Compensation Court of New South Wales CITATION : Rawson v State of New South Wales [2001] NSWCC 102 PARTIES : Dianne M Rawson v State of New South Wales MATTER NUMBER(S) : 8820 of 1996 JUDGMENT OF: O'Toole J at 1 CATCHWORDS: Proceedings to Obtain Compensation :- Epidemiology LEGISLATION CITED: CASES CITED: DATES OF HEARING: 28/09/99, 29/09/99, 17/04/00, 18/04/00, 19/04/00, 21/11/00, 26/03/01 DATE OF JUDGMENT: 05/25/2001 FOR APPLICANT: Mr J Gracie instructed by McClellands LEGAL REPRESENTATIVES: FOR RESPONDENT: Mr P Sweeney instructed by P W Turk & Associates JUDGMENT: 1. On 22 July 1996, Dianne Marie Rawson, the widow of William John Rawson (the deceased) filed this application for determination (application). Initially, the applicant alleged that the nature and conditions of the deceased's employment as a Vocational Instructor at the respondent's Juvenile Detention Centre at Reiby (Reiby) exposed him to lead salts, chromates, and Xylene, causing his death on 12 June 1996 from acute myeloid leukaemia (AML). During interlocutory proceeding heard by Truss J on 7 April 1998, and by me on 29 April 200, the applicant was given leave to plead that additionally, the nature and conditions of the deceased's employment between 1 January 1989 and 30 May 1995 exposed him to aromatic hydrocarbons including Toluene and Benzene, thereby causing his fatal AML. The applicant alleges that at relevant times, she and the three children of her marriage to the deceased - Shayne William Rawson, born on 20 August 1981, Matthew Rawson, born on 29 June 1984, and Belinda Anne Rawson, born on 27 December 1988 - were dependent upon the deceased for support. 2. The respondent's Answer, filed on 5 September 1996, denies an employment injury causing the deceased's AML or death. On 17 August 1998, Terrence James Gould was the respondent's Manager of its Mt Penang Juvenile Justice Centre. On 14 April 2000, he was the respondent's Manager of its Baxter Juvenile Justice Centre. Gould deposes to his knowledge, information and/or belief on those dates of the respondent's Statements in Answer to the applicant's Interrogatories (exhibits A and HH). The Statements admit, inter alia, that in the course of the deceased's teaching spraypainting to the respondent's young male detainees, he was exposed to lead chromates and to aromatic hydrocarbons including Xylene, Toluene and Benzene, and that he used a "Two Pack" spray painting system. In address, the respondent properly concedes that if, contrary to its case, the deceased's fatal AML were caused by an employment injury, at relevant times the applicant and her three children were dependent upon the deceased for support. 3. The parties' legal representatives practice regularly in this jurisdiction and are familiar with the Court's methods of recording its proceedings. The hearing of this application commenced before me on 28 September 1999 and occupied some six days of the Court's proceedings. In accordance with the Court's usual practice, the whole of the application, including the applicant's proceedings for Interrogatories heard by Truss J on 7 April 1998 and by me on 4 August 1998, and counsel's brief final submissions to me on 26 March 2001, is sound-recorded by the Court's contractor (contractor). 4. In response to the Court's format "REQUEST FOR [a] TRANSCRIPT [of] … Evidence … in ABRIDGED form … [omitting] opening and closing addresses, legal argument [and] legal discussion … " the contractor transcribed in his usual format the applicant's, Professor George Crank's, Dr Michael Harvey's, Professor Frank Firkin's and Professor Jerry Koutts' depositions. Additionally, at one or both parties' request, the contractor transcribed interlocutory argument on expert evidence and my invitations to counsel to expand upon specific evidentiary objections when the transcript of their questions and that evidence became available: conveniently, those exchanges raise central issues in this application. 5. The contractor does not transcribe the Court's proceedings verbatim. Usually, the contractor omits from his transcripts questions which counsel withdraw voluntarily and features of speech including false starts and repetitions which (in the contractor's opinion) are not crucial to Judges', counsel's or witnesses' intended meaning. Conversely, the contractor rectifies speakers' grammatical anomalies and completes their partial words. The contractor's transcribers are not present during the Court's proceedings. Therefore, the contractor occasionally misidentifies a speaker or is unable to decipher sound-recorded speech. The contractor signifies, with series of periods, English speech which is unintelligible to him. 6. In final submissions neither party addressed the evidentiary objections I had invited counsel to expand. During the applicant's submissions, her counsel realised that the pagination on his transcript differs from the Court's. As far as one can ascertain from the depositions recited by one or both counsel to expert witnesses and/or in address, the contractor has provided the parties and the Court with the same transcript: typographical features of the respective texts probably account for discrepancies in their pagination. 7. During the respondent's address, its counsel discussed the contractor's apparent misapprehension of a few homophonous words. In my view, the meaning of those words is elucidated by their voluminous context but in the absence of the parties' agreement thereon I reminded counsel that the Court's sound-recording is retained indefinitely and could be made available promptly if either party were instructed to question the contractor's accuracy. Neither counsel took up my offer nor suggests that the transcript is inadequate for the purpose of determining this application. Therefore, it is unnecessary to reiterate each of the parties' arguments merely to ensure that it is noted. 8. Broadly stated, the applicant's central submission is that the deceased's fatal AML resulted from his exposure to unidentified toxic substances and from his exposure to Toluene (exhibit V) Xylene (exhibit W) and compounds thereof (exhibits C, E, F, G, H, J, K, L, M, N, O, P, Q, R, S, T, U, XX, YY, ZZ, AAA and BBB) two of which include a "Benzene (impurity) … VLOW" (exhibits B and D). The applicant's counsel relies heavily upon her uncontradicted deposition that when the deceased taught spraypainting to the respondent's detainees his skin, hair, clothes and underclothes were covered in spraypaint and that his clothing smelled of the "paint and chemicals" he used for spraypainting. 9. The applicant relies upon Seltsam Pty Ltd v McGuiness and Anor (2000) 49 NSWLR 262; and Bendix Mintex Pty Ltd and Ors v Barnes (1997) 42 NSWLR 307: she argues that the epidemiological studies in evidence (exhibits JJ, FFF, GGG, HHH and JJJ), a report by Dr Jogenoer Singh Sekhon (Dr Sekhon) to the applicant's attorneys of 4 September 1996, and Dr Sekhon's clinical records of the deceased's consultations (exhibit BB) support Professor Crank's and Dr Harvey's hypothesis that the deceased's contact dermatitis was caused by leukogenic aromatic hydrocarbons to which the respondent exposed the deceased. The applicant also relies upon Jones and Dunkel (1958-1959) 101 CLR 298; and Apollo Shower Screens Pty Ltd and Another v Building and Construction Industry Long Service Payments Corporation (1985) 1 NSWLR 561: she argues inferences adverse to the respondent's case because it failed to call its employees including Gould and one Geoff Riddell who was the Manager of Administration at Reiby when the deceased's employment and/or claim for workers' compensation was investigated by the respondent (exhibits PP, QQ, SS, UU, VV, WW). 10. This Court is accustomed to medical practitioners' clinical notes, acronyms, abbreviations and symbols. Exhibit BB was admitted without objection but the partially ineffective photocopy of Dr Sekhon's records is extraordinarily difficult to understand. The pagination in red ink on exhibit BB was added by counsel as a suggestion that Dr Sekhon's records of the deceased's consultations were made in that sequence. The transcript includes counsel's, expert witnesses' and my repeated attempts to decipher Dr Sekhon's equivocal handwriting. The applicant's counsel informs the Court that his written submission, suggesting the partial meaning of the few clinical notes on which he relies, was engrossed during a telephone consultation with Dr Sekhon: the submission itself illustrates some of the difficulties with which exhibit BB confronts the applicant and the Court. 11. Additions and alterations to the clinical notes obfuscate dates on which the deceased consulted members of Dr Sekhon's practice. The configuration in which the deceased's consultations are recorded intermingles notes with disparate dates between "[23].5.90" and "27.3.92". The perplexing sequence of dates between "…6.93" and "15.4.94" on pages "6", "7" and "8" of the notes conveys the impression that relevant consultations were not recorded contemporaneously. Dr Sekhon's brief report to the applicant's attorneys of 4 September 1996 is of limited assistance in understanding his handwritten notes of those few consultations he summarises in his report, and is of scant assistance in deciphering the remainder of his clinical records. 12. A partially ineffective photocopy of the deceased's leave records (exhibit KKK) sheds more light on exhibit BB. Exhibit KKK includes illegible and overwritten characters but the printed form on which the respondent recorded the deceased's reasons for his absences from work contextualises the respondent's handwriting. Exhibit KKK enables one to identify in exhibit BB the deceased's complaints of employment injuries, of symptoms consistent with exposure to aromatic hydrocarbons, and of possible symptoms of AML. 13. With those reservations, contemporaneous records of the deceased's employment and medical history are more reliable than the applicant's memory. She is unsophisticated and frankly concedes that she "honestly can't remember times and specific dates or years" of the relevant events she recalls long thereafter. The applicant's deposition that in 1982 the deceased developed "a very bad back" which incapacitated him intermittently, and her recollection of a troublesome lesion on his ear are consistent with exhibit BB. The applicant's inability to recall the deceased's spraypainting in 1991 during his ordinary working hours accords with the preponderance of the evidence. 14. The respondent's counsel did not challenge the applicant's credit and in address disclaims any such challenge. However, cross-examination reveals her limited knowledge of the deceased's work for the respondent. The applicant's deposition that in 1990 the deceased voluntarily taught spraypainting to the respondent's male detainees is not corroborated by exhibit RR. The applicant's inability to remember or ignorance of the deceased's medical treatment for specific conditions - for example, the squaemous cell carcinoma excised from his hand (exhibit BB) - is unremarkable in their domestic circumstances. 15. Some three years after Matthew Rawson's diagnosis with aplastic anaemia and two and half years prior to the deceased's diagnosis with AML the applicant separated permanently from the deceased. Thereafter, the applicant's knowledge of the deceased's health and activities was and is sketchy. On the other hand, her deposition, the deceased's correspondence with the respondent (exhibits KK, PP and RR) and the respondent's correspondence with Riddell, Gould, HealthQuest and Professor Firkin (exhibits LL, NN, QQ, SS, UU, VV and WW) are more reliable than exhibit OO as a source of relevant facts. 16. Professor Crank (exhibit AA) directs the Centre for Chemical Analysis, the University of New South Wales, and is a former Associate Professor of Organic Chemistry at the University of New South Wales. He specialises in the toxicology of aromatic hydrocarbons including Benzene, Toluene and Xylene. 