Harre CJ
```html 1 D COURT 1 IN THE GEORGE T OF THE CAYMAN ISLANDS HOLDEN AT/90 GRAND CAYMAN ( CAUSE NO. 1 BETWEEN: 61 AINSWORTH ANTHONY MYERS (As Personal Representative of the PLAINTIFF FF DR. FRANK KOHLSCHIEIN， MBCHB MRCVG DEFENDANT AND： FOR THE PLEA Ramon Alberga O.C. and Mr. Graham Ritchie FOR THE DEFENCE Mr. Timothy Shea EVIDENCE ARRE C. led. H JUDGMENT This tria plaintiff who was suffering from terminal 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1</
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```html defendant's negligence has been admitted but there was argument during the case. Jn the light of the finger which I shall make this will be a secondary matter but I shall miss observation on it now nevertheless, as I was invited to do. ies it ac over the arguments, which were about whether the defendant's admission of negligence also constitutes an admission of liability, which I was amply satisfied that, on the balance of probabilities, was the defendant's negligence and breach of duty which either caused or materially contributed to the condition in which the negligence was at the time of the trial and the pain and suffering which she had endured and would continue to endure. Liability, as I established. In the correspondence the defendant admitted negligence. But it was not clearly established whether he was admitted negligence in not having taken the steps which the plaintiff's witnesses regarded as appropriate in August 1989, or because of the delay which had lapsed at some later stage. Liability, as I established. In the correspondence the defendant admitted negligence. But it was not clearly established whether he was admitted negligence in not having taken the steps which the plaintiff's witnesses regarded as appropriate in August 1989, or because of the delay which had lapsed at some later stage. If I accept the negligence dated from August, and that certain balance of probabilities the plaintiff's cancer was at that time, then the disaster which followed must be laid wholly at the door of the defendant. That the principle established unanimously by the House of Lords in Hotson v Berkshire Area Health Authority, 1987 2 Affter other which was the converse on the facts of the present case. If defendant expressed most succinctly by Lord Ackner as follows - int of diability is established, on the balance of lefties, the loss which the plaintiff has as; is payable in full. It is not reduced by reducing his claim by the extent to which he has failed to prove his case with 100% mal ot If, on the other hand the defendant was not negligent in not dealing with the Y: Y, then the question of causation would have been quite different in nature. However, in her letter of 11th June 1992, the plaintiff's attorney did say that negligence as pleaded in the statement of claim is admitted. That includes, as a particular of the case "GR pl te d; te c wi ```
```html the def 'Despit negligence, the following - 989 of faillant' e being told by the Plaintiff on 23rd August form u+; jianed and/or neglected and/or refused to a thorough or any examination of the er er It is clear that that negligence dated from 23rd August 1989 was being al Notwitn However, what was described as "counsel's final position unfrom t causation issue" was set out in a letter dated 24th June 1994.xpectahe defendant's attorney. It was this- hich ed, have hstanding the negligence of the defendant admph 1 as been admitted, the Plaintiff would still dergone the same treatment procedures, a 90 Edi rncy." I was reoubt a An on behalf of the defendant, to the following passage of parags he harri32 of the textbook "Medical Negligence" by Powers and Harris, to pent in xpression of 'liability' by a defendant is warrocely understood to include an admission that s atory consequences pleaded (though not their er n the defendant, but for the avoidance of he written and open admission that such efendal ly obtained before a plaintiff may safely tt to trial on the issue of quantum alone." The time w turn this case on this issue amply illustrates the good sense of k her sting at the end of that passage. What the defendants to irney said fell short of the "written and open admisio med was appropriate and I would not have been content to shut the certificat out on the basis of an admission as to liability and not been rendered academic by the findings of fact to which I " hnc F re this case was given by the plaintiff herself and by two expert w eal witnesses. The defence called no witnesses. Because fe h2 ate of health the plaintiff was unable to come to the pm "ra give oral evidence but it was by leave of the court et19y affidavit and subject to cross-examination by conference t' of ma en n" sl; no rt d ```
