MUNG YEE KI v. CHUNG NING

HCPI 1223/2003

IN THE HIGH COURT OF THE

HONG KONG SPECIAL ADMINISTRATIVE REGION

COURT OF FIRST INSTANCE

PERSONAL INJURIES NO.1223 OF 2003

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J U D G M E N T

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1. This is an assessment of damages arising from a traffic accident in which the plaintiff suffered personal injuries.

2. At about 1:30 a.m. on 8 December 2000, the plaintiff, aged 21 then, was a passenger in a public light bus (Registration No. DD 1326) which collided with a private car (Registration No. GA 7384) driven by the defendant on the Kwai Chung flyover.  As a result of that collision, the plaintiff suffered personal injuries.

3. The details of that collision need not be gone into as it has no relevance to the issues relating to this assessment suffice to say that liability having been admitted by the defendant in the present case, Interlocutory Judgment was entered against the defendant on 3 December 2003 with damages to be assessed.

4. This is therefore the assessment of damages.

Injuries and treatment

5. After the accident, the plaintiff was taken by ambulance to the Princess Margaret Hospital.  Upon admission, he was confused and found to have suffered multiple lacerations over the forehead, right shoulder, right hand, left thumb, index and middle fingers.  The left index finger extensor tendon was partially cut.  His left pupil was dilated.  His neurological status rapidly deteriorated and CT scan of the head showed comminuted depressed frontal skull vault fracture and skull base fracture involving the orbits, frontal sinus and fractures of the left temporal bone and zygoma as well.

6. Exploration of the forehead wound, surgical toilet and repair of the finger tendon were performed on the same day.  Subsequently, the plaintiff suffered epidural haematoma over the frontal region, traumatic subarachnoid haemorrhage and pneumoencephaly.  As a result, Craniotomy, evacuation of the epidural haematoma and fixation of the skull bone fragments by mini-plates were carried out on the same day.

7. The plaintiff was left with poor vision of his left eye and there was impairment of left eye extraocular movements.  Reopening of the craniotomy and left orbitotomy as well as decompression and repair of dural tear were performed on 14 December 2000

8. The plaintiff further developed cerebrospinal fluid (CSF) leakage from the nose and the right ear which healed with conservative management; endocrine dysfunction with hypopituitarism requiring hormonal replacement; delirium which was treated conservatively and right hand dorsum ulceration which required splintage.

9. One month after his injuries, the plaintiff developed wound dehiscence over his forehead wound.  Wound debridement and rotational flap and free skin graft from the left side of his neck were performed on 5 January 2001.  He was discharged from the hospital on 23 January 2001.

10. He was left with limitation of extraocular movement and visual impairment over his left eye.  He also had limitation of right hand movement.

11. On 9 March 2001 the plaintiff was admitted to Princess Margaret Hospital for complaint of intermittent purulent discharge from his forehead wound.  CT scan showed a collection over the epidural space together with intracranial air.  The diagnosis was epidural abscess, osteomyelitis and wound dehiscene.  He was treated and discharged on 15 March 2001 but again re-admitted from 20 to 22 March 2001.

12. The condition did not heal and the plaintiff was again admitted to the hospital on 26 March 2001.  Wound exploration and debridement, craniectomy and removal of the necrotic bone and plates as well as drainage of the epidural abscess were performed on 2 April 2001.  A subclavian line was inserted under local anaesthesia on 19 April for venous access and prolonged course of antibiotics was prescribed.  The plaintiff was discharged on 15 May 2001.

13. He was also assessed as having depression by Clinical Psychologist.

14. Still later, the plaintiff further suffered from chronic skull bone infection and was arranged to receive surgery to remove all affected bone and to receive antimicrobial therapy.

