that she felt frank neck pain for the first time after the October 1984 accident. The history obtained by Dr O'Donovan may not have been as exactly consistent with the appellant's account to the Court as his Honour thought. However, earlier in his report of 13 December 1988 Dr O'Donovan said: "Mrs Leczkiewicz had already been in a motor car accident in 1982. Sometime after this she first developed tingling in the index, long and ring fingers of both hands, worse on the right than the left. This does not constitute a history of injury but rather describes the onset of symptoms attributable to cervical spondylosis." I think that although Dr O'Donovan did not express this accurately, the pre-accident symptoms he had in mind were the pain and tingling in the fingers of both hands, the only relevant pre-1984 accident symptoms referred to earlier in his report. This was consistent with what the appellant told the trial judge about the cup-holding incident and what happened thereafter. Dr Ganora, in his report of 20 June 1989, observed that on detailed questioning the appellant conceded that she had experienced no neck pain or other neck related symptoms following the first accident. During this time she was experiencing pain in both hands radiating proximally to the dorsum of the hands. On the other hand in his report of 12 September 1985 Dr Bornstein, speaking of the February 1982 accident, said: "At the time she had some pain in the neck but this did settle." Her evidence appeared to be inconsistent with the history given to Dr Bornstein and possibly to Dr O'Donovan. Had his Honour been satisfied that no neck pain was experienced until after the October 1984 accident the basis for accepting Dr O' Donovan's opinion may have been undermined. But the trial judge made no finding as to when the appellant experienced neck pain. On the whole I am not satisfied that this Court can say that his Honour wrongly accepted the opinion of Dr O'Donovan for this reason. However the appellant's major point about the validity of Dr O'Donovan's opinion was different. In coming to deal with this point, which is central to the appeal, the form of Dr O'Donovan's evidence should be noted. It consisted of his report of 13 December 1988. The report was tendered by the respondent and, we are told, not objected to by the appellant. Dr O'Donovan was not required to give oral 8 UNREPORTED JUDGMENTS evidence and hence was not cross examined on his report. Dr O'Donovan's opinion was that with regard to the 1984 accident the appellant sustained a ligamentous strain of the cervical spine, causing a traumatic cervical syndrome. His Honour set out, in the passage I have quoted, Dr O'Donovan's conclusion that the accident produced temporary aggravation of the appellant's cervical spine condition and that this had, for all practical purposes, ended when she returned to work at about the end of January 1985. Her incapacitating symptoms thereafter at whatever level one accepts them were to be related to other factors such as the 1982 incident or the work she was doing or active progression of her condition. Dr O'Donovan said x-rays of the cervical spine were performed in November 1984 and showed long standing cervical spondylosis with narrowing of C5/6 and established osteophyte formation. This radiographic picture and the onset of symptoms two to three years before were consistent with the gradual evolution of cervical spondylosis due to constitutional factors or previous injury. If previous injury was responsible for the onset of the spondylosis, that injury occurred prior to 1982. Dr O'Donovan did not, in his report, refer to a CT scan. A report from The Imaging Centre - Bankstown of 13 June 1985 "CT Cervical Spine", which was in evidence, said, inter alia,: "At C6/7 narrowing of the disc space is noted. Posterior spondylotic lipping is seen arising from the surface of C7 protruding into the spinal canal producing some localised deformity of the dural sac and there may well be a small separated bone fragment in association with this." In his report of 20 June 1989, Dr Ganora said that a CT scan of the cervical spine was performed on 10 April 1985. In substance he then described this in language similar to that of The Imaging Centre report of 13 June 1985. In particular he referred to some deformity of the dural sac. Dr Ganora reported: "Following the motor vehicle accident of October 1984 she developed neck pain and it is probable that she sustained a cervical intervertebral joint sprain to account for the neck pain. This would constitute and aggravation of her pre-existing cervical spondylosis and degenerative disc disease at C5/6 and C6/7. It is also possible that her hand symptoms, particularly the sensory disturbance and clumsiness in the right hand may be due to neurological dysfunction arising from changes at C5/6 or C6/7 causing nerve fibre irritation in the cervical spine. The osteophyte visible on CT scan encroaching into the spinal canal is