Prosser v Eagle [2002] NSWSC 256

New South Wales Supreme Court

CITATION : Prosser v Eagle [2002] NSWSC 256 CURRENT JURISDICTION: Common Law Division FILE NUMBER(S) : SC 20460/94 HEARING DATE(S) : 15/10/01 - 15/11/01 JUDGMENT DATE : 2 April 2002

Sarah Kimball Prosser (Plaintiff) PARTIES : Sandra Eagle (First Defendant) The North Coast Area Health Service (Second Defendant) JUDGMENT OF : Dunford J

COUNSEL : R Ingram (Plaintiff) D Higgs SC (Defendants) SOLICITORS : McClellands (Plaintiff) Blake Dawson Waldron (Defendants) CATCHWORDS : NEGLIGENCE - medical practitioner - failure to diagnose condition Commercial Union Assurance Co v Ferrcom Pty Ltd (1991) 22 NSWLR 389 Rogers v Whittaker (1992) 175 CLR 479 CASES CITED : Ainsworth v Levi (unreported - Court of Appeal - 30 August 1995) Lowns v Woods [1996] A Torts R para 81-376 Shead v Hooley [2000] NSWCA 362 Rosenberg v Percival [2001] HCA 18, 75 ALJR 734 DECISION : See para 177.

IN THE SUPREME COURT OF NEW SOUTH WALES COMMON LAW DIVISION DUNFORD J 2 APRIL 2002 20460/94 Sarah Kimball PROSSER v Sandra EAGLE & Anor JUDGMENT 1 His Honour: In these proceedings the plaintiff, Sarah Kimball Prosser, claims damages for professional negligence allegedly visited on her following the birth of her second child. The first defendant, Dr Sandra Eagle, is the medical practitioner who treated the plaintiff at the Coffs Harbour District Hospital, a public hospital conducted by the second defendant, the North Coast Area Health Service. The negligence alleged is the failure to diagnose and appropriately treat a disruption of her pubic symphysis which she claims she suffered at the time of, and as a result of, the birth. INTRODUCTION 2 The litigation has had a sorry history. Although the events complained of occurred in September-October 1988, the proceedings were not commenced until 1994. In the proceedings as originally constituted, the plaintiff alleged negligence on the part of the first defendant in failing to accede to her request to facilitate the birth by way of a caesarean section, thereby causing the disruption, and secondly in the failure after the birth to diagnose and appropriately treat the condition. 3 The first trial took place from 3-12 February 1997 before Bruce J, when judgment was reserved. Judgment was ultimately delivered on 17 July 1998 and damages assessed on 12 August 1998. 4 His Honour found both allegations of negligence established but only gave reasons in respect of the first allegation, saying merely that: "The alternative basis put for liability is also made out in my view but there is no significant damages which flow from the breach." His Honour went on: "So far as the claim against the hospital is concerned I accept that the physiotherapist employed by the hospital Mrs Muir became aware of the problem but apparently did not communicate the information to any treating doctor or record it in the hospital records. In my view such conduct constitutes an actionable breach of duty but the damages are minimal." 5 The defendants appealed and on 4 June 1999 the Court of Appeal upheld the appeal, holding that the first head of liability was not established, but because of the trial judge's failure to give reasons ordered a new trial limited to the issues (i) whether there were breaches of duty by either defendant in the care and treatment of the plaintiff in the period from the birth on 11 September 1988 to the date of the post natal check-up on 20 October 1988 and (ii) if so, the amount of any damage suffered. An application by the plaintiff for special leave to appeal was refused by the High Court on 30 November 1999. 6 On 30 August 2001, Bell J by consent ordered that the issue of breach of duty be tried separately and prior to the issues of causation and damages, the plaintiff having undertaken that in the event of her being successful in establishing breach of duty she would agree to mediation in an attempt to resolve the further issues. The allegations of negligence now relied upon are subscribed to paragraph 6 of the Further Amended Statement of Claim filed in Court during the hearing on 2 November 2001. 7 One of the obvious consequences of these delays is that the memories of the parties and witnesses are strained and faded. This is a particular problem for the plaintiff who has only her memory to rely on, whereas the defendants and their witnesses from amongst the hospital staff are able to rely on the clinical notes and other records made by them at the time, both for what such records say and for such further recall of memory as is prompted by such notes. In addition they are able to rely on, and give evidence of, their usual practice in particular circumstances and situations, a course not available to the plaintiff. 