17. Neither the letter Professor Crank received from the applicant's attorneys bespeaking his advice on this application nor his report of 17 July 1997 evaluating the toxicity of lead chromates, Xylene and Toluene is in evidence, but he recounts to the Court the assumptions he was asked to make and the relevant opinions and hypotheses thereon he reported to the applicant's attorneys. Understandably, Professor Crank cannot recall the two or three safety data sheets he sighted more than two years prior to his deposition but he identifies by description the documents in evidence upon which he based his report. 18. Professor Crank did not inspect the respondent's spraypainting facilities and was not informed of the deceased's exposure nor level of exposure to any particular chemical. Professor Crank cannot recall the distinct malignancies recorded by epidemiologists in the studies basing his written opinion that "on the balance of probabilities [the deceased's] exposure to paint solvents and chemicals was the cause of or significantly contributed to [the deceased's acute myeloid] leukaemia". 19. Professor Crank deduces from the first page of his report to the applicant's attorneys that he evaluate the toxicity of one of numerous similar "Two Pack" automotive spray painting systems. Professor Crank reported: "It is likely that other paints [used by the deceased in the course of employment with the respondent] would contain similar chemicals and would have carcinogenic properties". As I understand Professor Crank's deposition, during the nineteen nineties the majority of automotive spraypainting compounds included similar solvents, pigments and polymers and had toxic properties similar to the "Two Pack" system and other chemicals he was asked to evaluate. 20. Professor Crank reported to the applicant's attorneys that the "degree of [the deceased's] exposure to … solvents and chemicals [whilst employed by the respondent] … is likely to have been quite high". Professor Crank assumed that the deceased developed "a skin condition" recorded in exhibit BB as a result of the deceased's "clothes … hands and hair and skin [being] covered in paint [suggesting to Professor Crank that the deceased] had unusually high exposure to [spray]paint". In Professor Crank's opinion, automotive spraypaints contain carcinogenic chromates and solvents and none is "completely safe". 21. In-chief, Professor Crank was asked to evaluate the toxicity of the Benzene impurity recorded in exhibit B. Professor Crank's assertion that until he was shown exhibit B in this Court he was unaware of the deceased's exposure to Benzene, is not persuasive. Professor Crank's explanation for his report's failure to implicate a Benzene impurity in Xylene, is not persuasive. He properly concedes that a similar proportion of Benzene is commonplace in Xylene and in Toluene. Professor Crank's concession that no reliable epidemiological data link Xylene or Toluene with cancer weakens his hypothesis that "there is no safe level of exposure to Benzene" and undermines his suggestion that trace Benzene in aromatic hydrocarbon solvents is potentially leukogenic. 22. Professor Crank's assumption that in 1992, the deceased was an amateur spraypainter is contradicted by the deceased's correspondence with the respondent (exhibits KK, OO, PP and RR) by the applicant's deposition, and by Gould's handwritten comment on exhibit PP. Professor Crank's assumption that the deceased developed "a skin condition" because the respondent's spraypainting booth (spray booth) did not comply with statutory criteria for spraypainting is contrary to my findings of fact. 23. Dr Harvey is a Fellow of the Royal Australian College of Physicians. He graduated in Medicine from Sydney University. Dr Harvey was awarded his PhD by the same University for his research on molecular biology and haematology. Treatment of AML constitutes about one half of Dr Harvey's clinical practice of haematology. At any one time, between five and ten patients with AML are treated in Liverpool Hospital's Department of Haematology where Dr Harvey treated the deceased. 24. As I understand Dr Harvey's evidence, about 1989 he treated Matthew Rawson for "aplastic anaemia which was thought to possibly be secondary to Bactrim therapy" (exhibit DD). Bactrim is an antibiotic well known to Dr Harvey as a cause of aplastic anaemia. Dr Harvey speculates whether the deceased developed AML because of an inherited tendency towards bone marrow diseases and/or an inherited susceptibility to an environmental insult such as Benzene. Dr Harvey concludes that neither Matthew Rawson's nor the deceased's clinical presentation supports a diagnosis of an hereditary anaemia. Moreover, hereditary anaemiae are rare. 25. Dr Harvey concedes that initially, the deceased did not give a detailed history of exposure to chemicals. On 29 May 1995, the deceased merely "complained [to Dr Harvey] of a history of fever, malaise and sore throat for several weeks [and] had previously been healthy" (exhibit DD). Naturally, Dr Harvey's professional attention and urgent treatment were focused on delaying the deceased's death from AML. 26. On 15 May 1996, 4 June 1996, 30 January 1997 and on an unspecified date after the deceased's death, the applicant's attorneys wrote to Dr Harvey bespeaking his advice on this application: those letters are not in evidence but Dr Harvey's report of 30 April 1997 makes clear that his preceding reports to the applicant's attorneys were written without the assistance of the contemporaneous records he and Liverpool Hospital's staff had made of the deceased's treatment for AML. 27. None of Dr Harvey's reports implicates Benzene simpliciter. As I understand Dr Harvey's evidence, the applicant's attorneys initially asked him to assume the deceased's "long [occupational] exposure to a large number of chemicals … as a spraypainter … includ[ing] a large number of organic solvents [for some of which] the precise chemical composition [was] not given [to Dr Harvey] but from what [Dr Harvey could] gather [from the information furnished by the applicant's attorneys, Dr Harvey deduced that the deceased] also had exposure to lead chromate, xylene as well as a large number of paint related substances" (exhibit DD). 28. On 22 May 1996, Dr Harvey pointed out that "Xylene and other hydrocarbons may … contain benzene impurities". He tentatively opined: "to my knowledge [AML] has been linked to the aromatic hydrocarbon benzene. There is also recent evidence of carcinogenity of toluene and xylene at high concentrations in experimental animals … I believe it is reasonable to have a significant degree of suspicion that [the deceased's] occupational exposure may have been implicated in the causation of his [AML]" (exhibit DD). 29. On 4 June 1996, the applicant's attorneys requested Dr Harvey to assume the deceased's "heavy occupational exposure to lead salts, chromates and xylene" from which Dr Harvey deduced: "the question is obviously whether [lead salts, chromates and xylene] have played a role in the causation of [the deceased's acute myeloid] leukaemia". On 5 June 1996, Dr Harvey did "not think there [was] any evidence to link lead and chromates with acute [myeloid] leukaemia however [he thought] the case with xylene [was] much stronger [because Xylene is] closely related chemically to Benzene [and] Benzene is well accepted to have a link with aplastic anaemia and [AML]. There is less data in the literature on xylene however [Dr Harvey thought] it … reasonable to believe on the 'balance of probabilities' that a relationship exists between [the deceased's] industrial exposure [to Xylene] and the onset of [the deceased's AML]" (exhibit DD). 30. On 30 January 1997, the applicant's attorneys pressed Dr Harvey for an opinion "whether [the deceased's AML was] related to xylene exposure". On 30 April 1997, Dr Harvey responded: "There is not a recognised clear link between xylene and acute leukaemia. A closely related compound, benzene, however has been very closely linked with aplastic anaemia and to a lesser extent to [AML]. I think it would be impossible to prove beyond all doubt that [the deceased's] xylene exposure has been associated with the development of [AML]. By the same token a causative link is quite possible and reasonable on what is known of the chemical structure of xylene, however beyond this I think it is difficult to make any more dogmatic statement" (exhibit DD). 31. Dr Harvey was in Court during Professor Crank's evidence and defers to Professor Crank's expertise in toxicology. Dr Harvey concedes that his deposition is influenced by Professor Crank's assumptions including the deceased's "daily very heavy skin contact … heavy exposure to [aromatic hydrocarbon] solvents in the few years prior to [Dr Harvey's diagnosis of the deceased's AML, and the deceased's] … coming home with his clothes soaked in chemicals … [developing] recurrent rashes and … periods of feeling faint which are well known [to Dr Harvey as] symptoms of inhaling hydrocarbons". Dr Harvey disclaims specialised knowledge of the epidemiological data on which Professor Crank's evidence is based, but I infer from Dr Harvey's deposition that his own general impression of the same data strongly influences his conviction that the development of AML is linked with exposure to indefinite concentrations of Benzene for indefinite periods. 32. Professor Firkin (exhibit 2) graduated in Medicine from Sydney University. Monash University awarded his Doctorate. Since 1965, Professor Firkin has studied haematology: his research includes some three years' studying the molecular biology of drug-induced damage to mammalian cells. Professor Firkin is a Fellow of the Royal Australian College of Physicians, a Fellow of the Royal College of Pathologists of Australasia, and an Associate Professor of Medicine at the University of Melbourne. Professor Firkin is attached to St Vincent's Hospital in Melbourne where he specialises in clinical haematology and consults patients with AML. 33. Professor Firkin's report of 14 June 1997 (exhibit 1) focuses on the issue in this application whether Xylene caused the deceased's AML. In June 1997, Professor Firkin understood, correctly in my view, that Xylene "was the agent … specified by Dr Harvey … [as the chemical compound] responsible for the [deceased's acute myeloid] leukaemia … " Professor Firkin's report to the respondent's attorneys of 23 September 1999 is not in evidence but his deposition elucidates exhibit 1 and identifies the epidemiological data from the first half of the twentieth century on which Professor Crank's and Dr Harvey's respective hypotheses and opinions are based. The voluminous documentation on which Professor Firkin based exhibit 1 includes the deceased's own complaints to the respondent. Professor Firkin comprehensively explains his opinion that neither Toluene nor Xylene is leukogenic, and his hypothesis that the respondent did not expose the deceased to leukogenic concentrations of Benzene. 34. The applicant's counsel urges the Court to disregard Professor Firkin's evidence. Counsel contends that Professor Firkin is argumentative and countered cross-examination with evasive questions to counsel or the Court. The applicant's counsel contends that his cross-examination reveals Professor Firkin's ignorance of immunology and "inadequate analysis" of the issues in this application. Counsel asserts that Professor Firkin "is simply dismissive of what he doesn't understand" and that consequently, Professor Firkin "sought to ridicule" the epidemiological data on small cohorts of painters in exhibits FFF, GGG, HHH and JJJ. 35. The applicant's submissions on Professor Firkin's evidence might persuade a reader of the transcript who has not had my advantage of observing his courteous forbearance throughout her counsel's aggressive cross-examination. Counsel's abrupt, provocative delivery bemused and occasionally disconcerted Professor Firkin but did not disrupt Professor Firkin's lucid analysis of the epidemiological data upon which the expert witnesses' base their evidence: those features of counsel's and Professor Firkin's speech and presentation are crucial to my evaluation of the latter's credit and reliability but obviously do not survive, and could not be expected to survive, in the transcript of Professor Firkin's deposition: Paterson v Paterson (1953) 89 CLR 212 per Dixon CJ & Kitto J @ 218; Soulemezis v Dudley (Holdings) Pty Limited (1987) 10 NSWLR 247 per Mahoney JA @ 273-4; Devries and Anor v Australian National Railways Commission and Anor (1993) 177 CLR 472 per Brennan, Gaudron & McHugh JJ @ 475-477; Deane & Dawson JJ @ 478-479. 