It is important to refer to the sequence of events as set out in the statement of claim and confirmed by the plaintiff in evidence. After Dr. Pl. Hein had seen the plaintiff on the 30th May 1989 and confirmed that she was pregnant, she engaged him as her gynaecologist and obstetrician. He set up a programme for her to attend him on a regular examination and observation during her pregnancy. In July 1989, the plaintiff noticed that a small lump, in her estimation smaller than a pea, had developed in her right breast. On her next visit on 1st August 1989, the plaintiff brought this to the attention of Dr. Kohlschein. He was not concerned about it, did not examine the plaintiff, and assured her that many changes could occur in the breast during the course of pregnancy, including the development of lumps resulting from hormonal changes caused by it. Between his visit on 1st August and the plaintiff's next scheduled visit to Dr. Kohlschein on 22nd September, the lump continued to grow but was painless. On 9th September, the plaintiff advised Dr. Kohlschein that the lump had approximately doubled in size since July. Dr. Kohlschein did not examine the plaintiff's breast again, repeating what he was already told. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit on 12th October. By her next appointment after the lump had grown bigger and in the estimation of the plaintiff was approximately the size of a small plum, Dr. Kohlschein assured the plaintiff that there was nothing to worry about. The plaintiff accepted this and did not raise the question of the lump again until her next visit
```html 1 On 4th fu989 on990 the plaintiff gave birth to a son. From the 9th November ohlschwards she had had regular two weekly consultations with Dr. the ein. Although during the course of these she had informed any t the lump was getting bigger and firmer he did not carry out and a lim rther examinations and never departed from the assurance or advice which he had given both before and after his examination in th November. Followi her sirth of her son the plaintiff's breast was very tender, painful r praga to the touch and she developed a fever. Dr. Kohlschein was told her that there was nothing to worry about but he did rec on 8t at she discontinue breast feeding and that she wait for a fuould nax weeks to see what effect the fact that the plaintiff was no l edgiant or breast-feeding would have on the lump. The plaintiff cord. scharged from hospital on 6th January and next saw Dr. Kohlsche( deverch. On this occasion, for the first time, he said that the lump emmenably have to be removed but he indicated that he still wild h devwait out the six weeks to see if it would shrink of its own old deci He repeated this advice on 11th January. By about She u or 19th January the plaintiff noticed that smaller lumps han hoped around the primary lump. She had an appointment with a Gd that th Gynaecologist on 1st February who advised her that the lump four ove to be removed and recommended a mammogram. The plaintiff, a emoy Canadian Physician. She saw Dr. Kohlschein for the last timecevec in February and he then told her for the first time that she have a mammogram. She had this in Canada and it indicate 1 the lump was a solid mass which was possibly a carcinom Jar nderwent surgery on 6th March and the lump was diagnoseou icng malignant. Some of her lymph nodes under her right arm werent in jes for examination which revealed that the cancer had spread ton 19 the nodes. She was diagnosed as being at Stage 3 breast cov sh term to which I shall refer later. A complete mastecto t informed on 28th March. Between April and September 1990 she d a f eight cycles of systemic chemotherapy with os and wi re ```
The document discusses the progression of a breast cancer case, detailing the stages of the disease and the treatment received by the plaintiff. The plaintiff was diagnosed with Stage 3 breast cancer in February 1990. The classification of the stages of cancer was taken on the advice of Dr. Charles Wright and Dr. Charles Popkin, two medical experts. The plaintiff's ovaries were removed as part of the treatment, and subsequent rolls of oral synthetic anti-estrogen and radiation therapy were administered. The cancer has spread to the plaintiff's skull, thoracic spine, and iliac crest and right ischium. The document also describes the various stages of breast cancer, with Stage 1 being a small lump, two centimeters or less in diameter, and Stage 2 being either involvement of the lymph nodes in the arm pit and trunk or a tumor in the breast itself larger than 2-5 centimeters, with or without involvement of the lymph nodes. The prognosis is less favorable at Stage 2, and the method of treatment is more infrequent and distressing. The determination of whether the plaintiff was at Stage 1 or Stage 2 at the time when Dr. Kohls of the plaintiff's medical expert, Dr. Charles Wright, was exercising a proper standard of care, has been a significant issue in the case. The document concludes with a discussion of the size of the tumor and the likelihood of lymph node involvement. The smaller the tumor, the less likely it is that the lymph nodes will be involved. The document also mentions that the plaintiff's medical expert referred to the report which followed the diagnosis of the lump as "smaller than a pea," which is descriptive of an object not more than one centimeter in diameter.