8 For these reasons I consider there has been a degree of unconscious re-construction on both sides, but because of the lack of any contemporaneous records, the lengthy period she has had to think of it, the number of doctors she has seen, and amount of surgery undergone, such unconscious reconstruction has probably been more extensive on the part of the plaintiff. Both the plaintiff and the first defendant at times made concessions or volunteered information apparently contrary to their respective interests, and I do not consider that either of them deliberately attempted to mislead the Court. FACTS 9 The plaintiff was born in California on 22 November 1954. She migrated to Australia in 1982, was married on 30 August 1986 and gave birth to her first child, a son, on 25 December 1985. Such birth took place at the Coffs Harbour District Hospital ("the Hospital") and the plaintiff was under the care of the first defendant. The plaintiff has also had bowel problems since childhood as referred to in the reports of Dr Child of 13 November 2000 (Ex. 10) at p 2 and Dr Korda of 4 October 2000 (Ex. 11) also at p 2. 10 During 1998 she again became pregnant and again consulted the first defendant, the child being due on or about 27 August that year. During her pregnancy she put on up to about 20 kilos in weight and became concerned about the size of the baby, although Dr Eagle said that she expected the baby to weigh a little over 8 pounds, very similar to her first son. 11 Towards the end of her pregnancy she had pain in her lower back with a sciatic type referred pain down the legs, usually only the left, but at no stage prior to the birth did she have any pain in the front of the pelvic area and in particular no pain in the area of the pubic symphysis or in the sacro-iliac joints at the rear of the pelvis. 12 The child was not born on 27 August but the contractions started on the morning of 11 September 1988, and the plaintiff was taken to the Hospital at about 4am. She claims she was not allowed to push for about an hour and then Dr Eagle said she was going to use her hand to hold up the rim of the cervix. She was then told to push, she bore down with the next contraction and she said she felt the baby's head come down very hard, she felt popping, snapping and a great deal of pain in the pelvic area. Dr Eagle told her that the baby's shoulder was stuck, that she was going to free up the shoulder with her hand by rotating it around, which she did, and as the plaintiff had another large contraction, the baby was delivered with the doctor's hand. 13 The child, subsequently named Jordan, weighed 4.51kg (9lb 15oz) and was healthy. The plaintiff said she was left in the labour ward for about an hour and when told to go back to the ward she was unable to walk because of excruciating pain and needed a wheelchair. She described the pain as being in the whole pelvic area. Subsequently she was given some tablets and then an injection at around 9am. 14 That evening, 11 September, she continued to have intense pain and she could not roll over in bed or pick up anything of any weight. She said she could feel the bones at the front of her pelvis grinding if she tried to roll over in bed. 15 She saw Dr Eagle next on the following day, 12 September, she said she had extreme pain in the pelvic area and could not lie flat in bed and had to lie with most of her weight on her right buttock area. When she tried to roll over or shift her weight in bed she could feel the bones at the front of her pelvis grind together, and the pain was particularly sharp on the left side of her hip at the back, all of which she told Dr Eagle (T 177) who told her she could expect to be sore for a while, as she had had a big baby. 16 She recalled that one day, either 12 or 13 September, Dr Eagle lifted and rotated her left leg whilst she was lying in bed. She told Dr Eagle that it hurt a lot and she also recalled Dr Eagle pushing on the front of her pelvic area and asking if that hurt to which she said "yes" and she told her again about the bones grinding at the front when she moved (T 178). She also said that getting out of bed was extremely slow and painful and that it was extremely painful when she attempted to walk to the bathroom. 17 When she walked to the bathroom she noticed that her legs were some distance apart and the pain was so intense that she walked with a kind of waddle, while she could feel the bones at the front of the pelvis rocking up and down and back and forth (T 178). 18 She also recalled the physiotherapist who helped her get out of bed and supported her while she walked down the hall. She said she told her about the pain she was experiencing in the pelvis and the "rocking" of the bones at the front as she walked and shifted her weight, and that the physiotherapist said that it was not uncommon for the ligaments in the pelvis to stretch during birth, but what the plaintiff was describing made her think that the front had separated. The physiotherapist then brought her a hot water bottle to relieve the pain but the pain in the front of the pelvis was so intense that she ended up tucking it under her left buttock where she received relief to that part of the body. She only recalled seeing the physiotherapist on one occasion. 