Stephen Paul Worley v The Ambulance Service of New South Wales [2004] NSWSC 1269

New South Wales Supreme Court

CITATION : Stephen Paul Worley v The Ambulance Service of New South Wales [2004] NSWSC 1269 HEARING DATE(S) : 22 March 2004 - 15 April 2004, 9 August 2004 - 18 August 2004, 1 February 2005, 4 February 2005 JUDGMENT DATE : 1 February 2005

JUDGMENT OF : Barr J at 1 DECISION : Verdict and judgment for the plaintiff in the sum of $2,628,032.57. For orders see paras. 263-265.

CATCHWORDS : Negligence - whether plaintiff's injury and disability caused by treatment given by defendant - whether defendant treated plaintiff in breach of required standard of care - whether plaintiff guilty of contributory negligence - whether defendant entitled to statutory defence. PARTIES : Stephen Paul Worley, The Ambulance Service of New South Wales FILE NUMBER(S) : SC 20456/01 COUNSEL : P S Jones and I S McLachlan P E Blacket SC and M J Windsor SOLICITORS : Forners Frances Allpress

- 1 - IN THE SUPREME COURT OF NEW SOUTH WALES COMMON LAW DIVISION

GRAHAM BARR J

4 FEBRUARY 2005 (Reasons for judgment revised 9 February 2005)

20456/01 STEPHEN PAUL WORLEY v THE AMBULANCE SERVICE OF NEW SOUTH WALES

JUDGMENT 1 HIS HONOUR: The plaintiff, Stephen Paul Worley, sues the defendant, the Ambulance Service of New South Wales ("the Ambulance Service"), for damages to compensate him for injury, loss and damage which he suffered upon and consequent upon the occurrence of a cerebral haemorrhage on 7 October 1998. It is Mr Worley's case that the haemorrhage resulted from inappropriate treatment administered to him by officers of the Ambulance Service. The facts 2 Mr Worley was a forty-eight year old postman. He had been in that work since 1991. Earlier on he had worked in various occupations. He was by all accounts a hard worker, a man who always provided for his family. During the course of his job he used to ride a motor cycle along the footpaths of the suburbs, collecting mail and delivering it to letter boxes. He carried the mail in pannier bags on the back of his motor cycle. He ran the risk, as an open-air worker, of insect bites and stings. These were a problem because the letter boxes into which Mr Worley had to put the mail were often close to flowering shrubs which attracted insects. 3 Mr Worley had been stung on occasions and had proved allergic to bee venom. On 23 October 1992 he consulted his general practitioner, Dr Kefalas, having been stung on the chest by what might have been a wasp. There was local swelling, but apparently no general illness. His blood pressure was normal at 134/80 and there was no swelling of the throat. 4 On 8 January 1993 he was referred by a doctor to Blacktown hospital suffering an allergic reaction to what he probably said was a bite. There was pain at the site, on the left chest, and itchiness there for about fifteen minutes. He had no difficulty in breathing. His blood pressure was 150/75 and his pulse rate 80 beats per minute and regular. Air entry to the lungs was marginally reduced on both sides. He was wheezing. Those at the hospital thought that he had been stung by a bee or wasp. 5 On 8 November 1996 he saw Dr Kefalas, having been stung on the left elbow. The sting had been extracted, suggesting that it was the barbed sting of a honey bee. He was hot and felt unwell. Dr Kefalas wondered whether there was anaphylaxis, but did not make such a diagnosis. He did not record any wheezing or swelling of the throat. 6 On 25 April 1998 Mr Worley attended Nepean Hospital, having been stung on the left foot by a bee. A nurse noted that as well as the foot, the left arm and armpit were swollen. He had a slight tightness in the throat and face, together with swelling. The chest was clear with good air entry. The pulse rate was seventy and the blood pressure 130/70. Adrenaline was administered subcutaneously. The treating doctor, Dr Rajaratnam, wrote a letter referring Mr Worley to Dr Frankum, a specialist in desensitising persons who were allergic to bee stings. Two days later Mr Worley saw Dr Kefalas about the sting. His blood pressure was normal. 7 On 7 October 1998 Mr Worley's base was the Mail Delivery Centre operated by his employer, the Australian Postal Commission ("Australia Post") at Glendenning. He began work at 5.30am. After sorting mail and loading it onto his motor cycle he began his deliveries. His work took him to Quakers Hill. As he was delivering mail there he was stung by a bee at the base of his neck on the left side. He thought that that happened at about eleven o'clock. He rode his cycle to a reserve nearby, got off it, took off his helmet, sat down and had a drink of water. He noticed that his neck was reddening and decided to return to the Mail Delivery Centre. He was at the reserve for about ten minutes. He rode his cycle back to Glendenning. He used the road, not the footpath, though it was necessary for him to negotiate a very tight pedestrian railway crossing near Quakers Hill station. Generally he rode at about forty kilometres per hour. The distance was 5.4 kilometres and the journey took about twenty minutes. 8 On the way he met Ms Julie Ferguson, his supervisor. He told her that he had been stung by a bee and asked her to return with him to the Mail Delivery Centre. Ms Ferguson was under a lot of pressure to finish the job that she was doing and declined to go with him. She noticed that his face was red. She described him as flustered. 