36. None of the expert witnesses is an epidemiologist. Professor Crank properly disclaims specialised knowledge of dermatology but his discipline includes the effects of aromatic hydrocarbons on human skin. Dr Harvey, Professor Firkin and Professor Koutts are experienced clinical haematologists. In Melbourne, Professor Firkin's clinical practice includes the treatment of AML. As Dr Harvey and Professor Koutts explain, most cases of AML in the Sydney area are treated by clinical haematologists although young patients with AML are referred to paediatric establishments or clinicians. 37. Professor Koutts was awarded his Doctorate for research in biochemistry and immunology: the latter discipline is closely related to haematology. Professor Koutts is a Member of the Australian, American and International Societies of Haematology, and Associate Professor of Medicine in the Department of Medicine at Westmead Hospital. For twenty years, Professor Koutts has been Head of the Department of Medicine's Clinical Haematology Unit. For eighteen months, he has been Head of the Department's Diagnostic Laboratory focusing on blood disorders. At Westmead Hospital, Professor Koutts administers the Laboratory, supervises the diagnosis of patients with blood disorders, and treats patients with blood disorders including AML. A research programme within Professor Koutts' Department studies acute leukaemiae. 38. Professor Koutts' critical analysis of the epidemiological studies in evidence and his conclusion that the small cohorts of painters reported therein are unrepresentative, reinforce Professor Firkin's evidence. Similar adverse criticisms of exhibit GGG are published by its authors: the validity of those criticisms is admitted openly by the authors of exhibit GGG. It seems to me that the authors' publication of their correspondence with exhibit GGG's critics, quoted by Professor Koutts, vindicates Professor Firkin's and Professor Koutts' scepticism of the theses advanced in exhibits FFF, GGG, HHH and JJJ. 39. The evidence in Seltsam Pty Ltd v McGuiness and Anor and Bendix Mintex Pty Ltd and Ors v Barnes differs from the epidemiological studies on which the applicant's case depends. Professor Crank's inability to specify an epidemiological study that would assist his drawing a link between spray painting and AML, and Dr Harvey's inability to specify an epidemiological study suggesting that Toluene causes AML, confirm my preference for Professor Firkin's and Professor Koutts' cogent expositions of the epidemiological data underlying the expert witnesses' evidence. 40. Moreover, contrary to the applicant's address, Dr Harvey and Professors Crank, Firkin and Koutts share extensive common ground. The expert witnesses' standards of "proof" are scientific criteria and their "evidence" for their respective hypotheses and opinions includes the results of research which is not before this Court, but the Court is not bound to adopt the terminology in which any of the monographs, reports or depositions is articulated. For the reasons in this judgment, if I misunderstand Professor Crank's or Dr Harvey's general agreement with the following, I would give their evidence lesser weight than Professor Firkin's and Professor Koutts' opinions and hypotheses. 41. As I understand Dr Harvey and Professors Firkin and Koutts, AML is an uncommon malignancy. Dr Harvey and Professor Firkin would not dispute that the incidence of AML in Australia is three per hundred thousand per year. Patients younger than sixteen years and older than ninety years present with clear signs of AML. In common with most malignancies, the incidence of AML increases with age, reflecting the normal, gradual failure of the body's complex protective mechanisms. 42. As I understand Dr Harvey and Professor Koutts, the clinical presentation of AML is non specific. A person with AML may feel tired or unwell, may be febrile, may bleed from the gums or may bruise easily. A full blood count usually is diagnostic of AML but a bone marrow biopsy may be necessary to detect the large numbers of leukaemic cells characteristic of AML. Most cases of AML progress quickly: a normal full blood count may be followed three months later with unequivocal clinical signs of florid AML. Untreated AML is fatal within months. 43. The mechanism which produces aplastic anaemia probably differs from the mechanism which produces AML. Aplastic anaemia occurs when a chemical or viral toxin or an unexplained process interrupts the normal production of bone marrow and blood cells. In the majority of patients treated for aplastic anaemia, the interruption is transient: the bone marrow recovers its capacity to reproduce normally. It is reasonable to infer from Dr Harvey's evidence, and I do infer, that Matthew Rawson, in common with the majority of patients treated for aplastic anaemia, recovered: neither Dr Harvey nor the applicant's evidence suggests the contrary. 44. As I understand Dr Harvey and Professor Koutts, if a toxin causing aplastic anaemia results in permanent genetic damage to the DNA of stem cells, the patient's recovery from the aplastic anaemia may not be normal and myeloid leukaemia may result. In the majority of AML patients, aplastic anaemia is not identified. The overwhelming majority of AML cases probably results from chance chromosomal changes in normal human biochemistry: a fortuitous mutation in the DNA controlling cellular growth leads to the malignancy - an abnormal proliferation of cells replacing normal bone marrow. For the vast majority of patients treated for AML in Australia over the past twenty years, there is no identifiable cause of AML in any age group. 45. A small proportion of the patients treated for Hodgkin's Disease with radiotherapy and/or the alkylating agents formerly used in chemotherapy develops AML one or more years thereafter: the radiotherapy and/or chemotherapy probably cause permanent damage to a cell's DNA and result in the ensuing malignancy - the abnormal proliferation of the cell. In Australia, other toxic chemical causes of AML are rare or non-existent. 46. As I understand the expert witnesses, they approve or do not dispute the methodology of epidemiologists who report a pattern of aplastic anaemia followed by AML in large cohorts of European workers during the nineteen thirties, nineteen forties and nineteen fifties. The workers used Benzene solvent and/or Benzene based solvents and glues for prolonged periods in unsanitary, unventilated factories and were exposed to concentrations of airborne Benzene averaging one hundred or more parts per minute. A preponderance of those workers developed an initial episode of aplastic anaemia. A statistically significant proportion of the workers who developed an initial episode of aplastic anaemia subsequently developed AML. 47. The expert witnesses agree that in the concentrations and for the periods recorded in the epidemiological data from the first half of the twentieth century, Benzene can cause AML: there is a threshold effect. Over the past fifty years, the incidence of AML resulting from domestic, commercial and industrial usages of Benzene has diminished substantially to proportions unidentified in reliable epidemiological studies of large, representative cohorts. Widespread domestic, commercial and industrial use of petroleum fuels probably does not increase the ordinary motorist's risk of AML. As I understand Dr Harvey and Professor Koutts, the interval between an exposure to Benzene which results in AML and unequivocal clinical signs thereof is speculative but could be decades. 48. The applicant alleges, Dr Sekhon certifies (exhibit BB), Dr Harvey opines and Professors Crank, Firkin and Koutts assume that the deceased's death was caused by AML. None of Dr Harvey, Professor Firkin, Professor Koutts, the applicant, nor the part of Dr Sekhon's clinical records I can decipher, suggests that the deceased was diagnosed with Hodgkin's Disease or aplastic anaemia. Professor Crank and Dr Harvey do not assert and Professors Firkin and Koutts dispute that the deceased's case fits into the classic pattern of AML arising from exposure to Benzine in the concentrations and for the periods established in the epidemiological data from the first half of the twentieth century. 49. As I understand Dr Harvey and Professors Crank, Firkin and Koutts, they agree that in the past fifty years the permissible proportion of toxic chemicals including Benzene in domestic, commercial and industrial compounds has diminished progressively. Permissible domestic, commercial and industrial practices have reduced progressively atmospheric contamination by potentially toxic chemicals including the aromatic hydrocarbons. Consequently, aromatic hydrocarbon compounds used for commercial and industrial purposes are likely to include less than one per cent of Benzene. Petroleum fuels for domestic, commercial and industrial purposes include low percentages of Benzene. 50. The expert witnesses agree that Xylene or Toluene commonly causes contact dermatitis, can irritate the eyes and can affect kidneys or the central nervous system adversely. In high concentration, Xylene is narcotic: immediate symptoms thereof are headache, nausea and/or dizziness. In sufficiently high airborne concentration, Toluene or Xylene can be fatal but there are not reliable epidemiological studies linking Toluene with carcinomata nor Xylene with the development of AML. Lead chromates are carcinogenic but probably do not cause AML. 51. In view of the significance the applicant attributes to exhibit BB, with the assistance of exhibit KKK and the parties' and the expert witnesses' suggestions, I have endeavoured to understand the histories, complaints, clinical examinations, diagnoses, medical advice, treatment, opinions, prescriptions, certificates and the results of the radiologists', haematologists', histopathologists' and cardiographers' investigations, recorded by members of Dr Sekhon's practice in exhibit BB. It seems to me that the majority of the following facts I find is common ground or uncontested. 52. The deceased was born on 6 June 1943. He was dominantly left handed. Between 1958 and 1963 the deceased was apprenticed, obtained his trade qualification and worked as an automotive spray painter. Between 1969 and 1974, he operated his own automotive spray painting business on Bay Street, Broadway, Sydney. Between 1975 and 1977, he was employed as a spraypainter (exhibits OO and RR). 53. Between 1958 and 1977, the deceased operated the equipment and repeatedly removed and re-applied the spraypaints, pigments, solvents and chemical compounds which automotive spraypainters were using in commercial and industrial spraypaint booths. Those substances accumulated on the deceased's skin and progressively covered the clothes he wore whilst spraypainting. After periods of spraypainting and related activities he cleaned his skin with paint solvent. 54. About 1978, the owner of a motel engaged the deceased as its manager. In 1979 the deceased met the applicant. On 22 March 1980 they married. The applicant lived with the deceased in self-contained accommodation at the motel and assisted him to manage the motel. The management of the motel necessitated the deceased's or the applicant's being available to attend to motel guests twenty four hours per day. There was no spraypainting booth at the motel. 