19 She denied Dr Eagle asking her whether she wished to be referred to an obstetrician or gynaecologist for treatment of the pelvic pain, and she denied that she asked to be referred to an orthopaedic specialist. On the Friday she had a high temperature, and although Dr Eagle asked her to stay whilst the temperature was checked out, she insisted on going home on that day. Meanwhile Dr Eagle had assured her that everything would be alright, that she could expect to be sore for some time because she had had a big baby and that it would take time to settle, but she would be alright eventually. 20 After going home she was in great pain on the Friday evening, and the following day felt extremely unwell so she returned to see Dr Eagle at her rooms. She said she found it very difficult to get up the stairs to Dr Eagle's consulting room and needed her husband's assistance to do so (T 185), she told the doctor she was feeling very sick, that she was unable to sit comfortably to feed her baby, that the bones were still rocking back and forth when she walked, that she had a lot of trouble getting up the stairs and that she was in a great deal of pain (T 186). 21 Dr Eagle did an internal examination and told her that she had a haematoma about the size of a grapefruit between the vagina and the rectum, and that the fever that she was suffering was due to this haematoma abscessing. 22 She claimed that Dr Eagle prescribed antibiotics for her on that day but later telephoned her to say that she was able to arrange for Dr Ghosh, a specialist obstetrician, to include the plaintiff in his surgery list at the private hospital in Coffs Harbour, Baringa Private Hospital ("Baringa") on the Monday morning for the purpose of having the haematoma surgically drained. 23 She said she entered Baringa on the Sunday evening (18 September) and she asked Dr Eagle, as she was going back to hospital, if it would be possible to have x-rays of the front and back of the pelvis done, but Dr Eagle told her that once the haematoma was drained she would be feeling more comfortable. The haematoma was drained the following day and following surgery the pressure from the haematoma was relieved but the "other pain" had not changed (T 190). She went home and "basically got on with my life the best I could". 24 She had a post natal (six week) check-up with Dr Eagle on 20 October at which time she was continuing to have bone pain, the rocking feeling when she walked, discomfort when she sat, pain on the left side and difficulty coping with the baby. Once again she had difficulty with the stairs at Dr Eagle's rooms. 25 She told Dr Eagle she was still having the pain, could not get up the stairs very easily, was still walking with the waddle and could still feel the bones rock when she walked, that trying to roll over in bed created a lot of pain at the front of the pelvis where she could feel the bones grind together and also at the back on the left side, along with sciatic pain down her left leg. She said Dr Eagle told her that it was ligament pain because she had had a big baby, parts of her body had stretched, and that it could be six months before she felt really well again (T 191-2). She agreed in cross-examination (T 264) that by the time of this consultation some of the pain in the pelvic area had improved and also her ability to walk, but she said she was still walking with a waddle with her legs apart (T 265). 26 Also in cross-examination she agreed that when giving evidence at the earlier trial before Bruce J she was unable to remember Dr Eagle palpating her pelvic bones whilst in Hospital, but she said she can remember it now; and her explanation for this was that she had tried to put it out of her mind over the years (T 198, also T 244-5). She seemed to say (T 199 – 203) that before she had the haematoma drained she had pain all over the pelvic area but after the drainage by Dr Ghosh the pain became more specific, although even before the haematoma was drained she had pain at the front of the pelvis. She also had other problems in the pelvic area, including a full colon. Some of her answers were difficult to reconcile particularly in detailed cross-examination (at T 215 to 222) concerning the clinical examination done by Dr Eagle. 27 As to her stay in Baringa, she said that the pelvic pain and looseness of the bones continued and, although she believed she reported these matters to the nursing staff she was very vague about such complaints, and she did not recall reporting them to Dr Ghosh. Also she could not recall Dr Ghosh examining her in the supra pubic area, or at all (T 238-9), although the Baringa notes and Dr Ghosh's evidence indicate that he did. 28 In November-December 1988 she again saw Dr Eagle, this time for continuing chronic constipation, and was referred to a surgeon, Dr De Bisscop, who operated on her bowels at Baringa. Although she claims she still had the pelvic pain, the grinding, the rocking and the waddle and said she mentioned these matters to the nurses, she did not have a specific recollection of telling anyone at the hospital that she was still having trouble walking because of the looseness of her pelvic bones (T 260). She does not recall telling either Dr Eagle or Dr De Bisscop of her pelvic problems at that time (T 258-9). 