9 When Mr Worley arrived at the Mail Delivery Centre he turned off the ignition of his motor cycle and got off the cycle. As he threw his leg over the machine to dismount he felt as though he may have had a bowel motion. He walked to the lavatory to check and ascertained that he had not soiled his clothing. He spoke to Mr Cameron, the manager of the Centre. According to Mr Cameron, Mr Worley came up to him at about midday and told him that he had been stung by a bee. He was unsure at first whether Mr Worley meant what he said. He was standing upright but leaning against the wall. When he was assured that Mr Worley was serious, Mr Cameron said that he would take him to the first aid room. The two walked there together. Mr Worley was unsteady but able to walk unaided. Mr Cameron noticed that his voice was becoming quieter and Mr Worley complained that he was short of breath. He drank a glass of water he was given. 10 It does not appear whether it was during or after the events I have summarised, but Mr Cameron telephoned the Ambulance Service at 12.01pm. So much appears from the records of the Ambulance Service. According to a Patient Report Form, the ambulance left the base at 12.04pm and arrived at the Mail Delivery Centre at 12.17pm. Two ambulance officers attended, Mr Parsell and Mr Page. Under the heading "HISTORY Chief Complaint" there appears this account in the Patient Report Form- Bite (sic) by bee/wasp to neck. Male pt æ allergy to wasps/bees bitten on neck 10 mins ago. Pt c/o feeling itchy/dyspnoeic. Pts face red/swollen. Pt c/o severe pain to neck associated æ bite. Audible exp wheeze. Obvious swelling to face. Tongue not swollen. Nil difficulty swallowing. Pt post treatment. Pt c/o severe itching to genitalia. 11 Those who are stung by bees may suffer more than local symptoms. In susceptible people, there may be a general and more serious allergic reaction to the venom. Anaphylaxis is a severe general allergic reaction. The word describes a constellation of symptoms and has no precise definition about which everyone agrees. The definition used by the Australasian Society of Clinical Immunology and Allergy is as follows: Anaphylaxis is a rapidly evolving generalised multisystem allergic reaction characterised by one or more symptoms or signs of respiratory and/or cardiovascular involvement, and involvement of other systems such as the skin and/or gastrointestinal tract. 12 The venom imparted in a bee sting will in some people dilate the blood vessels, allowing fluid to leak into surrounding tissue. This may have several consequences, two of which are important for present purposes. The first is that as a result of the increased volume of the blood vessels and the reduced amount of blood within them there is a fall in blood pressure. This may be rapid and may result in less efficient perfusion of oxygen to the muscles and the brain. When perfusion becomes lower than is necessary to enable the affected parts to function normally the patient is said to be in shock. The second consequence is the effect of the leaking fluid. The tissue into which it flows swells. When that tissue is near the airways their capacity may be reduced by the swelling and they may even become blocked. 13 Perhaps the principal indicator whether a patient may be in shock is the blood pressure. Most practitioners would regard a patient whose systolic blood pressure was less than 90 millimetres of mercury as probably in shock, though some would say less than 80. One specialist who gave evidence, Dr Raftos, would say less than 100. Systolic blood pressure is not a universally accurate indicator of shock, however. A slight woman might well have a normal systolic blood pressure of about 90 or less. Whether shock is present is a matter for judgment and other signs may have to be taken into account, for example the heart rate and the appearance of the skin. 14 Ambulance officers who attend to any person they believe may be experiencing anaphylaxis are therefore concerned to note, among other things, the blood pressure, the heart rate and the condition of the skin and to ascertain whether the airways are compromised by swollen tissue. 15 Adrenaline, which is also called epinephrine, particularly in the United States of America, is by common consent a drug appropriate for the treatment of shock in a number of conditions, including anaphylaxis. It is a molecule which is secreted in the human body and released naturally in response to stress. It has two effects which combine to raise blood pressure: it increases the rate at which the heart pumps blood and it contracts the walls of the blood vessels. It acts quickly but only for a short time. 16 The Ambulance Service issues instructions to its ambulance officers in documents called protocols. The ambulance officers must comply with those protocols and have no discretion to depart from them. On 7 October 1998 there were in force Protocol 8, entitled Anaphylactic Reactions, and Pharmacology 201, entitled Adrenaline. Ambulance officers dealing with a case are required to write on a Patient Report Form the numbers of the protocols which they follow. Numbers 8 and 201, among others, were written on Mr Worley's Patient Report Form.