55. Between 1981 and about 1985, the deceased occupied a garage under the motel where he spraypainted and performed related activities. The garage was several times the size of the courtroom where the applicant gave her oral evidence. Between periods of motel work, the deceased spraypainted two or three motor vehicles per month for friends who paid him less than the commercial value of that work. He also spraypainted Harley Davidson "teardrop" fuel tanks. In the motel garage, the deceased operated equipment including a sprayer and repeatedly removed and re-applied the spraypaints, pigments, solvents and chemical compounds which automotive spraypainters were using in commercial and industrial spraypaint booths: those substances accumulated on the deceased's skin and progressively covered the shorts and shirt he wore whilst spraypainting. Prior to periods of motel work and after spraypainting and related activities he cleaned his skin with paint solvent. 56. In 1985 or 1986, the owner of the motel died and the deceased was made redundant. Between 1985 and 1987, the deceased, the applicant and their sons lived at St Peters. Between 1986 and July 1990, the deceased worked as a bus driver. Between periods of employment, the deceased spraypainted motor vehicles and Harley Davidson "teardrop" fuel tanks. He operated equipment and repeatedly removed and re-applied the spraypaints, pigments, solvents and chemical compounds which automotive spraypainters were using in commercial and industrial spraypaint booths: those substances accumulated on the deceased's skin and progressively covered the clothes he wore whilst spraypainting. After periods of spraypainting and related activities he cleaned his skin with paint solvent. 57. In 1987, the deceased and the applicant moved to a home in Campbelltown (Campbelltown) within walking distance of Reiby. Inside the security fence surrounding Reiby (the fence) the respondent detained male and female juvenile offenders against criminal law, most of whom were aged between twelve and sixteen years (exhibits A, KK, LL, NN, OO and RR). Between 1987 and 29 October 1992, the applicant, the deceased and their children consulted Dr Sekhon. Thereafter, the deceased consulted Dr Sekhon and a general medical practitioner/s in Dr Sekhon's practice (exhibit BB). 58. On 26 September 1987, the deceased's gums were examined. His periodontic exudate was diagnosed as "Pyorrhea. [He was prescribed] Amoxil. [He gave a history that he had] been in R[oyal] P[rince] A[lfred] H[ospital] - [with] Chest pain". Thereafter, members of Dr Sekhon's practice routinely monitored and recorded in exhibit BB the deceased's fluctuating blood pressure and pulse rate. On 3 October 1988, the deceased was taking "Aginine … [and] had no chest pain. [Dr Sekhon noted that the deceased] wants [a] blood test" (exhibit BB). 59. On 28 October 1988, the deceased's "Left eye vision [was] disturbed. [He was] ref[erre]d [to an ophthalmologist] Dr Bala" (exhibit BB). 60. On 22 December 1988, the deceased complained of an "Hyperkeratosis [on his] right hand middle finger" (exhibit BB). 61. On 11 September 1989, the deceased gave a history of "Pains & aches - [He had been] Vomiting [and had symptoms of a] Gastric [disorder. Clinical examination revealed that he was] Febrile. [He complained of diffuse muscular] Tenderness [and] Nausea" (exhibit BB). 62. In late 1989 or early 1990, the respondent introduced a spraypainting course for male juvenile offenders, aged between fourteen and fifteen years, who were detained inside the fence. Under the respondent's close supervision, between one and four of the detainees were permitted to spraypaint and performed associated activities in the respondent's maintenance workshop (workshop) outside the fence (exhibits A, HH, LL and RR). 63. On "[6].2.90 [the deceased was unduly] Cranky with [his] Kids. [No abnormality was detected to account for his irritability, blood pressure or pulse rate. He was prescribed] Propine" (exhibit BB). 64. On "[27].4.90 [the deceased complained of a] Sore throat … [Clinical examination revealed that his] Throat [was] inflamed. [An] U[pper] R[espiratory] T[ract] I[nfection was diagnosed. He was] cert[ified unfit for work] for one day" (exhibit BB). 65. On 30 April 1990, a "wart [on the deceased's] left middle finger [was troublesome. Dr Sekhon concluded that the wart] Will need Cortisone [and] cert[ified the deceased's incapacity from] 23.4.90 - 28.4.90" (exhibit BB). 66. On 23 May 1990, an "Hyperkeratotic lesion [on the deceased's] left middle finger [was diagnosed] ... Xylocaine 2 ml [was] infiltrated [into the lesion] - [The lesion was] Excised [and the wound was] - Sutured. [The wound was] Dressed. [The excised lesion was dispatched to] Histopathology" (exhibit BB). 67. On 9 June 1990, the deceased complained of a "Cold Sore - [and a] Sore Chest. [He was diagnosed with] Pharyngitis [was prescribed] Amoxil [and was advised to take] Strepsil" (exhibit BB). 68. On 2 July 1990, the deceased commenced full time employment as a Senior Youth Worker at Reiby. He worked at Whitton Cottage, inside the fence, where the respondent detained female juvenile offenders (exhibits KK, HH, OO, RR and KKK). On the days the deceased was rostered to work at Whitton Cottage his duties concluded between 17.00 and 19.00. 69. On 31 July 1990, the deceased was absent from work because his "wife [the applicant] haemmoraged [sic]". The respondent granted his leave for part of that day (exhibit KKK). 70. On 13 August 1990, the "Wart [on the deceased's] middle finger [was troublesome]". On "[31].8.90 [a] Skin Cancer [was diagnosed on his] right hand dorsum". On 1 or 2 September 1990 an "[injection of] Xylocaine 5 ml [was] infiltrated [into the carcinoma. An] eliptical incision [was made. The carcinoma was] excised [and the wound was] Sutured [with] Nylon. [The carcinoma was dispatched to] Histopathology". On 3 September 1990, the wound was "Healing well - [and was re-]Dressed". On 9 September 1990, "Histopathology - [reported that the lesion was a] Squaemous cell carcinoma" (exhibit BB) 71. 0n 10 or 13 September 1990, the deceased was "Seeing a spot in front of [his] eye. More so when [he] goes in [the] sun. [His] vision [had been] defective [when] tested 5 years ago. [He was] Advised [to] get [his] eyes tested [again]" (exhibit BB). 72. On 2 October 1990, a wart on the deceased's "left middle finger [was troublesome. He was advised to apply a] Wart prep[aration]" (exhibit BB). 73. On 30 November 1990, the respondent granted the deceased his accrued recreation leave (exhibit KKK). 74. On 1 December 1990, the deceased complained of his "Difficulty in Sleeping". No abnormality was detected to account for his sleeplessness, blood pressure or pulse rate (exhibit BB). 75. Between 9 and 13 January 1991, the deceased was absent from work. The respondent granted his five days' accrued recreation leave (exhibit KKK). 76. On 10 January 1991, the deceased's "Heart [was re-examined] - N[o] A[bnormality was] D[etected to account for his complaints, blood pressure or pulse rate. A] short Discussion [ensued concerning the deceased's general or emotional health]" (exhibit BB). 77. On 12 February 1991, the deceased complained of a "Spot in front of [his] right eye … [His] Eyes [were re-examined] - N[o] A[bnormality was] D[etected in his eyesight, but he had] Cystitis - [there were] styles [on his eyelid/s. He was] ref[erre]d to Dr Bala. [The deceased's] Heart [was re-examined]- N[o] A[bnormality was] D[etected to account for his complaints, blood pressure or pulse rate]" (exhibit BB). 78. On 25 February 1991, the deceased complained of "Blocked ears ... [and had] Pain in [his] right ear. [Clinical examination revealed that] Both [his] ears [were] infected [the] right worse [than the left. His] Throat [was re-examined] - N[o] A[bnormality was] D[etected therein. He was prescribed] Sofradex [for his ear infection]" (exhibit BB). 79. On 19 March 1991, the deceased gave a history of "occasional pain in [his] chest. [No abnormality was detected to account for his chest pain, blood pressure or pulse rate. He was prescribed] Anginine [and] Temazepam" (exhibit BB). 80. On "[…6].5.91 [the deceased complained of his] Difficulty in Sleeping [because he was] worried about [his] Son [Matthew Rawson. No abnormality was detected to account for the deceased's sleeplessness, blood pressure or pulse rate. He was prescribed] Temazepam" (exhibit BB). 81. Between 31 May and 4 June 1991, the deceased was absent from work. The respondent granted his five days' accrued recreation leave (exhibit KKK). 82. On 19 July 1991, the deceased had "Pain in [his] chest - [and complained of] anxiety. [His] Heart [was re-examined] - N[o] A[bnormality was] D[etected to account for his chest pain, anxiety, blood pressure or pulse rate. He was prescribed] Anginine [and] Temazepam" (exhibit BB). 83. On "[…8].8.91 [the deceased gave a history that he had] Injured [his right] leg … at work [There was a] Laceration on the back of [his] leg on [the] bone. [The laceration was] Infected. [He also was] Getting flushing in [his] face. [No abnormality was detected to account for the deceased's facial flushing, blood pressure or pulse rate]" (exhibit BB). 84. Between 26 August 1991 and 11 September 1991 the deceased was incapacitated by the injury to his right leg. The respondent granted his accrued recreation and/or annual leave (exhibit KKK). 85. On 11 October 1991, the deceased complained that he had "Difficulty in sleeping - [because of] Backache - [and because he was] worried about [his] son [Matthew Rawson. The deceased was prescribed] Temazepam [and] Panadeine Forte" (exhibit BB). 86. On 16 October 1991, the deceased complained of "Shortage of breath [leading to] Palpitations [and] Tightness of [his] chest. [He gave a history that he was] Under tension because of [the] sickness of his son [Matthew Rawson. The deceased was prescribed] Ducene [and was advised to take] Aspirin. [An] X-ray [of the deceased's] chest [was arranged. A] Dry Wen on [his] ear [was examined. He was advised to apply] Wengot" (exhibit BB). 87. On 17 October 1991, the deceased was "Still feeling the same. [Clinical examination and plain radiological film of his] chest Lung[s and] Heart [revealed] N[o] A[bnormality to account for his breathlessness, palpitations, tightness in the chest, blood pressure or pulse rate. He was prescribed] Penicillin" (exhibit BB) because the wen on his ear was inflamed. 88. On 21 November 1991 the deceased was having "Difficulty in sleeping [because of a] Foot injury. [He was referred to a] Dr McDermott. [The deceased also was] Very worried about [his] son [Matthew Rawson. The deceased was prescribed] Temazepam, Ducene [and] Panadeine Forte" (exhibit BB). 89. On 28 November 1991, the deceased confirmed that he had "been taking Temazepam … [but was] still not sleeping very well [and had] Severe backache. [During clinical examination he complained of] Tenderness [over his] lower lumbar injuries. He was prescribed] Temazepam [and] Panadeine Forte" (exhibit BB). 90. On "10.12.[91 the deceased complained of] Depression [and was] not sleeping well. [He was prescribed] Ducene, Temazepam [and] Panadeine Forte". On 20 December 1991, his "[pre]scrip[tion]s [for] Panadeine Forte, ducene, Temazepam [and] Anginine [were] Repeat[ed]" (exhibit BB). 91. On 31 January 1992, the deceased complained of "Anxiety. [He was prescribed Ducene, Temazepam [and] Panadeine Forte [and was] Advised [to have a] blood test" (exhibit BB). 92. On 28 February 1992, the deceased was "Worried about [his] son [Matthew Rawson, and had] Backache. [The deceased was prescribed] Ducene, Temazepam [and] Panadeine Forte" (exhibit BB). 93. The deceased also was worried about the respondent's male detainees at Reiby. He became aware that "some of the juveniles [sic] … were bored, or [were] having some form of trouble in the cottages [inside the fence where they were detained. He wished] to enable [those detainees] to gain confidence to compete in the Work Force [upon their release from Reiby]" (exhibit RR). 