29 About six months after the birth, having moved to Canberra, she continued to suffer pelvic pain, particularly in the area of the pubic symphysis. She consulted Dr Close who carried out a number of tests, including having her stand on one leg at a time and also caused her to have her pelvis x-rayed. In the light of the clinical examination and the x-rays, Dr Close considered that the plaintiff probably had a disruption of the pubic symphysis and referred her to an orthopaedic surgeon, Dr Gillespie, who confirmed the diagnosis; and he called in a senior orthopaedic specialist, Dr Coyle; and ultimately Dr Coyle carried out surgery on the pubic symphysis on 7 September 1989 with Dr Gillespie assisting. Unfortunately the operation was not a success and despite a number of subsequent operations the plaintiff is still considerably disabled. 30 Although the plaintiff claims that she made constant complaints to Dr Eagle and to the nursing staff at the Hospital, and although the Hospital notes, including those made by Dr Eagle, record continuing pelvic pain, there is no record whatsoever of any complaints of a grinding sensation when rolling over in bed or transferring her weight from one side to the other, nor is there any record of any complaint of the bones rocking up and down or her feeling movement or looseness when she was walking. One can understand how in a busy hospital nursing staff and the doctors may omit from time to time to record details of a specific complaint of pain, but I consider it unlikely that if the complaints were made as specifically and as frequently as the plaintiff claims they were, that there would be no reference to such specific complaints in the Hospital records. Similar considerations apply to the records of Baringa and Dr Ghosh. Once again there is reference to pelvic pain but no reference to specific pain over the area of the pubic symphysis and no record of complaints of grinding, rocking, moving, looseness etc on walking. 31 Moreover, the plaintiff's husband gave evidence and said he visited his wife daily whilst she was in Hospital and can recall her complaining of a grinding sensation when she rolled over in bed, but he gave no evidence of his wife ever complaining to him of looseness or movement on walking; and on one occasion when he was visiting his wife, Dr Eagle was doing her rounds and he did not give any evidence of his wife complaining, at least on that occasion, to Dr Eagle about grinding, looseness, movement etc. He gave no evidence of assisting his wife up the stairs to Dr Eagle's surgery on Saturday 17 September, or of any difficulties she had walking or complaints of looseness or grinding of her pelvic bones at any time after her discharge from Coffs Harbour District Hospital on 17 September. I appreciate that he was only called on the limited issue of whether she complained to him of a grinding sensation, but his lack of evidence on these other matters does not assist the plaintiff: Commercial Union Assurance Co v Ferrcom Pty Ltd (1991) 22 NSWLR 389 at 418-9. 32 Dr Eagle, the first defendant was, and is, a general practitioner with an interest in obstetrics and holds a Diploma in Obstetrics and Gynaecology. She had only a vague recollection of the plaintiff's confinement and hospitalisation without reference to the hospital notes and a large part of her evidence was based on her usual practice. She did recall seeing the plaintiff during the course of her second pregnancy and described it as a normal pregnancy except for the occasion on 24 June 1988 when the plaintiff visited her urgently with a panic attack and she recalled another episode when the plaintiff complained of upper abdominal pain, which is not unusual in pregnancies and which resolved. Then on 18 August 1988 she noted that the plaintiff had mild sciatica, which apparently resolved as there was no further record of it. She was present at the birth which she described as a normal vaginal delivery with a second degree perineal tear which required stitches, that is a skin tear from the lower edge of the vagina extending approximately midway towards the anus. The baby weighed 9lb 15oz at birth. Dr Eagle was not aware of any popping, snapping or tearing other than the perineal tear at the time of birth. 33 Later on the day of the birth, the plaintiff complained (as recorded in the Hospital notes) of coccygeal pain and backache. She was given Aspalgin, a mild analgesic which did not relieve the pain and so Dr Eagle was asked to see her. She complained to Dr Eagle of severe pelvic discomfort, the doctor examined her and found that she was tender particularly in the perineum and towards the coccyx, and over the sacro-tuberous ligament, more tender on the right. She concluded that she was suffering from ligamentous pain and arranged for Dr May, a fellow medial practitioner, to authorise the administration of Pethidine and Stemetil which are analgesics. These apparently had some effect in relieving the pain. 34 By 10pm that evening the plaintiff had been up to toilet and shower and at 6am the following day the nursing notes record that she had again been up to the toilet, but Aspalgin had again been given for coccyx pain. 35 Over the next couple of days the plaintiff developed a large bruise in her perineum and complained of generalised pain corresponding to and just beyond the area of the bruising. 