15. The plaintiff had persistent skull deformity.  His forehead was depressed due to the underlying frontal sinus fracture and previous cranioplasty.  On 8 October 2002 the plaintiff was admitted to Queen Mary Hospital and reconstruction surgery was performed on the following day.  The skull defect was reconstructed by ribs harvested from the chest and the soft tissue coverage was achieved by a free Latissimus Dorsi flap.  After the operation, the plaintiff was left with scars on his back and his ability to pull is weakened because the muscle was harvested for reconstruction.  Elevation of his left eyebrow is impaired.  He was discharged on 24 October 2002.

Neurological condition

16. The plaintiff was examined by his expert neurologist, Dr Edmund Woo on 16 May 2002.  At the examination, the plaintiff’s responses were slow and laboured and he rarely spoke.  He was noted to be irritable at times, shouting at his family members over trivial matters and to have suicidal ideas.  While the plaintiff could handle his daily activities, he took exceptionally long in dressing and bathing.

17. The plaintiff was also noted to have headaches mainly at the left frontal region at the site of his craniectomy.  These headaches occurred two to three times a week and lasted for two to three hours each time.  The headaches were associated with dizziness.

18. Moreover, he also had diplopia at the extremes of lateral gaze horizontally.  It was observed that he had no seizures after the early days of the accident.  The mental state examination showed that the plaintiff had global cognitive dysfunction.  He was severely lethargic and apathetic.

19. Dr Woo commented that the plaintiff’s severe depression, resulting in pseudo-dementia, was the main cause of his global cognitive dysfunction.

20. Dr Woo assessed him to have 11% impairment of the whole person.

21. Dr Brian Choa, the neurology expert instructed by the defendant, was of the opinion that the plaintiff was malingering on the basis that the cosmetic effects of his scars, though not insignificant, would not normally have a sever impact on a male person whose livelihood does not depend on his appearance, and that his persistent hiding behind a low-worn cap and dark glasses is somewhat histrionic behaviour.

22. However, Dr Choa accepts that the plaintiff did sustain a serious cerebral injury and at the time he was examined (in May 2004) was still suffering from its psychological consequences, affecting both his behaviour and his apparent intellectual impairment.  He makes an assessment of 10% impairment.

23. As for his diplopia, Dr Choa takes the view that the plaintiff has a mild bilateral sixth nerve palsy which only controls horizontal eye movement.  As such he is unsure that the plaintiff will have double vision in the primary position (i.e. looking straight ahead).  Moreover, surgical correction or correction with a prismatic lens is often highly successful.  Therefore he is of the opinion that the degree of impairment for this condition should be reduced to 5% of the whole person.

24. Dr Choa further states that from a neurological point of view, the plaintiff does not exhibit any focal neurological deficit and should be able to pursue a career in design-related work.  If he were unable to do so, it would be because of his psychiatric illness.  His long term loss of earnings capacity should not exceed 10%

Cosmetic condition

25. Dr Ian Nicolson, a plastic surgeon, examined the plaintiff and his report was agreed into evidence.

26. There are readily noticeable pale accident scars over much of his forehead.  On the left side of the forehead there is a conspicuous light brown raised slightly bulbous patch of skin flap where skin from the back of his chest has been transferred to cover a defect in the underlying bone.  The remainder of the left forehead is covered by noticeable pale laceration, abrasion and surgical scars.  There are also faint scattered scars on his nose and ear region.

27. There are extensive neurosurgical and laceration scars over the vault of the skull from ear to ear as well as other scars in the frontal and left parietal region.  These are concealed by the normal lie of the hair.

28. On the left side of his neck there is a surgical scar crossed by multiple pairs of stitch mark scars in the left supraclavicular region at the site where a full thickness skin graft was harvested.

29. On the right shoulder there is a readily noticeable area of irregularly pigmented mildly thickened healed abrasion scar.

30. On the posterior aspect of the left chest is a readily noticeable irregularly pigmented vertical surgical scar where skin and muscle free flap was harvested.

31. On the right wrist and back of the hand, there are several noticeable healed laceration scars.

32. On the left hand, there are a number of laceration scars over the fingers.

33. Dr Nicolson was of the opinion that the cosmetic disability of the plaintiff and all his scars are permanent and are not expected to alter to any significant extent with time and that no further plastic surgery or lasar therapy could significantly improve the appearance of his scars.