consistent with these findings." Dr Ganora was of the view that the appellant would be unfit for work requiring heavy lifting or carrying or tasks involving repetitive or sustained upper limb activities, especially above shoulder height. The appellant submitted that it must be assumed from the fact that Dr O'Donovan did not refer to the CT scans that he did not have them available to him in forming his conclusion. The argument continued that he would have reached the same conclusion as Dr Ganora if he had had the CT scan available. This conclusion, it claimed, would have been more favourable to the appellant and would have been accepted by his Honour. Amongst other things it would have shown an ongoing neck disability with consequent pain due to the October 1984 motor vehicle accident and continuing up to the trial and beyond. If this were the case both the allowance for general damages and past economic loss were insufficient and some allowance should have been made for future economic loss. WESZKIEWICZ v NEW SOUTH WALES INSURANCE MINISTERIAL CORPORATION (formerly GOVERNMENT INSURANCE OFFICE OF NEW SOUTH WALES (Sheller Jajudgment Introduction) Dr O'Donovan was not asked, because he was not called, whether he had seen the CT scan and, if he had, whether he took it into account in forming his opinion, or, if he had not, whether viewing it made any difference to his opinion. The appellant submitted that it was not necessary for her to cross examine Dr O'Donovan. It was sufficient to point to the absence of reference by him to the CT scan. This was said of itself to demean his opinion. We were told this argument was put to the trial judge. There may be occasions when a party need do no more, when asking the Court to reject an opinion expressed in an expert report, which has been admitted in evidence without objection, than point to the fact that it proceeds on the basis of assumptions of fact not established in evidence. In the present case we were asked, without the benefit of medical evidence on the point, to infer that other opinion should have been preferred by his Honour because Dr O'Donovan did not take into account the CT scan. I would reject this argument. Dr O'Donovan formed an opinion based upon material to which he referred. None of that material is shown to be inaccurate or wrong. If the appellant wanted to challenge his opinion on the basis that there was other material to which Dr O'Donovan did not refer and which adversely affected his opinion, the appellant was bound to put it to him in cross examination or call other evidence to demonstrate this was so. She did neither. Accordingly I do not think that the ground relied upon for contradicting his Honour's conclusions based upon the acceptance of Dr O'Donovan's opinion is made out. If it was open to the trial judge to act upon Dr O'Donovan's opinion, as I think it was, the conclusions he reached about the appellant's neck injuries must stand. ADEQUACY OF GENERAL DAMAGES His Honour accepted that the 1984 accident produced a temporary aggravation of the appellant's cervical spine condition. However he concluded that for all practical purposes this had ended when she returned to work at about the end of January 1985. He said that there might be some continuing element of discomfort referable to the incident but nothing of any incapacitating nature. Importantly he said that nearly all of the appellant's suffering resulting from the October 1984 accident was over by early 1985 "but that some minor continuing element may have persisted for a time after that." He sought to reflect this in the award of interest. If the respondent had not accepted that the amount awarded for interest should be treated, as his Honour in part intended, as a component of general damages so that effectively the amount awarded for general damages was $8,600, I would be inclined to think that the amount awarded was so low as to suggest appealable error. However looking at the two figures, as his Honour apparently intended them to be looked at, I am not persuaded that the amount for general damages was manifestly inadequate. This does not overlook the fact that at the date of trial his Honour thought that there may be some continuing element of discomfort. The appellant in her written submissions suggested that the damages for loss of earnings were too low and that some amount should be allowed for future loss of earning capacity. However this part of the appeal, which was not pressed in oral argument, fails once it is accepted that his Honour's conclusion based upon Dr O'Donovan's evidence was open. CONCLUSION I propose the following orders: 1. Leave to the respondent to file a cross appeal refused; 2. Appeal be dismissed with costs. 10 UNREPORTED JUDGMENTS 1. Leave to the respondent to file a cross appeal refused; 2. Appeal dismissed with costs. Counsel for the Appellant: P Stone 5 Instructed by: Gun Hamilton and Blay Counsel for the Respondent: MA Elkaim Instructed by: GM Meadows