36 Dr Eagle said that when she saw the plaintiff on the morning of 12 September, she noted that the perineum suture was intact and the suture line was clean, dry and hygienic, and in answer to her questions the plaintiff told her that she felt a little better and so she noted that the pelvic pain was settling. By reference to her usual practice she believed that she would have palpated the lower abdomen (that is the fundus and the uterus) about 1 inch below the umbilicus, but would not have carried out any further physical examination on that occasion. 37 That same day, Sister Fenton, the nurse in charge, recorded in the Hospital notes that the plaintiff was severely bruised in her anal/buttocks area, was unable to sit thereon and was having difficulty in handling the baby because of the discomfort. Sister Seiver that evening noted that she was ambulating slowly, but just to the bathroom and needed help changing the baby. 38 On 13 September she was still painful in the coccygeal area and unable to sit on her buttocks, needing assistance at times. When Dr Eagle saw her she noted that she was bruised in the perineum and buttocks area. On 14 September according to the Hospital notes she complained that she was still sore, and in particular complained of bilateral hip pain radiating to the knee similar to the pain she had had during the pregnancy at 6 months and her buttocks were still bruised, she was having difficulty handling the baby because of discomfort, her perineum was red and painful and according to the Nursing Care Plan she was painful when walking. 39 By this stage the first defendant was concerned about the plaintiff's continuing complaints of pain and tenderness, but felt that the bruising was probably the cause of the problem. She would have liked to have done an internal examination at that stage but considered that it would have caused too much pain for the plaintiff unless done under anaesthetic, and she did not have ready access to an anaesthetist at the time; but she thought there was a real problem (T 894). 40 By 15 September the plaintiff was still complaining of excessive pain and now was referring to pain across the front of the pelvis as well, and Dr Eagle decided to do a detailed clinical examination. Specifically she palpated across the iliac crest including the front of the pubic symphysis from one side of the ilium to the other, using two thumbs so as to be able to exert pressure with one thumb on top of the other, asking the patient to tell her exactly where she was sore and in particular if there was anywhere more sore than elsewhere. She also felt the symphysis, in particular to try and ascertain whether the joint was enlarged or not. She recalled the plaintiff telling her that it was painful everywhere she pressed, but on specific questioning she was not able to isolate an area of more intense pain. As Dr Eagle pressed across and down at the joint of the symphysis pubis she felt no swelling and the joint was narrower than the width of her thumb. Although the plaintiff complained of being tender at the joint she did not say that it was more tender at the joint than elsewhere. 41 Following that, the doctor did what are called "spring tests", that is pressing downwards and outwards on the iliac crest sides of the thighs whilst the plaintiff lay on her back. Once again the plaintiff complained of pain but did not isolate or localise the pain. The doctor then compressed the hips as hard as she could by pressing inwards and once again no specific pain was elicited at the symphysis. She then slid her hand under the plaintiff's lower back and palpated across the back in a line from the sacro-iliac joint to the other side and once again there was no complaint of focal pain (T 765-6). 42 Dr Eagle could not recall doing any further tests but, as already noted, the plaintiff gave evidence that she also abducted the left leg (she was not sure whether it was done to both legs) whilst the plaintiff was lying on her back. After the examination Dr Eagle got the plaintiff to walk along the bed and across to the ensuite bathroom, a distance of approximately 4 to 5 feet. The plaintiff moved slowly, was extremely upset at walking and said it was painful to do so, but the doctor did not observe the sign that she was looking for, namely a waddling movement of the pelvis. The plaintiff walked with her hands along the bed, grabbing for the furniture (T 768-773). 43 The first defendant was concerned that there may have been a disruption or tearing of the symphysis pubis and these tests were carried out in an effort to determine whether that was the appropriate diagnosis; but in the absence of localised or focal pain she formed the view that her pain was not the result of any disruption, but normal tenderness, of the symphysis pubis (T 919, 931-2). 44 Dr Eagle had not done the "spring tests" before and had not had any previous experience of patients suffering a post partum disruption of the pubic symphysis, although she was aware of the condition. It is not uncommon for women to develop looseness in the pubic symphysis prior to giving birth, and she was familiar with the walk associated with that condition and did not observe that instability when the plaintiff walked. 