34. Dr Nicolson further states that the plaintiff appears very psychologically disturbed and because of that he doubts very much whether the plaintiff would be a suitable candidate for cosmetic surgery when so little can be done for him.

35. Dr Nicolson assesses 5% permanent cosmetic disability over and above the plaintiff’s other combined disabilities such as neurological, psychiatric, visual and endocrine.

Psychiatric condition

36. The plaintiff was jointly examined by psychiatric experts in April 2004 Dr K. Singer (instructed by the plaintiff) and Dr Lo Chun Wai (instructed by the defendant).  The joint report of the two experts in psychiatry was agreed into evidence since there was little or no differences between them in the opinion they arrived at in relation to the plaintiff’s psychiatric condition.

37. In their joint report, they made the finding that the plaintiff was suffering from (1) Depressive Disorder; (2) Post-traumatic Stress Disorder (PTSD); and (3) Dementia due to Head Trauma.

38. For the Depressive Disorder, that manifests itself in the form of depressive mood, lack of interests energy and motivation, sleep impairment, retardation, restlessness, and feelings of worthlessness.  The disorder is moderate in degree and is a psychological reaction to the accident and its physical and psychological consequences. 

39. Associated with it, the plaintiff shows features of personality change in reaction to his disfigurement with feelings of inadequacy, social ineptness and hypersensitivity, a sense of humiliation and discrimination and fear of embarrassment, ridicule, criticism and rejection in social situations with consequent avoidance of social activities and interpersonal relationships.  The personality change or disorder is severe in degree.

40. For the PTSD this is shown by his exposure to a traumatic event which threatened serious injury.  It manifests itself in persistent re-experiencing of the traumatic event such as nightmares and flashback of the accident.  It results in the plaintiff’s persistent avoidance of stimuli associated with the accident and numbing of general responsiveness such as avoidance of minibuses, going out alone, conversation of the accident and coldness to family members.  It also takes the form of persistent symptoms of increased arousal such as sleep impairment, irritability and reduced interests in activities.

41. The condition, having lasted more than three months, is now chronic and is moderate to severe.

42. The Dementia due to Head Trauma is shown by the plaintiff’s impairment of memory and executive functioning which results from very severe head injury from the accident and is mild to moderate in degree in that work and social activities are impaired but the capacity for independent living largely remains.

43. In association with the Dementia, the plaintiff has features of Post Concussional Syndrome (PCS) as shown by his headaches, dizziness and irritability.

44. The Dementia is a probable diagnosis inferred from the severity of the head injury and from symptoms of cognitive impairment from information but not based on findings on examination as the plaintiff was not sufficiently co-operative.  Moreover, there was an element of exaggeration because some of the answers given by the plaintiff suggested sever cognitive impairment but which was inconsistent with his ability to relate certain aspects of his history which indicated mild to moderate cognitive impairment at most.

45. As for prognosis, both Dr Singer and Dr Lo were of the view that the prognosis for the Depressive Disorder is not good because its causes are mostly severe and permanent, but it may improve with treatment to become mild in a couple of years.  For the PTSD, he is unlikely to improve without treatment.  With treatment, his symptoms are likely to become mild in a couple of years.  The Dementia as well as the headaches and dizziness of the PCS are permanent.

Endocrinological condition

46. Dr David Chang Chee Siu, specialist in endocrinology, examined the plaintiff and gave an expert medical report dated 20 June 2005.  His report was agreed into evidence its contents not being disputed.  The opinion of Dr Chang is as follows :

47. The plaintiff developed Hypopituitarism and Cranial Diabetes Insipidus within days of the accident as can be seen from the reports of the Government hospitals.

48. He had suffered from panhypopituitarism, a condition that occurs with severe frontal damage as the pituitary gland is situated on the frontal base of the skull.  Fracture there would cause irreversible damage and loss of function of the pituitary gland.