It showed it that it was histologically Grade 1 which he ignored as being the least aggressive type of tumour. Now this is inconsistent with certain statistics which were put both Myers and Wright and Dr. Popkin in support of the proposition that Mrs. L. was already in Stage 2 by August 1989 on the balance of probabilities. That proposition was supported by statistical findings appearing in a special article of 5 book entitled "Breast Diseases" which brings together the views of 11 contributors, and other evidence indicating that there is a high likelihood of lymph node involvement in pregnant women. An occasional medical review entitled "Mammary cancers and pregnancy" by John M. Anderson, a consultant surgeon which appeared in the British Medical Journal in 1979 shows at page 1125 on the basis of six studies an overall percentage of 76 in the incidence of histological axillary lymph node metastases in mammary cancers detected during pregnancy or lactation. Nevertheless, that same review also includes a graph showing curves for 221 pregnant or lactating patients and the same number of non-pregnant patients with mammary cancers who were matched known survival in both groups. Overall the survival was the same in both groups although the five-year survival of patients treated in the second half of pregnancy was only 11% compared with 48% for those treated in the first half. Notwithstanding these findings, Dr. Wright confirmed his opinion that Mrs. Myers were more likely than not to have been in stage 1 in August 1989. In support of this he pointed out that neither the size nor the histological grade of the tumour in women included in the statistical surveys alone. Both are known in the case of Mrs. Myers and it is self-evident that these matters, and indeed all known clinical factors, should be weighed in ascertaining the probabilities in relation to each individual patient as opposed to a statistical group. Dr. Popkin confirmed Dr. Wright's opinion that there was a direct relation between the size of the lesion and the lymph node involvement.
```html 9 involve nth Dr said that when Mrs. Myers first raised the question of the lump ble th t. H. Kohlschein it was a very small lesion and it was most prote at the lymph nodes were not involved. ques to I now tu would e evidence of the two medical experts as to what in their vi ac have been the outcome for the plaintiff had the defend apa d with a proper degree of professional competence， and the rela shined stion as to what that degree of professional competence an was， ex "1 two 23 19 thbnderticulars of negligence pleaded against the defendant in the a th tatement of claim are these
Ac rd August 1989 of the presence of a lump in the right breast he failed and or neglected ight's or refused to perform a thorough or any as amination of the plaintiff's right breast. it Failed again to examine thoroughly or at lle b the plaintiff's breast on 22nd September 89 when the plaintiff expressed concern that wer lde a lump appeared to be growing". In Dr. have in no opinion， the cancer should have been diagnosed in August 1 rscurate diagnosis is not， he said， difficult nowadays ease and a ne it was psy would have been the diagnostic method he would and a ne ld appropriate. h have req r ). b Both doc al pose of the view， not only that Mrs. Myers was more likely lymp likely to have been at Stage I in August 1989， but also that rast had the been， as it should have been， diagnosed and treated at actu that time and more likely than not that she would have been cured and be there wo been no recurrence. Dr. Popkin put her chance of a re cure at w w accept that evidence. ba len As for the ollowing a diagnosis of cancer， Dr. Wright described a the irn c ollow te between the relatively benign procedure of segmented di astectomy， more th ibly associated with other treatment， depending on 8( h nodes were involved， and the treatment which the he di plaintic sec ly had to undergo. I shall refer again to the mental nt and phys r hish h involved in that when dealing more fully with the inv di th ont le ```
```markdown # Evidence of Dr. I. Popkin It fell to Dr. I. Popkin, who is the gynaecologist to whom she had been referred, to explain to the plaintiff the factors involved in the decision on the matter of whether to undergo an operation for the removal of her ovaries. On the one hand, the reduction of the risk of recurrence of cancer was a consideration. On the other hand, the loss of the prospect of having any more children and the immediate onset of the menopause were factors to be considered. Dr. Popkin had already had counselling and completed chemotherapy and she decided upon the operation. Dr. Popkin had considered the consequences of that operation, physical and mental. Reduction of the level of two hormone factors would be an immediate reduction of the risk of recurrence of cancer, but the loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the knowledge that the cause of this is cancer, would be an immediate physical price of the reduction of cancer risk. The loss of both breast tissue, with the