94. In 1992, in conversation with one Liam Guilfoyle, then Supervisor of Reiby, the deceased offered to teach automotive spraypainting to the respondent's male detainees. Guilfoyle informed the deceased that the respondent's budget was insufficient to pay a spraypainting teacher. The deceased offered to teach spraypainting gratis to the detainees (exhibits KK and RR). The respondent permitted the deceased to teach spraypainting in the workshop. On the deceased's rostered days off and at intervals between his full time duties at Whitton Cottage, he taught fourteen and fifteen year old male detainees tasks which apprenticed spray painters were learning. The deceased enjoyed teaching his trade (exhibit RR). At times, he was occupied in the workshop until 19.00 or 19.30. 95. In the workshop, the deceased initially wore "Stubbie" shorts and a shirt or tee shirt. He used and was exposed to spraypaints, pigments, solvents and chemical compounds which automotive spraypainters were using in commercial and industrial spraypaint booths. More paint accumulated on the deceased, his shorts and his shirt than the applicant had seen on him or his clothes over the preceding thirteen years. At times, the deceased arrived at Campbelltown with thick paint on his hands, paint splattered on his face, paint in his hair and/or paint on his arms. 96. The applicant was accustomed to washing her own and her children's clothes before washing clothes which the deceased had worn whilst spraypainting. The applicant smelled "paint and chemicals" on the clothes worn by the deceased for his voluntary work. She realised that domestic washing products did not remove paint from those clothes. She purchased and used industrial soap in the washing machine at Campbelltown but progressively, paint accumulated on the deceased's "Stubbies", shirt, joggers and socks. 97. The applicant noticed the deceased's difficulty removing thick paint from his skin. She purchased and he used industrial soap to clean the skin he exposed whilst spraypainting. The applicant became concerned that spraypaint and related substances would destroy the deceased's shorts and shirt/s. He acquired and wore overalls whilst spraypainting. Progressively, spraypaint accumulated on the deceased's overalls. 98. The applicant became concerned that the "paint and chemicals" on the deceased's clothing would have an adverse effect on their children's health, and in particular on Matthew Rawson's health. She cleaned the washing machine at Campbelltown and asked the deceased to carry clothes to Reiby so that he could wash in the respondent's industrial machine the clothing he wore whilst spraypainting. Thereafter, the deceased arrived at Campbelltown in clothes he had carried to work earlier the same day. 99. The deceased's spraypainting tuition was beneficial to the respondent's male detainees. On discharge from Reiby, three former inmates obtained spraypainting employment. "The [respondent's spraypainting] program [for its detainees and/or the deceased's voluntary role therein] was mentioned [favourably] in the March [1992] addition [sic] of the Juvenile Justice Bulletin [published by the respondent]" (exhibit RR). 100. The deceased's voluntary work probably was beneficial for his emotional health. Between March and June 1992, he was prescribed psychotropic medication but his complaints of anxiety, depression and chest pain abated (exhibit BB). 101. On 18 March 1992, "Pterygia [were diagnosed on] both [the deceased's] eyes. [He was] Advised [to wear] Sun Glasses [and was prescribed] Chloromycetin eye drops. [His] Blood [was] tested". On 23 March 1992, the "Blood report [was] discussed [with him. His blood] Sugar … [and] Tryglycerides … [were explained to him. The potential benefit of changes to his] Diet [were] Discussed [with him]" (exhibit BB). 102. On 27 March 1992 the deceased had "Backache - [and] pain on [his] shoulder. [He was prescribed] Temazepam, Ducene [and] Panadeine Forte" (exhibit BB). 103. On 2 May 1992, the deceased applied for "the position of Vocational Instructor (Spraypainting)". His assertion that he had had twenty seven years' "experience as a Spray Painter [including] 4 years [self-employed in his] own business on Bay Street, Broadway, Sydney" is corroborated by the applicant's deposition. The deceased stressed his concern for detainees' welfare: he "always maintained a safety factor [sic] to ensure that [the detainees'] using … [spraypainting] products are safe from any danger … " The deceased's assertion that he had been "running the Spray Painting program at Reiby … for the [preceding] 12 months" (exhibit RR) is hyperbole but clearly conveys his firm intention of securing the position with his trade qualification and experience. 104. Between 4 and 29 May 1992, the deceased was absent from work. The respondent granted his accrued annual leave (exhibit KKK). 105. On 4 May 1992, the deceased had "Backache. [He was prescribed] Temazepam … Diazepam [and] Panadeine Forte". On 5 May 1992, he had "Difficulty in sleeping - [and had] lost [his] prescription [for Temazepam: the prescription was replaced]" (exhibit BB). 106. On 23 May 1992, the deceased was "Getting breathless - [but had] no pain in [his] chest. [The results of an] E[lectro] C[ardio] G[ram were] normal. [He was] Advised [to perform] exercises". On "[…]3.6.92 [his] Heart [was re-examined] - N[o] A[bnormality was] D[etected to account for his chest pain, breathlessness, sleeplessness, blood pressure or pulse rate. He was prescribed] Temazepam [and] Ducene" (exhibit BB). 107. Between 30 June 1992 and 20 July 1992, the deceased was absent from work. The respondent granted his twenty one days' accrued recreation leave (exhibit KKK). 108. On 10 July 1992, the deceased complained of his "Difficulty in sleeping. [He was prescribed] Temazepam [and] Ducene" (exhibit BB). 109. About June 1992, the respondent provided a "Two Pack" spraypainting system for use in the workshop. Intermittently thereafter, the deceased used the "Two pack" spraypainting system in the workshop (exhibits A and HH). 110. About 21 July 1992, the deceased commenced his duties as Vocational Instructor (Spraypainting). The deceased's duties occupied between twenty and thirty hours per week and included his vehicle recovery, damage assessment, quantifying and ordering material, quotations, dismantling motor vehicle components, panel beating, the use of a cleaning machine, spraypainting and his close supervision of between one and four male detainees aged between fourteen and fifteen years. Intermittently, the deceased used the "Two pack" spraypainting system in the workshop. Following his representations to Guilfoyle, Gould and/or one Alan Brown, the respondent's then Project Manager, the respondent applied for the requisite permit from the WorkCover Authority of New South Wales (Authority) and designed, selected, acquired, assembled and/or constructed the spray booth in the workshop (exhibits A, HH, KK, PP and CCC). 111. At Reiby, the deceased disputed with the respondent the design and/or construction of the spray booth (exhibit KK). At Campbelltown, during evening meals with the applicant, the deceased angrily complained about the spray booth and the "Two Pack" system. 112. On 23 July 1992, the deceased's prescriptions for Temazepam and Ducene were repeated. On 3 August 1992, he had a "Sore throat … [Clinical examination revealed that he was] Febrile [but his] Throat … [and] Lungs [were] clear". On 4 August 1992, his prescriptions for Temazepam and Panadeine Forte were repeated. He complained: "Can not Sleep [and conceded that he was] still [engaging in] heavy drinking. [He was advised to attend] A[lchoholics] A[nonymous: its programmes were] Discussed [with him]" (exhibit BB). 113. On 13 August 1992, the deceased complained of "Anxiety. [His] Heart [and] lungs [were re-examined] - N[o] A[bnormality was] D[etected to account for his anxiety, blood pressure or pulse rate. He was prescribed] Temazepam, Panadeine Forte [and] Ducene. [He continued to have] Difficulty in sleeping". On 24 August 1992, he was "Under Stress - [in] Consultation [he was counselled. He was prescribed] Temazepam .. [and] Panadeine Forte" (exhibit BB). 114. On 1 September 1992, the deceased was "Worried about his son [Matthew Rawson] - [In] Consultation [the deceased was advised to] Stop [worrying because worry leads to] Anxiety but [he was] aware [of the cause of his] Stress. [He was prescribed] Temazepam, Panadeine Forte [and] Ducene". On 10 September 1992, he was "Under stress [and was] not able to sleep. [His] Heart [was re-examined] … N[o] A[bnormality was] D[etected to account for his sleeplessness, blood pressure or pulse rate. He was prescribed] Temazepam [and] Panadeine Forte" (exhibit BB). 115. On 17 September 1992, the deceased had work-related "Backache - [and had] Difficulty in Sleeping [because he was] Under stress. [He was prescribed] Temazepam, Panadeine Forte [and] Ducene" (exhibit BB). 116. On 2 October 1992, the deceased complained of chest "Pain [and of] tightness of [his] chest on exertion. [His] Heart [was re-examined] - N[o] A[bnormality was] D[etected to account for his chest pain, tightness in the chest, blood pressure or pulse rate. He was prescribed] Temazepam, Panadeine Forte [and] Anginine". On 19 October 1992, he was "Depressed [and had] Not [been] able to sleep. [He also complained of] Backache. [He was prescribed] Ducene, Temazepam [and] Panadeine Forte" (exhibit BB). 117. On 30 October 1992, the applicant and the three children, then aged between four and eleven years, left Campbelltown and travelled to Wollongong where they spent a fortnight in a women's refuge. They then travelled to Lismore where they were provided with four weeks' emergency accommodation until the Housing Commission made available for their occupation the premises in Lismore where the applicant continues to reside. 118. Between 2 and 13 November 1992, the deceased was absent from work. The respondent granted his accumulated recreation leave (exhibit KKK). He moved into the respondent's staff accommodation at Reiby. Thereafter, he resided within the fence (exhibit OO). 119. On 25 November 1992 the deceased had a "Sore blocked [left] ear … [He felt] dizzy [and complained of] nausea. [He was prescribed] Ducene [and] Sofradex". On 21 December 1992, he was "Still feeling dizzy. [Clinical examination revealed that his] left ear [was] infected [and that there was a] Sun spot on [his] eye" (exhibit BB). 120. On 12 January 1993, there was an "Infected cyst [on the] left side of [deceased's] neck. [He was prescribed] Amoxil". On 13 January 1993, "Xylocaine [was] infiltrated [into the cyst on his] neck. [The] Hyperkeratosis [was excised. The wound was] Sutured [with] Nylon [and was] Dressed. [The excised tissue was dispatched to] Histopathology". On 20 January 1993, the wound was cleaned with "Saline …. [Clinical examination revealed that the wound was] Healing well [but the deceased had] Conjunctivitis [in] both eyes - [He was prescribed] Soframycin" (exhibit BB). 121. About 12 February 1993, the deceased fell at work (the fall) injuring his lumbar spine. He reported the fall to the respondent and claimed workers' compensation from the insurer. The insurer allocated "No A1779499" to the deceased's claim (exhibit KKK). Subsequently "W C pd" by the insurer to members of Dr Sekhon's practice for some forty five consultations with the deceased between 12 March 1993 and 20 May 1995 (exhibit BB). 122. On 13 February 1993, the deceased gave "[a history of the] fall at work. [He complained of] Pain [in his] back - left lower lumbar region. [During clinical examination he complained that his] Lower back lumbar injury [was tender. He also had symptoms diagnosed as] Sciatica [but there was] No neurological sign [in either of his legs. He was administered an] Inj[ection of] Xylocaine [with] Depomedrol. [A spinal] Xray [was arranged. The radiologist reported] … O[steo] A[rthritic] Changes. [The deceased was prescribed] Orudis" (exhibit BB). 123. On 14 February 1993, the deceased complained that his back: "Pain is not improving". He was "Advised [to attend a] Physio[therapist. The deceased was prescribed] Panadeine Forte" (exhibit BB). 