Keenan v O'Callaghan (Approved)

Factual and Procedural Background

The Plaintiff, a married woman with four children born in 1987, worked part-time as a cleaner prior to the incident. The claim arises from a road traffic accident on 17 February 2007 at a roundabout in The City, where the Defendant negligently drove onto the roundabout and collided with the Plaintiff's vehicle, causing injuries. The court was tasked solely with assessing damages, focusing on the nature and extent of the Plaintiff's injuries and the valuation of consequent claims.

The impact was light to moderate, causing a twisting motion to the Plaintiff's spine and a hyperextension/hyperflexion injury to her neck. The Defendant argued the Plaintiff suffered only minor to moderate whiplash, while the Plaintiff claimed more extensive cervical, thoracic, and lumbar spine injuries, including the activation of a previously asymptomatic congenital Chiari malformation. This condition led to chronic pressure headaches requiring major surgery in August 2020.

Following the accident, the Plaintiff reported severe neck and arm pain, headaches, and neurological symptoms. MRI and further specialist consultations confirmed the Chiari malformation and associated complications. The Plaintiff underwent invasive decompression surgery which initially relieved her symptoms but she continues to suffer from chronic cervicogenic and anterior chest wall pain, managed by denervation therapy and proposed spinal cord stimulator insertion.

The Plaintiff also developed psychological symptoms diagnosed as an adjustment disorder linked to chronic pain and family stresses. Claims include general damages for pain and suffering, special damages, past and future loss of earnings, and the cost of a spinal cord stimulator with lifetime battery replacements.

The Defendant disputed several aspects including the timing and cause of the Plaintiff’s incapacity to return to work, the causal link between the accident and the Chiari malformation symptoms, the extent and nature of the injuries, and the Plaintiff’s future loss of earnings claims.

Legal Issues Presented

1. Whether the Plaintiff was due to return to work on 20 February 2017 and whether her injuries from the accident prevented this, as opposed to being related to a prior accident.
2. Whether the accident caused the Plaintiff’s congenital Chiari malformation to become symptomatic, necessitating decompression surgery.
3. The nature and extent of the Plaintiff’s cervical spine injuries, specifically whether chronic cervicogenic pain from facet joint damage resulted from the accident.
4. Whether the accident caused chronic anterior chest wall pain and the causal connection to the trauma.
5. Whether the Plaintiff’s lower back symptoms and leg weakness were caused by the accident.
6. The extent to which the Plaintiff’s psychological adjustment disorder is attributable to the accident.
7. The appropriate period and extent of past loss of earnings attributable to the accident.
8. The validity of the Plaintiff’s claim for future loss of earnings contingent on spinal cord stimulator insertion and retraining.

Arguments of the Parties

Plaintiff's Arguments

• The Plaintiff asserted she was due to return to part-time cleaning work on 20 February 2017 but was incapacitated by injuries sustained in the index accident.
• She contended that the accident caused her congenital Chiari malformation to become symptomatic, leading to chronic, debilitating pressure headaches requiring surgery.
• The accident caused chronic cervicogenic pain due to damage to cervical facet joints, as diagnosed by her treating pain specialist.
• The Plaintiff claimed chronic anterior chest wall pain caused by trauma at the level corresponding to the seatbelt strap.
• She attributed some lower back symptoms and leg weakness to the accident.
• The Plaintiff claimed an adjustment disorder caused by chronic pain and family stresses related to her injuries.
• She claimed past loss of earnings from 20 February 2017 to trial and future loss of earnings for one year, conditional on spinal cord stimulator insertion and retraining.
• The Plaintiff argued she would undergo the spinal cord stimulator procedure and complete retraining to return to sedentary work.

Defendant's Arguments

• The Defendant disputed that the Plaintiff was due to return to work on 20 February 2017 and argued her injuries merely exacerbated prior injuries from a 2016 accident.
• The Defendant challenged the causal link between the accident and the onset of symptomatic Chiari malformation.
• The Defendant contended the injury was consistent with a soft tissue whiplash injury rather than facet joint damage.
• The Defendant disputed the causal connection between the accident and the Plaintiff’s anterior chest wall pain.
• The Defendant denied a causal link between the accident and the Plaintiff’s lower back symptoms.
• The Defendant questioned the extent to which the psychological symptoms were attributable to the index accident, suggesting pre-existing anxiety and insomnia.
• The Defendant argued the Plaintiff’s claim for loss of earnings should be limited to a shorter period, potentially ending around February 2021 after expected recovery from surgery.
• The Defendant contended the Plaintiff would not undergo proposed spinal cord stimulator insertion and therefore future loss of earnings claims should be limited accordingly.

Table of Precedents Cited

No precedents were cited in the provided opinion.

Court's Reasoning and Analysis

The Court found the Plaintiff to be a very genuine and honest witness, fully supported by her treating medical experts. It accepted that the injuries sustained in the index accident were distinct from and not exacerbations of prior injuries. The Court found it inherently probable that the Plaintiff was due to return to work on 20 February 2017.

The Court accepted medical evidence that the trauma caused the Plaintiff’s congenital Chiari malformation to become symptomatic, resulting in chronic, excruciating pressure headaches necessitating decompression surgery. It gave weight to the presence of impulse headaches, abnormal cerebral fluid flow demonstrated on imaging, and expert testimony supporting causation.

The Court accepted the diagnosis of chronic cervicogenic pain caused by trauma to cervical facet joints, likely to continue indefinitely. It found the Plaintiff medically fit for sedentary work post-surgery but susceptible to flare-ups that impair competitiveness unless a spinal cord stimulator is inserted and retraining completed.

The Court attributed the Plaintiff’s adjustment disorder to the chronic pain from the accident rather than pre-existing psychological conditions.

The Court found the anterior chest wall pain causally related to the accident but rejected a causal connection with the Plaintiff’s lower back and leg symptoms.

In assessing damages, the Court noted the unusual injury profile limited the utility of the Book of Quantum guidelines. It emphasized fairness and proportionality in the award, considering the Plaintiff’s relentless suffering, extensive medical treatment including major surgery, ongoing chronic pain, and impact on family and work life. The Court accounted for future pain relief prospects through the spinal cord stimulator, while acknowledging some residual risk.

Holding and Implications

The Court awarded judgment for the Plaintiff in the sum of €335,174, comprising:

• €110,000 for general damages (€85,000 past pain and suffering; €25,000 future pain and suffering)
• €20,009 agreed special damages
• €92,869 for past loss of earnings (including interest)
• €14,196 for future loss of earnings for one year
• €98,100 for the cost of a spinal cord stimulator and lifetime battery replacements

The decision directly compensates the Plaintiff for her injuries, losses, and future care needs. No broader legal precedent was established beyond the particular facts and expert evidence of this case.