```html July. item indant produced a schedule in rebuttal. I shall deal with each of the sequence used in both schedules. Some of the matters rect which is first, that the plaintiff was already suffering from cancer when she of tre; or consulted Dr. Kohlschein and would have had to undergo some for a. Th peatment in any event. Medical 33.02 Prescription costs are agreed at $160.00 The plai er iff was costs claimed by the plaintiff for a prosthesi wig and uary s. e treatment of stage I would not have required any of these it Blue Crod have brs hospitalised in Saskatoon， Saskatchewan for 27 days between and s of 1990 and May 1992 as an in-patient and had 22 out-patxi mendedies"， at a total cost of $10，553.26. Some hospital costs wo， rive， i been incurred in any event to reflect the probable surgery armpi nd ad by Dr. Wright. His evidence was that on a diagnostic procedure following a needle biopsy in August 1989 he would have rec days segmented mastectomy which would have taken out the small luteal aome surrounding tissue. The breast would have been retained amount， llary node sampling done. If the lymph node samples were nege radiotherapy would have been given to the residual breast a t after the baby's birth. Dr. Wright described this as a bene betweedure and the plaintiff would have been discharged after twencu gavt the latest if pregnant. A deduction of 10% of the total ho beyond out-patient costs seems to me to be the maximum reasonably h't. I therefore award $9497.90. Home/Chih wh The plaintiff returned to Canada in February 1990 and her mother ex up full-time work to look after her and her newly born sonnt The plaintiff claims， on her mother's behalf， the differenceFe $3 en her mother's earnings in 1989 and 1990. On Dr. Wright's imp ene， the plaintiff's treatment would have been over and done with a ul Nigel's birth. On the other hand， even if she had been per， at deadly， the probability is that she would have had to er'sp er ld ， reh ```
```html 12 arrange working for some kind of day care for him if she were to continue example. But I have no evidence about that. I do not know, f whether any member of her husband's family was in Cayman's is able to do this free of charge or what time her husband estima al iceman, would have had free during the day. The plaintiff 1991 al ted that during her temporary employment in Canada from Aug 927.85 to March 1992 Nigel went to a day care centre for to March about 8 lies asmonth. My view is that I have to ignore speculative possibility to what would have happened in Cayman and award the sum of Sects sought. Cost of airfa ng the plaintiff and her family to Canada cannot aff These comprise an airfare to Miami, shipping of personal ppr, sponsorship of plaintiff's husband to become a jec landed while and clothing for Nigel. It is not clear to me why a round re to Miami in February 1990 is claimed as part of to Nigrel ate it to the plaintiffs' account in her affidavit of what going from in that month. I therefore disallow the item of $349.24 the allowing the other relocation costs totalling 11s $1060.67 trav g I shall n any ulate on how, if at all, the Myers family might have relocate in happier circumstances. As for the cost of caayman clothing el, it is obvious that a baby born in Cayman in January might to need extra clothing to face February in Canada and indeed defendant does not press his objection to this item. Cost of lodgel 1 allow this item in full, at $1，802.50. Telephone 1 deduct 10% of the total as likely to have been an incurred at event, leaving $379.95. Transport ada 2， d， In my view, transportation costs in Canada or Cayman for the lit reatment at Stage I would have been minimal. ignore 7， imaward the $734.40 claimed. Board an ig for the plaintiff and son whilst in Canada is， of l The plaintiff and Nigel lived with her parents in be the id ```