124. On 23 February 1993, the deceased gave a history that his "Face grows bright red at night time after four drinks". He conceded that his "Back is improving with physio[therapy] - Much less [pain]". On 24 February 1993, the deceased complained of persisting "Backache - [and] Pain radiating now to [his] hip. [He was given a] Letter [requesting a physiotherapist] for Physio[therapy to his] back" (exhibit BB). 125. On 24 February 1993, the respondent supplied one safety suit with an oxygen hood and cylinder for use by persons engaged in activities inside the spray booth. The respondent provided three or four disposable safety suits with disposable face masks for use by persons engaged in spraypainting and/or related activities in the workshop (exhibits A and HH). 126. On 26 February 1993, the deceased complained of "Pain on [the] left side [of his back and a] sore buttock with radiation [of pain into his] legs - No neurological sign [was detected in either of his legs. He was prescribed] Codeine Forte [and was advised] To keep on physio[therapy]". On 3 March 1993, he complained that he was still "Having backache - [the] pain was easing now but coming back and radiating to [his] leg. [During clinical examination, he complained of his] Tender lower lumbar injury. [He was prescribed] Codral Forte" (exhibit BB). 127. On 8 March 1993, the deceased complained that he: "Could not Sleep last night [because of] excruciating pain. [During clinical examination, he complained of his] Tender right S[acro] I[liac] joint. [The possibility of a spinal] Manipulation [under general anaesthesia was] discussed [with him. He was prescribed] Ducene [and] Sinequan" (exhibit BB). 128. Between 12 and 19 March 1993, the deceased was incapacitated by the fall. The insurer paid his weekly workers' compensation (exhibit KKK). 129. On 12 March 1993, the deceased complained: "Nothing is working - Still limping - Can not Sleep … " During clinical examination, he had "Pain radiating to [his] left leg. [He was administered an] Inj[ection of] Xylocaine [with] Decadron - epidural[ly and was prescribed] Dymadon Forte" (exhibit BB). 130. On 15 March 1993, the deceased complained of "Pain in [his] leg [and] Cannot Sleep at night". He was "ref[erre]d to [Dr Giblin, an] orthopaedic surgeon". On 16 March 1993, the deceased confirmed that he had "seen Dr Giblin - [and] wants to be admitted in [sic] hospital". The deceased was administered an "Inj[ection of] Pethidine. [He was afforded] Slight relief with - [the] Pethidine [injection]". At 16.30 on 16 March 1993, he was prescribed "Endone tab[lets for incapacitating pain]" (exhibit BB). 131. Between 22 March and 14 June 1993 the deceased was incapacitated by the fall. The insurer paid his weekly workers' compensation (exhibit KKK). 132. On 24 March 1993 the deceased gave a history of his "Very painful [spine and/or leg, of his] entering hospital [and of his being administered] Pethidine [intravenously. He had been] admitted in [sic] hospital under Dr Giblin [who had performed a] Spinal Manipulation [under general anaesthesia]" (exhibit BB). 133. By 26 March 1993, the deceased was "Attending [a] chiropractor". The deceased conceded that his back "Pain has eased". He was administered an "Inj[ection of] Valium". On 29 March 1993, he had "been [back] to [the] chiropractor - [and was] feeling well [but was] still limping and [had] pain [in the] right side [of his back. [During clinical examination, the deceased complained that he was] Tender [over his] lower lumbar injury [caused by the fall]. Movements [of his spine were] painful. [He was administered a further] Inj[ection of] Valium" (exhibit BB). 134. On 31 March 1993, the deceased was informed that a "C[omputerised] T[omographic] Scan [of his lumbar spine] shows degenerative changes [and a] Disc protrusion at S1 [compressing his first sacral] nerve root. [His] Pain [was] improving [but he was] nervous. [He was prescribed] Ducene" (exhibit BB). 135. On 2 April 1993, the deceased complained that "Pain [was] still shooting down [his] leg. [Since he had] Had [the] Spinal manipulation done [by Dr Giblin the] Pain [had become] worse". The deceased was prescribed Temazepam. He was administered an "Inj[ection of] Valium". He was advised to "wait for one week" before deciding whether to undergo the discectomy, proposed by Dr Giblin (exhibit BB). 136. On 5 April 1993, the deceased complained that his back "Pain has not improved - still getting pain in [the] back". He gave a history that he had "seen Dr Giblin [again. Dr Giblin was] going to operate on him. [The deceased was prescribed] Panadeine Forte. [He was given a] Letter [requesting a physiotherapist] for [further] physio[therapy]" (exhibit BB). 137. On 14 April 1993, the deceased was "Attending [a] chiropractor [and was] Getting better [but] still [had] pain in [the] leg ... [During clinical examination, the deceased complained that he was] Tender [over his] lower lumbar injury [caused by the fall. He was prescribed] Panadeine Forte" (exhibit BB). 138. On "19.[4].93 [the deceased complained that his] Pain [was] still there. [He gave a history that he had] been [to a] Sol[icitor] about [his] wife [the applicant] & [their] children. [The deceased also had] Had Physio[therapy treatment from the] Chiropractor. [The deceased was] Cert[ified unfit for work] for one week [and was prescribed] Panadeine Forte" (exhibit BB). 139. On "[2]3.4.93 [the deceased was] Still going to [the] Chiropractor [for] Physio[therapy treatment with] slight improvement. [The deceased was prescribed] Dymadon Forte". On 28 April 1993, he was "Not getting better. [He was] Advised to go to [a] Physio[therapist. [The deceased was prescribed] Dymadon Forte [and was] cert[ified unfit for work for a further] 4 week[s]" (exhibit BB). 140. On 1 May 1993 the deceased "Still [had] Severe pain in [his] back. [He was prescribed] Temazepam [and] Dymadon Forte". On "[5].5.93 [he was] Going for physio[therapy] - [and was] feeling better. [The] Pain [was] still in [his] legs [but was] slight to what it was". On "[7].5.93 [the deceased was] Getting better - [he had] Pain in [his] leg only 10-15% [of the time.] Physio[therapy] ha[d] improved [his condition. He was prescribed] Panadeine Forte" (exhibit BB). 141. On 12 May 1993, the deceased's back "Pain [was] improving - [but] on increased [extension there was an] Abnormal Sensation in [his] leg. [He was prescribed Dymadon Forte". On 17 May 1993, he was "Going for physio[therapy and] feeling better [but he had a] Slight burning Sensation in [his] left leg [and was] still tender [in the] lumbar spine. [He was prescribed] Panadeine Forte" (exhibit BB). 142. On 20 May 1993, the deceased's "Backache [had] improved. [He was prescribed] Panadeine Forte". On 28 May 1993, his "Back pain [had] Improved. [He was advised to] Continue [taking] P[anadeine] Forte & [to continue attending the] physio[therapist. He was certified unfit for work] For [a] further [two weeks, and was advised to] rest and [to take] more analgesia & [to continue] physiotherapy" (exhibit BB). 143. By 2 June 1993, the deceased had "seen [the] Compensation doctor … [nominated by the insurer. The deceased … was prescribed] Panadeine Forte". On 9 June 1993, the deceased's "Back [was] improving - but [he was] not ready to work. [He was advised to] Continue physio[therapy. He was given a] Letter for [the] police for [the purpose of explaining that his] car [had been] parked wrongly [because of the effects of the fall. He was prescribed Panadeine" (exhibit BB). 144. On 15 June 1993, the deceased had "no pain". [He was certified] Fit to resume [his normal] duties [that day, but he was prescribed] Temazepam" (exhibit BB). 145. Between 15 and 19 June 1993, the deceased was absent from work. The respondent granted his five days' accumulated recreation leave (exhibit KKK). 146. On 16 June 1993, the deceased confirmed that he was taking "Panadeine Forte [for] Tightness [of his] lumbar sp[ine. A] Lump behind [his] ear - [was diagnosed as a] Cyst [which] will need excision". On 19 June 1993, the "Cyst [behind the deceased's ear was] infected - [and] very tender. [He was prescribed] procaine [penicillin]" (exhibit BB). 147. On 21 June 1993, the deceased's "Backache [was] getting better [but he was attending the] Physio[therapist] still. [During clinical examination, he complained that he was] Tender over [his lumbo sacral junction. He was prescribed] Panadeine Forte." On 26 June 1993, the deceased still had "Backache - [but felt] better [there had been an] Improvement - [he had pain] only now and then [when] twisting [his spine. He was prescribed] Panadeine Forte" (exhibit BB). 148. Between 29 June 1993 and about 21 July 1993, the deceased was absent from work. The respondent granted his accumulated recreation leave (exhibit KKK). 149. On "[2].7.93 [the deceased complained of] Back pain [on] Movements turning [his] back [and of a] slight burning sensation [at the] back of [his] leg [and of back] Pain in [the] morning. [He was prescribed] Panadeine Forte". On "[1]2.7.93 [the deceased's] Backache [was] improving. [During clinical examination, he complained there was] still tenderness [over his lumber spine. He was prescribed] Panadeine Forte". On 17 July 1993, the deceased's "Back [was] still hurting. [During clinical examination he complained of] Slight tenderness [over his lumbar spine. He was prescribed] Panadeine Forte" (exhibit BB). 150. On "2[6].7.93 [the deceased's] Back [felt] better but [there was a] burning sensation on [the] lateral side of [his] right leg - [During clinical examination, he made] no [complaint of] tenderness [over his] lumbar injury [caused by the fall. He was prescribed] Panadeine Forte" (exhibit BB). 151. On 6 August 1993, the deceased's back "Pain [was]still there - [and there was] tingling in [his] leg. [During clinical examination, he complained that he was] Tender [over his] lower lumbar injury [caused by the fall. He was prescribed] Panadeine Forte". On 13 August 1993, "Tingling [in the deceased's leg was] getting less [and he had] not been for physio[therapy. He was prescribed] Panadeine Forte" (exhibit BB). 152. On "19.[8].93 [there was a] F[oreign] B[ody in the deceased's] left thumb - [it was] removed … He was prescribed] Panadeine Forte. [The deceased had] Backache [but] no pain. [His] Leg [was] hurting". On 27 August 1993, the deceased conceded: "Back is better now - only leg trouble. [He was prescribed] Panadeine Forte" (exhibit BB). 153. On 3 September 1993, there was a "F[oreign] B[ody in the deceased's] right eye … [A] Xylocaine [eye] drop - [was administered and the foreign body was] removed. [He was prescribed] … eye drops [and] Panadeine Forte. [He gave a history that his] Back [was] better. [Later the same day, there was a] Purulent discharge [from the deceased's] right eye. [He was prescribed] Supramycin [eye] drops" (exhibit BB). 154. On 10 September 1993, deceased's "Back [was] improved - [but his] Leg [was] still tingling. [He was prescribed] Panadeine Forte". On 20 September 1993, he was "Still getting pain after driving. [He was prescribed] Panadeine Forte" (exhibit BB). 155. Between 21 September and 2 October 1993, the deceased was absent from work. The respondent granted his thirteen days' accumulated recreation leave (exhibit KKK). 156. On 28 September 1993, the deceased had work-related back pain whilst "Travelling. [He was prescribed] Panadeine Forte" (exhibit BB). 157. Prior to October 1993, the respondent requested the Authority to approve the spray booth. On 14 October 1993, the Authority inspected the workshop and the spray booth and concluded that both structures complied with the relevant legislation. One Atkins, a Senior Inspector of the Authority's Technical Support Unit Engineering Services recommended the Authority's approval of the spray booth (exhibits A, HH, CCC and DDD). 158. On "1[5].10.93 [the deceased was] Getting [an] ache [in his] left leg - [and] Backache. [During clinical examination, he complained that he was] Tender [over his] lower lumbar region. [He was prescribed] Panadeine Forte" (exhibit BB). 