45 She said that although she excluded the disruption of the symphysis pubis as the cause of the plaintiff's pain, she was nevertheless concerned about such continuing pain and the continued difficulty in walking, and for this reason she was anxious to get a second obstetric opinion, but she said the plaintiff asked for an orthopaedic surgeon to be consulted which she, Dr Eagle, did not consider appropriate, as she was unable to elicit any excessive pelvic movement. She made a provisional diagnosis that the plaintiff's problems were mainly muscular and considered that the appropriate treatment was gentle and regular movement, warmth and encouragement; and for this reason she arranged for the plaintiff to be seen by the physiotherapist, Mrs Muir. Her entry in the hospital notes was as follows: "Physio to see O/E No XS pelvic movement - muscular symptoms mainly For gentle regular movement/warmth encouragement Otherwise well" The next entry in the hospital notes is by the physiotherapist; Mrs Muir, later that day as follows: "Seen by physio - Encouraged to ambulate - Hot pack applied to back suggest pelvic rocking with knees together as able" and on 16 September she recorded: "Seen by physio. Encouraged to ambulate. Hot pack to lumbar sacral spine with some relief." 46 Elizabeth Muir is an experienced physiotherapist with considerable experience in obstetric work. She was involved with a patient some years ago when working at Dorrigo District Hospital who had a medically severed symphysis pubis which had made a deep impression on her, and she said that if she ever saw anything like it again it would have alarmed her. She said that if a patient had pain across the front of the pelvic girdle you would look for some laxity, but all post partum women have some laxity in their pelvic ligaments, and if the plaintiff had complained to her of rubbing or grinding she would have suggested that the patient stay in bed and referred her to Dr Eagle, and possibly discussed it with an orthopaedic surgeon. If such complaints were made she would be looking for increased laxity in the symphysis pubis and would try standing the patient on one foot and then the other. She would not encourage her to ambulate. 47 She was referred particularly to her entry in the Hospital notes on 15 September 1988 and she said that note was inconsistent with a complaint by the plaintiff of pain across the pubic bones or any complaint of movement or grinding on walking etc, and similarly her entry on 16 September with reference to encouragement to ambulate and the application of a hot pack to the lumbar sacral spine is inconsistent with there having been a complaint made to her that day about pain across the symphysis pubis. 48 She insisted (at T 1133-4) that if the patient had complained of popping, snapping or movement of the pelvic bones she would have noted it, and she was sure that if the patient said that when she walked the bones at the front of the pelvis moved, she would have remembered it because of what she described as the "quite horrific experience" she had previously had at Dorrigo and would have written it down in the notes (T 1134). She said that if she had found tenderness over the pubic symphysis but thought it was within ordinary physiological limits post partum she would not have been concerned about it and would not have written it in the notes, but if the patient said she was sore all along the front of the pubic bone and had considerable pain she would have noted it (T 1139-40). 49 That afternoon (15 September) Dr Eagle and Mrs Muir had a conversation in the corridor at the Hospital. According to Dr Eagle's evidence in chief (T 809), Mrs Muir asked the doctor what she thought the problem was. Dr Eagle said she was concerned about the pelvic outlet and the ligaments supporting it, and asked the physiotherapist whether she thought there was anything orthopaedic which the doctor had not been able to detect. Mrs Muir replied that she did not think so, that the plaintiff was a little tender across the pubic symphysis, but she felt it was within physiological bounds. 50 In cross-examination, Dr Eagle said (T 938) that she told Mrs Muir that she had identified pain over the pubic outlet ligaments, and asked whether she thought there was any pubic symphysis problem, the doctor having examined her that morning herself. Mrs Muir replied that she did not think that it was a pubic symphysis problem of an unnatural or injurious degree, that the symphysis was a little tender but she felt it was physiological. 51 The first defendant's evidence of this discussion in the first trial (Ex. K) had been as follows: "I spoke with Beth after she had seen her. Beth asked me what I felt was the problem and I said I felt it was probably to do with the ligaments supporting inside the pelvic area and the haematoma related to that and I asked Beth whether she felt there was any orthopaedic problem that I had not been able to detect and she said she did not think so …