```markdown # Transcript of the Document The document discusses a case involving a plaintiff who claims CDN$200 per month from February 1990 until April 1991. The plaintiff claims this amount for board and lodging expenses on behalf of herself and her parents. The defendant addresses the claim by stating that lodging costs would have been covered by rent payments and "boarding" would have been provided by the plaintiff's parents in any event. The document also mentions that the plaintiff's parents made their home available to her, resulting in some utility costs for 25% of the time. Household articles must have been provided by the plaintiff's parents, and the plaintiff and her family would have incurred costs for utilities and other expenses. The document further discusses the plaintiff's employment by the Cayman Islands Government as a teacher. She had been offered a contract for a further year from September 1989, which was a temporary post. The document notes that the plaintiff's contract would be terminated when a Caymanian became available for the position. The plaintiff's husband was a narcotics officer with the Royal Cayman Islands Police, and he had lived in Cayman for several years before coming to Canada. In 1989, her salary was CDN$2,255.65 per month, and it would have increased by 23% from January to April 1990. The document also includes a table with the following information: | DATE | ITEM | DOCUMENT | AMOUNT (CI$) | |------------|---------------------|----------|--------------| | 1 January | Loss of increase in salary at the rate of CI$371.00 per month | 1,113.00 | ```
```html 31 Oct 1990 Loss of wages 14 14，861.00 1 Janua 1992 0 30 June 40，337.00 LESS：ECDN$2，2 ts temporary teacher in Canada from 56，311.00 August 2 1991 to 2 march 1992 at a net salary 10，736.89 0 se month 555.65 per month equals CDN$15，789.55 45，574.11 LESS：I tinuance at the rate of CDN1，039.25 706.69 point for the month of June， 1992 44，867.42 Plai ther iant The def not ceeks to reduce that sum to $25，736.89 on the following grounds her (id not la re is no documentary evidence that the ntiff has or would have been offered a new nan Istract commencing in September 1990. There c that be any such evidence. But I infer both from the evidence betw Al own high academic record and husband's position in the 19 ands Police that on the balance of probabilities she royal C get would have ru but Alternatively there is no documentary evidence that she did not receive a 23% salary increase Si Septeen the 1st January 1990 and the 1st April tr. (ass be po ry That is until I believe the plaintiffs affidavit evidence that she did it. (i be my event， given earlier diagnosis and tment， the Plaintiff would probably not have ncari able to commence her teaching duties in ener 6 ember 1989 until at least April 1990 av uming that there would still have been a tion available for her) and probably not 1 1 September 1990 at the commencement of the ```
```html 15 academic year.) This is t, a ne eculat on who said d insuming the cancer was at Stage I in August 1989 and then n ipaching he bud, the plaintiff could have resumed normal life, and her temp was profession in two to three weeks. In any event the plaintain- maternity leave until 31st March. (iv a com probability is further that, given the no rary nature of the contracts and the at Caymanian status of the Plaintiff, she would have been offered a further contract onc ending September 1991 and that any Y, I a rnative employment would have been in Canada lower rate of salary, with tax. at g as agreeite view of the balance of probabilities as I have said. enov rnin Accordin seen is ward the sum of $44，867.42 claimed by the Plaintiff. ice of Costs of ea These we ands Gd at $2，547.00 FUTURE f ay Loss of As will ht of from what I have already said， I have come to the view that had one r been for the matters complained of in this suit the plaintif have returned to her employment as a teacher with the Cayman I overnment after the conclusion of her maternity leave. The evid Dr. Wright was that the plaintiff was highly unlikely to survi 1r and could die at any time. Of course， both doctors expressed te caution but Dr. Popkin's evidence was also that the plaintif h was probable sometime within the next year. In the los re tht a multiplier of one was the prop len ear future loss of earnings. One year's salary at f， f ve be sl d eri ```