49. Dr Chang explains that the pituitary glands has two lobes, the anterior pituitary and the posterior pituitary.  Damage to the anterior pituitary results in hypofunction of the adrenal glands, the thyroid, the gonads and tissues responsive to growth hormones while damage to the posterior pituitary leads to or results in Cranial Diabetes Insipidus.

50. The government medical reports show that the plaintiff requires medication for the treatment of hypofunction of the adrenal glands, thyroid, testes and posterior pituitary (known as Cranial Diabetes Insipidus).  The results of the endocrine tests confirmed the presence of panhypopituitarism and Cranial Diabetes Insipidus.

51. In the case of the plaintiff, he suffers from Adrenal, Thyroid, Gonadal Hormone and Posterior pituitary deficiency which is due to the gravity of the brain injury.  The more severe the damage, the more hormones deficiency.  The plaintiff will need lifelong hormonal replacement as recovery is very unusual.  Of the hormones deficiency, the most critical is adrenal hormone — hydrocortisone.  Acute deficiency of this hormone can be life threatening.

52. Posterior pituitary hormone ADH is also critical as either insufficient or excess can lead to dehydration or water intoxication.

53. Deficiency of the thyroid hormone can lead to slowing down of the body metabolism and if untreated can lead to hypothermia in cold climates.

54. Gonadal hormone deficiency results in loss of libido, masculinity and infertility.  Replacement of testosterone can improve masculinity but fertility is a much more difficult disability to treat.

55. In a further report dated 22 June 2005, Dr Chang confirmed that in the case of the plaintiff, there is no evidence of Growth Hormone deficiency as he has normal IGF-1 when assessed in November 2004.  However there is a high chance that he may develop Growth Hormone deficiency in future and this can only be confirmed by periodic (yearly) testing of IGF-1.

Ophthalmological condition

56. Dr Tsui Chung Wan, a specialist in Ophthalmology, being the plaintiff’s expert in that field, gave a medical report dated 16 March 2005 as to the plaintiff’s condition.  That report was agreed into evidence with no dispute as to its contents.

57. The opinion expressed by Dr Tsui in that report can be summarized as follows :

58. Amongst other injuries, the plaintiff suffered a fracture of orbits and traumatic optic neuropathy in the traffic accident on 8 December 2000 and is still attending regular follow up treatment at the Department of Ophthalmology of Caritas Medical Centre every three months.

59. The examination on 3 March 2005, the best-corrected visual acuity was 15% visual impairment in the right eye, and 60% visual impairment in the left eye.  There was generalized visual field constriction in both eyes, more profound in the left than the right eye.  Defective colour vision was also present in the left eye.

60. There is no evidence of direct injury to eye globes.  The visual impairments in both eyes is mainly caused by traumatic optic neuropathy due either to direct compression of optic nerve by fractured bones or indirect blunt injury to optic nerve from the accident and is characterized by visual acuity, visual field abnormalities and defective colour vision.  The clinical evidence is compatible with the diagnosis.

61. The test for diplopia is not conclusive and the result not consistent.  Diplopia should not occur if there is no defective extraocular movement.  Therefore it is probably caused by left eye enophthalmos, which is the result of fracture of left orbit, left temporal bone and zygoma.

62. The presence of the mildly dilated pupil in the left eye has resulted in photophobia and the plaintiff is advised to wear sunglasses especially in bright sunshine.

63. Combining the disability in all aspects of visual function, the plaintiff suffers from 42% impairment of the whole visual system which is a 40% impairment of the whole person according to the AMA Guide.

64. Ophthalmologically, the conditions of both eyes are now stable and no further treatment is required.

Pain suffering and loss of amenities

65. As can be seen from what is stated above, the plaintiff in this case has obviously suffered very serious injuries and resultant disabilities in this case.

66. The plaintiff’s claim for compensation under this head of damage is for $1 million.  The defendant, on the other hand, submits that a reasonable award would be $800,000. 

67. The only real dispute between the parties as to the injuries and disabilities of this plaintiff relate only to the differences in opinion between the two respective neurologists, Dr Edmund Woo for the plaintiff and Dr Brian Choa for the defendant.