159. On 21 October 1993, the Authority confirmed its Inspector's opinion that the design and installation of the spray booth and workshop complied with the relevant legislation. The Authority approved the spray booth (exhibit CCC). 160. On 1 November 1993 the deceased's back "Pain [was] getting better. His] Heart [was re-examined] - N[o] A[bnormality was] D[etected to account for his blood pressure or pulse rate. He was prescribed] Panadeine Forte". On 13 November 1993, he was "Still getting backache. [During clinical examination, he made] No [complaint of] tenderness [over his lumbar spine. He was prescribed] Panadeine Forte" (exhibit BB). 161. On 27 November 1993, the deceased's "Pulse [rate was normal. His] Heart [was re-examined] - N[o] A[bnormality was] D[etected to account for his blood pressure. He was] Still getting backache - but improving. [He was prescribed] Panadeine Forte" (exhibit BB). 162. On 20 December 1993, the deceased's "Sciatica [was] improving". He confirmed that he: "Continues on … Panadeine Forte [every] day". A member of Dr Sekhon's practice suggested: "[The deceased] Needs [a] referral to [a] Neurosurgeon for a 2nd opinion re[garding the advisability of the] discectomy [proposed by Dr Giblin]" (exhibit BB). 163. Between 28 December 1993 and 27 January 1994, the deceased was absent from work. The respondent granted his accumulated annual leave, sick leave and recreation leave (exhibit KKK). 164. By "31.[1].94 [the effects of the back injury, caused by the fall, had diminished. The deceased's] Calf muscle [was] affecting [him] only. [He was prescribed] Panadeine Forte" (exhibit BB). 165. On 3 February 1994, a "C[omputerised] T[omographic] Scan [of the deceased's lumbar spine was performed]". For part of that day, he was absent from work. The insurer paid his weekly workers' compensation (exhibit KKK). On 4 February 1994, the deceased was informed that the "Scan - Shows spondylitic changes at [the] L5 S1 - disc encroaching [on the adjacent nerve root on the] right side". On 4 February 1994, the deceased was "Not able to sleep [because of back pain]". By "[7].2.9[4, his] Back [had] improved" (exhibit BB). 166. Between 5 and 9 April 1994, the deceased was absent from work. The respondent granted his five days' recreation leave (exhibit KKK). 167. On 5 April 1994, the deceased complained that he "Gets pain every now [and] then [and that his] Slight discomfort on sitting [for] long [periods became] worse. [There had been] no improvement [in those symptoms. He was prescribed] Panadeine Forte" (exhibit BB). 168. On 15 and 16 April 1994, the deceased was absent from work. The respondent granted his two days' leave on his presentation of a "M[edical] C[ertificate opining his in]flu[enza]" (exhibit KKK). 169. On 15 April 1994, the deceased had a "Sore throat. Surgery [was performed: the] Cyst [behind the deceased's ear was excised. Clinical examination revealed that he was] Febrile [and his] Throat [was] inflamed [but his] Lungs [were] clear" (exhibit BB). 170. Between 28 June 1994 and 11 July 1994, the deceased was absent from work for an aggregate three and one half days. The respondent granted his accumulated recreation leave (exhibit KKK). 171. On 11 July 1994, the deceased had "Backache after [a] long drive. [During clinical examination he complained that he was] Very tender [over his right] lower lumbar spine … [He was prescribed] Panadeine Forte" (exhibit BB). 172. On 25 July 1994, there was an "Itchy rash all over [the deceased's] body. He was diagnosed with an] Allergic [reaction and was prescribed] Teldane" (exhibit BB). 173. On 18 and 19 August 1994, the deceased was absent from work. The respondent granted his two days' accumulated recreation leave (exhibit KKK). 174. On 30 August 1994, the "Rash on [the deceased's] body [recurred. He was diagnosed with] Scabies - [and was prescribed] Ascabiol". The deceased gave a history that his "Back has Improved" (exhibit BB). 175. On 14 September 1994, the "Rash [was] all over [the deceased's] body [again] - [and was] Itchy. [He was administered an] Inj[ection of] Kennacort". On 15 September 1994, the "Rash [was] looking better. [The deceased was administered an] Inj[ection of] Kennacort … [and was advised to] Rest for one week" (exhibit BB). 176. Between 17 September 1994 and 1 October 1994, the deceased was absent from work. The respondent granted his leave. The deceased presented the respondent with a "M[edical]/C[ertificate opining his] Dermatitis" (exhibit KKK). 177. On 17 September 1994, the deceased's "Rash [was] getting better [but he still had] Dermatitis [on] both [his] hand[s. He was administered an] Inj[ection of] Kennacort [and was advised to] Rest for one week". On 19 September 1994, he had "Very dry Skin [and complained of the] Itch - [but his] rash [was] getting better" (exhibit BB). 178. On 20 September 1994, the deceased had "Backache [with] slight pain in [his] leg on bending. [During clinical examination, he complained that he was] Tender [over his] lower lumbar injury [caused by the fall. He was prescribed] Panadeine Forte" (exhibit BB). 179. On 23 September 1994, the deceased's "Rash [was] Still itchy [and he had] Dermatitis [on his] hands - [He was administered an] Inj[ection of] Kennacort". On 24 September 1994, the "Rash [was] improving - [The deceased was administered an] Inj[ection of] Kennacort [and was] cert[ified unfit from] 25.9.94 - 1.10.94". On 25 or 26 September 1994, the "Rash [had] improved [but the dermatitis on his] Hands [was] still not better" (exhibit BB). 180. On 2 October 1994, the deceased resumed work. On 4 October 1994, he was "Itchy on [his] abdomen. [His abdominal rash was infected with] Can[dida] Streptococcus". The deceased thought the rash on his "Back has improved". Dr Sekhon examined the "Rash [on the deceased's] back [and decided to] Watch and see" (exhibit BB). 181. On 7 November 1994, the "Rash [was] all over [the deceased's] body again. [He realised that the rash was present] only when [he was] working. [His skin was] Itchy [and] Dry. [He was administered an] Inj[ection of] Decadron" (exhibit BB). 182. Between 9 and 15 November 1994 the deceased was absent from work. The respondent granted his accumulated "Sick [leave]" although the "M[edical]/C[ertificate]" he presented was "(unreadable)" (exhibit KKK). 183. On 9 November 1994, the deceased's "Skin rash [was] not improving". Dr Sekhon concluded that the deceased "will need [a] biopsy [and] cert[ified the deceased] unfit for one week - [because the] Rash [was] very itchy" (exhibit BB). 184. On 10 November 1994, "Xylocaine [was] infiltrated [by Dr Sekhon into the deceased's abdomen] - [a] Skin biopsy [was] done [by Dr Sekhon. He used] one stitch [of] nylon [to suture the wound. He prescribed the deceased] Ducene. [Dr Sekhon dispatched the excised tissue to] pathology" (exhibit BB). 185. On "[15].11.94 [the deceased's] Rash [was] getting less and less itchy … He was certified] Fit for [normal] work on 16.11.94" (exhibit BB). 186. About 18 November 1994, the "Biopsy report [on the deceased's abdominal lesion diagnosed an] Allergic [reaction. Dr Sekhon prescribed the deceased] Betnovate [and] advised [the deceased] to change his job as a painter thinking [that the deceased suffered from] contact dermatitis" (exhibit BB). 187. On 6 December 1994, Dr Sekhon diagnosed a "Skin cancer [on the deceased's back. The deceased complained that carcinoma was] very itchy. [Dr Sekhon concluded that the carcinoma] "Will need excision" (exhibit BB). 188. Between 27 and 30 December 1994, the deceased was absent from work. The respondent granted his accumulated recreation leave (exhibit KKK). 189. About 17 January 1995, the deceased "Pulled the roller door [causing] Backache again [and] tingling in [his] leg. [During clinical examination he complained that he was] Tender [over his] lower lumbar spine. He was prescribed] Panadeine Forte. [He also was] Jittery [and complained:] Can't sleep" (exhibit BB). 190. Between 28 February and 6 March 1995, the deceased was absent from work. The respondent granted his accumulated recreation leave (exhibit KKK). 191. On 28 February 1995, the deceased was "Feeling dizzy. His] Heart [was re-examined] - N[o] A[bnormality was] D[etected by Dr Sekhon to account for the deceased's dizziness, blood pressure or pulse rate. Dr Sekhon prescribed] Cerumol [for an accumulation of] Dry Wax [in] both [the deceased's] ears" (exhibit BB). 192. On 9 March 1995, the deceased was absent from work. He presented the respondent with a "Medical Condition M[edical]/C[ertificate opining his incapacity]". The respondent granted his accumulated sick leave (exhibit KKK). 193. On 9 March 1995, the deceased gave a history that he had "Had [an] angina attack [the preceding] Saturday [and that] Anginine [had] relieved [his chest] pain. His] Heart [was re-examined] - N[o] A[bnormality was] D[etected by Dr Sekhon to account for the deceased's chest pain, blood pressure or pulse rate. Dr Sekhon] Advised [the deceased to have an] E[lectro] C[ardio]G[ram and a] blood test" (exhibit BB). 194. On 4 April 1995, the deceased was absent from work. The respondent granted his accumulated recreation leave (exhibit KKK). 195. On 16 May 1995, the deceased had "Backache - [and] pain radiating to [his] right leg. [During clinical examination he was] Tender over [his] lumbar lower region - [There were] no neurological signs [in either of his legs] - [Dr Sekhon arranged a] C[omputerised] T[omographic] Scan [of the deceased's lumbar spine, and prescribed] Codalgyn Forte" (exhibit BB). 196. On 20 May 1995, the deceased was "Still having pain. He was prescribed] Codalgyn Forte". On 23 May 1995, he complained: "[The] Pain is getting worse". He was prescribed] Codalgyn Forte" (exhibit BB). 197. On 25 May 1995, Dr Sekhon examined "[a lesion] on [the deceased's] tongue". The deceased complained: "Back is hurting too much" (exhibit BB). 198. On 27 May 1995 the deceased complained to Dr Sekhon of "Backache - [and] still [had] too much pain [and] Cannot sleep". Dr Sekhon administered an "Inj[ection of] Pethidine [and prescribed] Codalgyn Forte" (exhibit BB). 199. After working on 27 "May 1995 … a Saturday [the deceased] felt very ill … [He] went to Camden Hospital, where [he] complained of a sore throat and could not swallow, a blood test was taken … [He] was immediately transported by Ambulance to Liverpool Hospital" where he was diagnosed with AML (exhibit KK). On 29 May 1995, Dr Harvey arranged a blood test and a bone marrow biopsy which identified the leukaemic cells characteristic of AML. Dr Harvey diagnosed or confirmed the deceased's diagnosis of AML (exhibit DD). 200. On 30 May 1995, the deceased ceased his duties as a Vocational Instructor (Spray Painter). Thereafter, AML and its sequelae and treatment incapacitated him. The respondent granted his accumulated sick leave, recreation leave and unpaid compassionate leave (exhibit KKK). Between November 1995, when the deceased's entitlement to accumulated sick leave expired, and April 1996, the respondent, Dr Helen Gapper and HealthQuest evaluated the deceased's capacity for his former duties in the workshop (exhibits NN and QQ). The deceased gave Dr Helen Gapper a history (exhibit NN) similar to the history he initially conveyed to Dr Harvey (exhibit DD) and similar to the history in exhibit KK. 201. Between November 1995 and June 1996, as a result of the deceased's AML and its sequelae including hospitalisation and chemotherapy, he had negligible use of his right hand. Periodically he was totally incapacitated by AML. At other times, he was unfit for tasks requiring the use of his left hand. In periods of clinical remission from AML, he was capable of office work with his dominant hand and arm (exhibits BB and NN). 202. On 19 January 1996, Dr Jagger discussed the implications of the deceased's AML with Riddell, then Manager of Administration at Reiby (exhibit NN). About 25 January 1996, the deceased resumed work for the respondent avoiding "any kind of contact with chemicals or work in the spray booth" (exhibits OO and QQ). 