```html $26，232.t to 31 income continuance under Canadian Social Security provision.) least March 1993 gives an award under this head of $20，578 lead "los Claim for Bri years." h The defence accepted in principle that a claim under the had been recognised and approved by the House of Lords in Pickton as British Rail Engineering Ltd. (1980) AC 136 but there was no admission as to the multiplicand and dispute as to the multiplier. It was， f 12 th multiplicand should be 2/3rds of the plaintiff's earnings dea la intiff proposed a multiplier of 16. The defendant argued that iteming a normal life expectancy of a woman of 36 a multipli ing wo dy would be appropriate， but even assuming earlier diagnosis for on eatment in August 1989， and no nodal involvement at that time， the maximum multiplier would be 8. There is a high degree of speculation inherent in assessment of damages under this head. I have already mol t with the plaintiff's loss of earnings up to date of trial an ht t my e year thereafter. She had no prospect whatever of ever resi lity； trk again. At the time of trial she was 35 years old. She had the fi d cancer at the age of 32. The medical evidence was that it pl ug likely than not that with proper diagnosis she would have been， "lost. While a decision on the balance of probabilities determin ces of issue of causation and liability， it does not at all follow， live， that in assessing lost years I should disregard the poss n that there would have been a recurrence of the disease even if a. N'tment had been promptly and properly carried out. Dr. Wright t hat the chances of a complete cure were 80%. I shall reduce t ons years" element of damages by reducing the multiplier by 20% c oc gure which I would otherwise have arrived at for the reason. n's antiff expressed her confidence that she would have continue ha stt g until retirement at 60 and said that the financial circumster ： si the family were such that they could not have afforded sun's off one income alone. Whether her husband's progress de le police force would have altered that situation cannot be assessed. w antor can fluctuations in the plaintiff's level of salary can hc； ib l t he ； d se； i ```
```html costs of child care of year live h or cat sun the cal is ive fl has ``` ```latex \textbf{Costs of year live child care} \textbf{of year live h} \textbf{or cat} \textbf{sun the cal} \textbf{is ive} \textbf{fl has} ``` ```markdown I will address this matter at the end of this trial. ```
```html judgment in 18 Future transportation and medical costs respect the ba or pa Damages ferred t and suffering and loss of amenity I was hospital fed to a number of authorities by each party on this issue. I have vi thound that but for the negligence alleged the plaintiff would Be languish of probabilities have been completely cured. That dise on whices the present case from Barnett v Kensington & Chelsea onl Ser Management Committee (1969) 1QB 428 and Sutton v Populat le hecs Family Planning Programme Ltd. (1981) Lexis In fore turning to another English case I will repeat the observat the h has been made before by this Court that such cases can be pufferi y as guidelines or pointers to the kind of awards that can be r iff wa However as there has to my knowledge been no previous nature in the Cayman Islands it is appropriate to cons vepassag principles expressly where the facts are comparab she Jefferson v Cape Insulation Ltd. (1981) Kemp F2-100 the plai spec pl has 47 years old. She went through some three years of amongsc ng from cancer with physical pain becoming acute and major intract treat prc some six or seven months before the trial. She then knew that teid not long to live and could die at any time. The follow airreadful ue from the judgment of Farquharson J is particularly relevant is aw also to bear in mind it seems to me the facts I have already found that the trievisery this woman is going to sustain is not the out which must be continually in her mind of cos her family and particularly her t child In any circumstances it must be a 1 possibility to contemplate for anybody o die that they are going to die in such t. ain and so far as she can understand it he continual influence of drugs ." 618000 Hc fed as damages for pain suffering and loss of amenity lor sfould have to be approximately doubled to take account of infla ipt slay However - Int s though the sufferings of the plaintiff in that case ```
```html 19 er were，th nd llygringsofMrs.Myershavebeeninmyjudgment substant suffeater. The defendant made some but not in my view owledgment of this，in proposing a figure of a little under $ She Myers has had to undergo hormone and chemo her o its distressing consequences，and the removal of one breast that irvaries. She was deprived of any chance of having any more ch indeed of being able to nurture her infant son for very lo of his knew that her death would leave her husband far from the land local birth to bring up the child. And the mental suffering of knowis 2 of a the days of life are numbered can only be increased in the cases cases a roman in her early thirties，the very prime of life. the course Among the cases which I was invited to consider was Adamek V Jurgens，old co 32 of 1990. The plaintiff suffered