68. I have no difficulty accepting the opinion given by Dr Edmund Woo in respect of this plaintiff.

69. I am unable to accept the opinion of Dr Brian Choa that the plaintiff was malingering for the reason given by him, that it was histrionic for the plaintiff to hide behind a low-worn cap and sunglasses because almost in the same breath, Dr Choa accepts that the plaintiff was suffering from psychological consequences of the accident which would affect his behaviour.

70. Whilst there may be some exaggeration by the plaintiff when examined by doctors or experts in the answers given by him, such exaggeration is of little significance when the overall picture of the injuries and disabilities suffered by this plaintiff is looked at.  In any event, the experts were fully appraised of such exaggeration given in answer by the plaintiff as stated in their reports.

71. From the two psychiatrists assessment of the plaintiff, it must be clear that due to his psychiatric condition which affects his behaviour, the plaintiff carries a sense of grievance and embarrassment because of his disfigurement.  Even if it was thought that such behaviour is not normal for a man of his age, it must also be remembered that the plaintiff is not a normal person due to his psychiatric condition, which is very much a result of the traffic accident.

72. Accordingly, I am of the opinion that the amount claimed by the plaintiff of $1 million is a reasonable sum, given all the circumstances of this case, to be awarded for PSLA.

Pre-trial loss of earnings

73. There is a claim for pre-trial loss of earnings by the plaintiff which is disputed by the defendant.

74. At the time of the accident, the plaintiff was 21 years of age and was studying in Form 7 for his A-level Examination which he was to take the following summer (i.e. about May 2001).  As a result of the accident, the plaintiff could not sit for his A-levels.

75. There is evidence from the mother that the plaintiff has always been interested in design and it was both the intention of the plaintiff and of the family that he should study design and thereafter pursue a career as a designer.  If necessary the plaintiff would study design abroad.

76. If such intention of the plaintiff had materialized and that the plaintiff had gone on to study design after his A-level examinations, there can be no question but that the plaintiff would likely have to spend some three or four years studying design and would not have been engaged in any remunerative employment before the trial of this matter (assuming there had not been any accident).  Therefore on that scenario, there would not likely have been any pre-trial loss of earnings.

77. However, the claim for pre-trial loss of earnings was put on the basis that it is accepted that the academic results of the plaintiff is not good and in those circumstances, his A-level results may not have been so good as to permit him to continue his studies in design after his A-levels examination.  In those circumstances, it is submitted by the plaintiff that very likely he might follow his father’s footsteps, after the A-level examinations, to be a driller.

78. On that basis, it was submitted that the loss of pre-trial earnings would be some $927,360 which is calculated on the basis that the plaintiff may be able to earn about $840 per day (a deduction from the father’s daily wage of $923) working 24 days a month for the pre-trial period of 46 months.

79. It was further submitted that even if the Court was not satisfied that the plaintiff could work as a driller, then the fall back position of the plaintiff in so far as pre-trial loss of earnings is concerned was that the plaintiff would not be idling about from June 2001 to the date of the assessment but would likely get himself engaged in some form of remunerative employment for that period.  Based on the fact that the plaintiff had previously, during one summer holiday, worked as a general worker for GrandMart it was suggested that loss of pre-trial earnings could be calculated on the basis that the plaintiff might be a general worker earning $10,000 per month for 46 months pre-trial.

80. The objection by the defendant is that there is simply no proper basis shown by the plaintiff upon which a claim for pre-trial loss of earnings could be made.

81. From all the evidence before me, there is some evidence to show and to support the mother’s evidence that the plaintiff is interested in design work.  The plaintiff had been awarded prizes and awards for design competitions in school.  They would point in the direction that the plaintiff has talents for design work and is interested in that field.

82. Whilst it is true that the plaintiff’s academic achievements may not be entirely satisfactory, his ambition to study design and become a designer need not necessarily be affected to any great extent by his academic achievements, or lack of it, in his Form 5 and A-level exams.  His talents or creativity in that field could well make up for his otherwise poor academic results.