203. On 8 February 1996, Dr Harvey examined an unusual papular rash on the deceased's abdomen. The deceased gave a history of a similar rash, two years earlier. Dr Harvey provisionally diagnosed a leukaemic infiltrate (exhibits DD and PP). 204. On 21 February 1996, the deceased complained of a "Swelling [on the] left side of [his] neck. [Dr Sekhon diagnosed the swelling as a] Cyst. [The deceased also complained that the] Rash on [his] abdomen [was] itchy. [Dr Sekhon examined the deceased's] Throat - N[o] A[bnormality was] D[etected by Dr Sekhon therein]" (exhibit BB). 205. On 26 February 1996, Dr Harvey referred the deceased to a specialist dermatologist, Professor Kate Georgouras, requesting her opinion whether a biopsy was advisable with a view to ascertaining whether the rash on the deceased's trunk and/or a nodular lesion on the deceased's left supraclavicular fossa was a leukaemic skin infiltration. Professor Georgouras arranged the biopsy. On 11 March 1996, the nodular lesions on the deceased's abdomen and left shoulder, the absence of similar lesions from his back and limbs, and the results of the biopsy diagnosing "a leukemic infiltrate … a relatively uncommon manifestation" alerted Dr Harvey to "the very real possibility of [the deceased's acute myeloid] leukaemic relapse" (exhibit DD). 206. About March 1996, the deceased associated his malaise with spraypainting. On 26 March 1996, he delivered exhibit PP to the respondent claiming "workers compensation, regarding the improper construction of the spray booth at Reiby … [The deceased alleged:] The spray booth … is not suitable for two-pack spraying [and does not comply with legal requirements] … due to the dangerous products used at the [workshop] … the [spray] booth does not have the required ducting, water trap or water bath floor … [nor] a special water trap for rubbing down the two-pack undercoat ... The ingredients in the two-pack paints will cause many health problems, including some forms of cancer ... In addition … because [the spray booth] does not have the required ducting, to remove the solvents and fumes into the water trap filters, the solvents are going into the air above Reiby … this could affect the health of workers and detainees …" 207. Upon receipt of exhibit PP, Gould wrote: "This submission was given to me 26/3/96 after [the deceased] had met with [the] H[ealth and] R[esearch] E[mployees'] A[ssociation] to discuss & lodged [sic] his W/C claim. This is the first time [the deceased] has raised the notion that 2 pack was not suitable. It is my under-standing that 2 pack was introduc[ed] at [the deceased's] request. He completed a 2 day course on the product" (exhibit PP). 208. On 12 April 1996, Atkins inspected the spray booth. At Atkins' request, the respondent immediately adjusted "insulation material [which] had slipped down on the exhaust duct where the duct extends through the roof of the [spray booth]" (exhibit DDD). 209. On 18 April 1996, the deceased dispatched exhibit KK to the "Workers Compensation Officer of the Health and Research Union N.S.W. [sic]" making complaints about the spray booth similar to his complaints in exhibit PP. On 7 May 1996, the deceased claimed workers' compensation benefits from the respondent alleging that he was exposed to harmful chemicals over extended periods between 1993 and 1995 and thereby developed AML (exhibit OO). 210. On 7 May 1996, Atkins opined: "The general condition of the [spray] booth [on 12 April 1996] was exceptionally good and [was] considered [by the Authority] to be as good as when it was originally inspected [on 14 October 1993] ... " Atkins concluded that, with the minor adjustment to "insulation material" which had been made by the respondent during his inspection on 12 April 1996, the "Spray Booth in its [then] condition complie[d] with" the relevant legislation (exhibit DDD). 211. On 12 June 1996, the deceased died. Dr Sekhon signed a Medical Certificate of Cause of Death. The Certificate opines that the deceased's death resulted directly from recurrent AML of approximately one year's duration, and that the antecedent cause of the deceased's death was a leukaemic skin infiltration (exhibit BB). 212. It seems to me that overall, the evidence merely raises a suspicion that the deceased's occupational exposure to aromatic hydrocarbons including a proportion of Benzene may have been implicated in the development of his AML. Of course, the applicant bears the onus of proving each of the elements of her case. 213. I infer that additional evidence from Gould, Riddell, Atkins or any other person who investigated at the respondent's behest its premises, the deceased's employment, the deceased's claim for workers' compensation, or this application, would not have advanced the respondent's case. However, the respondent's knowledge of the deceased's day to day activities in the workshop and the spray booth does not seem comprehensive. The deceased's sudden death prevented the insurer's interviewing him, inhibited the insurer's investigation of his claim for workers' compensation, and reasonably explains the inaccuracies in exhibit OO. 214. It is reasonable to infer from the evidence, and I do infer, that at relevant times the deceased was the only qualified spraypainter employed by the respondent at Reiby. His pivotal role and consuming interest in the respondent's spraypainting programme (exhibits KK, OO, PP and RR) the location of the spray booth and the workshop, outside the fence, and Gould's comment on exhibit PP, reasonably explain the respondent's inability to answer the applicant's Interrogatories comprehensively (exhibits A and HH). 215. For significant periods between July 1990 and March 1995, the deceased was incapacitated by the fall, by employment injuries to his back, leg and foot, by a pre-existing lumbar spinal lesion and/or by emotional distress, unrelated to this application. At other times, the psychotropic medication and strong analgesia the deceased was prescribed repeatedly and the derivatives of morphine he was administered intravenously for reasons unrelated to this application, probably diminished his capacity for spraypainting and his ability to supervise male juvenile offenders outside the fence. 216. Between 1987 and April 1994, the deceased's transient nausea, myalgia, gastric disturbance, upper respiratory tract infections and febrile episodes responded favourably to antibiotic and analgesic medication. It is unlikely that any of those indispositions was caused or aggravated relevantly by the deceased's use of or exposure to aromatic hydrocarbons or any other potentially toxic substance in the course of his employment with the respondent. 217. In November and December 1992, the deceased's dizziness probably was symptomatic of his ear infection. Between May 1992 and April 1993, his episodic dizziness, breathlessness and/or chest pain probably were symptomatic of the breakdown of his marriage and/or of his grave concern for Matthew Rawson. 218. I am not persuaded that the inflamed wen on the deceased's ear, any of the hyperkeratoses, warts or squaemous cell carcinoma excised from his hands, or the septicaemic cyst excised from his neck, were caused or aggravated relevantly by his employment with the respondent. The infections were transient and responded favourably to parasiticidal, bactericidal, anti-inflammatory, antibiotic and/or surgical treatment. 219. I am not persuaded that between 1992 and June 1994, the deceased's using the "Two pack" system, the workshop or the spray booth had any relevant effect upon his skin or health. The deceased's "Allergic [reaction]" in July 1994, the recurrent dermatitis on his hands, and the resurgence of those conditions when he resumed his duties in the workshop, are consistent with the warnings against undue contact with the skin and/or eyes in the safety data sheets including exhibits B, C, D, E, F, G, H, J, K, L, M, N, O, P, R, S, T, V and W. The deceased's contact dermatitis responded favourably to a topical antihistamine, to intravenous antibacterial and/or anti-inflammatory agents and to his ceasing spraypainting. 220. Prior to July 1990, the deceased's eyesight was "disturbed": the remainder of the evidence does not persuade me that his defective vision, the solar damage to his eyes, his bilateral conjunctivitis or his pterygia were caused or aggravated relevantly by his use of or exposure to aromatic hydrocarbons or any other potentially toxic substance in the course of his employment with the respondent. His infections responded favourably to antibiotic and antimicrobial medication. Perhaps the "F[oreign] B[ody]" entered the deceased's right eye in the course of his employment but its effect was transient and is immaterial to this application. 221. The evidence does not persuade me that at any time between 2 July 1990 and May 1995, the deceased used or was exposed to leukogenic concentrations of aromatic hydrocarbon compounds nor any other leukogenic substance in the course of his employment with the respondent. If, contrary to my view of the evidence, I ought to be persuaded that the deceased's AML resulted from his exposure to Benzene, I would be inclined to implicate his spraypainting between 1958 and June 1990, but I would not speculate when any such exposure occurred. 222. On four or more occasions including 3 October 1988, 2 October 1990, 31 January 1992, and 18 March 1992, a pathologist screened the deceased's blood and reported its relevant normality. As I understand the expert evidence, it is improbable that in 1987, the deceased's purulent periodontic exudate was symptomatic of myeloid leukaemia. It is unlikely that in March 1992, there were leukogenic cells in the deceased's blood, characteristic of AML, and it is highly unlikely that in October 1988, or January 1992, there were such leukogenic cells in his blood. 223. I do not speculate whether the infected cyst, excised from behind the deceased's ear in April 1994, was a leukaemic skin infiltration: the lesion was evident ten months earlier. I do not speculate whether the deceased's influenza in April 1994 was symptomatic of undiagnosed AML. The itchy lesion on the deceased's abdomen, infected with Candida Streptococcus and the carcinoma on his back were observed by Dr Sekhon within months of Dr Harvey's diagnosing the deceased's AML, but I do not speculate where either lesion was a leukaemic skin infiltration. The deceased's general malaise and dizziness in February 1995 are suggestive of his then undiagnosed AML, but the evidence is silent whether there were leukogenic cells in his blood, characteristic of AML. The deceased's "angina attack" in March 1995, and his incapacitating malaise in May 1995 are consistent with objective clinical signs of his florid AML, diagnosed by Dr Harvey. 224. The proportion of Benzene in the substances used by the deceased and to which he was exposed in the workshop, in the spray booth and in the course of his employment with the respondent probably was considerably lower than the percentage of Benzene in the spraypaints, pigments, solvents and/or chemical compounds he had used and to which he had been exposed over the preceding thirty four years. 225. The evidence does not persuade me that the deceased's AML or death was caused by or resulted from his employment with the respondent. 226. For those reasons, there will be an Award for the respondent. Mr J Gracie instructed by McClellands appeared for the applicant. Mr P Sweeney instructed by P W Turk & Associates appeared for the respondent. DISCLAIMER - Every effort has been made to comply with suppression orders or statutory provisions prohibiting publication that may apply to this judgment or decision. The onus remains on any person using material in the judgment or decision to ensure that the intended use of that material does not breach any such order or provision. Further enquiries may be directed to the Registry of the Court or Tribunal in which it was generated.