a severe leg injury ir ight on accident in which his fiancee was killed. He had a gruellindi of treatment，characterised by setbacks and disappoi le wound and considerable pain and compounded by the emotional distress bei bereavement which he suffered in the accident and which br in nal identifiable clinical depression. The prognosis was that he ort exp antinue to have recurring problems for the rest of his last， case prognosis was that he might lose the leg ng， 0， I assess，part on，suffering and loss of amenity of the present plaintif otaliting some three and a half years of very severe physical and emot fol $10 stress. It calls for a substantial award but Mrs. Mey rs' s ection of life，while exacerbating these sufferings while th penes also brings release from them. Moderation is called for，bean on (agasmind that in a case of this nature damages under this head for ic of a considerably larger award. Taking all these fac ount I assess damages for pain，suffering and loss of amenity ling 000.00 Ing， ，Lic 2，c and so far i wc in lows - PAST LOS f Th ig Medical int $ 160.00 Prescrip t tri ：ou at ：hc sm lev exs ti ```
```html Prosthetic bra 20 333.02 Blue Cross 333.02 Hospital care 9，497.90 Home/Ch.Med 257.04 Local Costs 2，927.85 Cost of pers on to Canada Shipping international effects 771.67 Sponsorship husband 85.00 Clothing 204.00 Air Train calls 1，802.50 Telephone rings 379.95 Transportation Canada 734.40 Plaintiff Nigel's 1，428.00 Board and costs of in Canada Loss of s 44，867.42 Cost of eating，sang home 2，547.00 FUTURE I insport Future all cost earnings 20，578.48 "Lost ya 209，856.00 Future of 12 and wheelchair 1，520.00 Future furniture 6，365.00 and medical 586.00 Pain，sue serv loss of amenity 100，000.00 ded. $404，901.23 Cost of ts child care and a m This claim was presented on the basis that a multiplied to b should be applied to the estimate at CDN$12，000.00 of the main costs of employing a nanny or home help to provide lifeces which the plaintiff，if she were able，would have proven'w. Further，or in the alternative，the plaintiff claimed：Pf of her husband and child damages for loss of wife's services( other's care. The defendant argued that on either basis thisi was essentially a dependency claim under part II of the Law of Reform Law(Revised) and should not be dealt with during the ref time of the plaintiff. On behalf of the plaintiff I was invited to shreak new ground and deal with the matter at trial during the tiff's life. In my view it would be quite anomalous for me to award under this head in a judgment based on evidence for while the plaintiff was still alive and delivered nunc te or he，gvi ```
```html pro tunc of the date of trial. 21 precise ibution the plaintiff's death need to be known. Moreover, the disbursement of an award under the Law of Torts Reform Law, which is for hile profit of dependents rather than the estate, may be differe and wh that under an action brought during the lifetime of a plaintif with which survives after the plaintiff's death in accord W the Estates Proceedings Law for the benefit of the estat represent both kinds of claim are carried on in the name of the persona Now thentative, they are different in nature. o he Both si e acknowledged that it might be appropriate to adjourn the claim farces of future child care until after the plaintiff's death. Laim that event has occurred, I believe that the wisest course are mac onar further argument related to the issue of future child clu That the basis of such an adjournment having taken place. Such rece ons ma under the equivalent statutes in England has given rise to o prable debate, and indeed specific statutory provisions there. lif which I It is ng le and the claim for future child care which has yet to be fin logctessed seems to me to be self-evident. Without wishing recove hcept any argument of the parties, I refer to observas after he in the House of Lords in Pickett v British Rail Engine and in particular the following from the speech of Lord Wi may it at page 778 of 1979 1 All ER- U assumed in the present case, and the tion is supported by authority, that if an 23 for damages is brought by the victim during etim and either proceeds to judgment or is his death under the Fatal Accidents Acts. tr assumption is correct, it provides a basis, ic and justice, for allowing the victim to th for earnings lost during his lost years." Such con as may flow from further argument on this issue will co de ff nt as not affis 1 ward which I have announced and judgment for aff or nc ti h are be entered as of the last day of trial. ul se db G. E. Harect Delivered as of 31st July 1992 Chief Just on 31st March 1994.