83. In those circumstances, my view from the evidence is that even if the plaintiff did not do well in his A-level exams if the accident had not happened, very likely he would still have pursued, in one form or another, his interests in studying design, whether in Hong Kong or abroad.

84. Effectively that means that there can be no loss of pre-trial earnings.  Accordingly no award will be made under this head of claim.

Future loss of earnings

85. In making this claim for future loss of earnings, the plaintiff relies on the agreed medical reports of the joint psychiatrists, the endocrinologist, the ophthalmologist as well as Dr Edmund Woo’s opinion and submit that the plaintiff will need five years of treatment before he could be well enough to take on any work, and in any event he will not be able to work either as a designer or as a driller.

86. Furthermore, the plaintiff suggests that a multiplier of 15 should be adopted.

87. As for the multiplicand, the plaintiff says that on the basis that the plaintiff would have qualified as a designer had it not been for the accident, the first five years should be calculated on a monthly salary of $15,000 as an art designer and the next 10 years (after treatment) the multiplicand be reduced by $5,301 (being the average earnings of a cleaner from statistics contained in the Quarterly Report on average Earnings) per month.

88. Alternatively as a driller, the multiplicand for the first five years be calculated at $840 per day working for an average of 24 days per month and for the next 10 years the multiplicand be again reduced by $5,301 per month working as a cleaner.

89. In the fallback position of the plaintiff is that of being able to work as a general worker.  It was suggested that the multiplicand for the first five years be at $10,000 per month and for the next 10 years the multiplicand be reduced by $6,000 per month.

90. On the other hand, the defendant, whilst admitting that there will be some future loss of earnings for the plaintiff, says that since the plaintiff was only in Form 7 at the date of the accident, there is insufficient basis for the multiplier/multiplicand approach to be adopted to calculate loss of future earnings.  The defendant submits that in this case a global award would be the proper approach to be adopted.  In line with that, it is suggested by the defendant that a global sum of $500,000 would be sufficient to compensate the plaintiff for loss of future earnings.

91. It is further submitted by the defendant (at the Court’s invitation) that if the multiplier/multiplicand approach be used, then a multiplier of 13 would be appropriate for this plaintiff.

92. Looking globally at all the evidence in this case, while it would not be difficult to decide on a multiplier of 15 in view of the age of the plaintiff and who is just at the threshold of entering the employment market in one form or another, having to decide on the multiplicand in such a case will pose the greatest of difficulty.  While I accept that the plaintiff is interested in design work, there is no clear indication that even with his interest in that area, he will succeed in qualifying as a designer let alone be employed as one.

93. In all the circumstances of this case, I have to agree with the defendant that the proper approach would be to assess a global lump sum award to the plaintiff for loss of future earnings rather than to use the multiplicand/multiplier approach in the assessment.

94. In deciding on the global sum to be awarded, I should make it clear that I do not accept the plaintiff’s submission that the plaintiff would not be able to work in the next five years while undergoing psychiatric treatment recommended by the two psychiatric experts in their joint report. 

95. My reading of their joint report indicates that the psychiatric treatment recommended is for two years and not five, as submitted by plaintiff’s counsel.  Very likely the ambiguity crept in because there was some suggestion in their report that the cost of medication was for five years.

96. In all the circumstances of this case, I am of the view that a global lump sum of $1.5 million should reasonably and properly compensate the plaintiff for his future loss of earnings.  This lump sum is made on the basis that it will also cover any handicap in the labour market which the plaintiff may have in his future work arising from his disabilities caused in the accident, so that his claim for loss of earnings capacity will also be covered.  Accordingly, there will be no separate award for that head of claim.

97. In cross checking such a global sum of $1.5 million against a multiplier of 15, it translates to $8,333 per month.  Given all the uncertainties in the case relating to the plaintiff’s loss of earnings, the global sum assessed would appear to be adequate compensation to the plaintiff for loss of earnings.

Special damages

98. The parties have agreed effectively all the items of special damages as follows :

Government hospital expenses	$18,832
Travelling expenses to and from hospital	25,370
Travelling expenses for family members	5,160
Chinese herbalist expenses, travelling and nourishing food	70,000
Expenses for domestic helper and services of mother and sister	240,000
Cost of medical and rehabilitation appliances	4,500

99. Total amount agreed for special damages comes to $363,862.

Future medical and travelling expenses

100. Three items under this head of damage have been agreed by the parties.  Medical expenses for public hospital is agreed at $14,640; psychotherapy and medication are agreed at $182,000 and future expenses for domestic helper is agreed at $96,000.

101. The above agreed items come to $292,640.

102. There are however, certain items under this head of claim which is not agreed between the parties.

103. Firstly, the plaintiff claims for future treatment in respect of endocrinologist consultation, testosterone replacement, and hydrocortisone, thyroxine and desmopressin.  While such future treatment is accepted by the defendant to be necessary, the dispute between the parties in this respect relate only to the multiplier to be applied. 

104. The plaintiff submits a multiplier of 18 on the basis that the above treatment and replacement is for life.  The defendant says 13 is the proper multiplier to be applied.

105. In view of the age of the plaintiff, and that the endocrine treatment and replacement is lifelong, I have no hesitation in adopting the multiplier of 18 as suggested by the plaintiff.

106. Accordingly, the cost of the future endocrinologists consultations is assessed at $54,000; the Testosterone replacement at $86,400 and for the Hydrocortisone, Thyroxine and Desmopressin medication at $486,000

107. Secondly, the plaintiff claims for future cost of Growth Hormone in the amount of $1,209,600 pursuant to the recommendation of the endocrinology expert, Dr Chang. 

108. However, it has to be borne in mind that the cost stated by Dr Chang for the Growth Hormone replacement is $1,400 per week.  Moreover it is the opinion of Dr Chang that there is a high chance of the plaintiff requiring Growth Hormone replacement, but even so only in the next 10 to 15 years since recent testing of his IGF-1 in November 2004 shows no evidence of Growth Hormone deficiency.

109. Taking all the above into account, the multiplier of assessing the Growth Hormone replacement will need to be trimmed down from 18 to one of 9 in all the circumstances.

110. Accordingly the cost of future Growth Hormone replacement will be assessed at $1,400 x 4 x 12 x 10 giving $672,000.

111. There is also a claim for infertility treatment with hormones the cost of which was estimated at $200,000 by Dr Chang.  It would appear from his medical report that this item of costs estimated by him was not, unlike the other items, based on the length of the treatment involved, but that it was a lump sum of $200,000. 

112. Although this item was also disputed by the defendant, in the absence of any good reason not to accept the recommendation of Dr Chang, his report being agreed by the parties, that amount of $200,000 will be allowed as being the future cost of infertility treatment.

113. Lastly, the plaintiff also claims $37,800 as being the future cost of travelling on the basis that he will need to travel some 630 times for his future treatment both endocrine as well as psychiatric. 

114. Given the circumstances of this plaintiff and his need for lifelong endocrine treatment and consultations as well as his future psychiatric treatment for some two years, the amount claimed for travelling is reasonable and will be allowed.

115. The total amount assessed under this head of claim comes to $1,828,840.

Interests

116. Interests will be awarded on damages for PSLA at 2% p.a. from the date of the Writ.

117. Interests on Special damages will be awarded at 4.122 % p.a. (being half judgment rate) from the day of the accident.

Summary of assessment

PSLA	$1,000,000
Future loss of earnings	1,500,000
Agreed Special damages	363,862
Future cost of treatment, medication and travelling	1,828,840
Interests on PSLA	38,333
Interests on Specials	72,492
Total:	4,803,527

Conclusion

118. Total damages assessed in respect of the plaintiff against the defendant amounts to $4,803,527.

Costs

119. There will be a costs order nisi that the defendant pays the plaintiff’s costs of the assessment to be taxed if not agreed.