PI Brief Update

Legal Mind Case and Commentary No 27: PTSD in Road Traffic Accident: A review of key medico-legal issues - Koch HCH, Jansen F, Crowther-Green H & Francis A

12/03/20. Background: Evidence for both physical and psychological injuries when litigated motorcycle accident is discussed. Issues of range of diagnostic opinions, duration and prognosis and rehabilitation are commented on.

Key Words: Motorcycles; Post-traumatic Stress Disorder; Road Traffic accidents; Diagnosis; Psychological Injury

Case: Heath v McCarthy [2019] 5 WLUK 637 and [2019] 7 C.L.213

Before: His Honour District Judge Lampkin 22.5.19 County court Liverpool.

Male (36) unseated from his motorcycle at high speed. Multiple multi-site physical injuries and psychological symptoms diagnosed as Post-traumatic Stress Disorder (PTSD). Significant interventions over the first 22 months post-accident which brought only partial improvement in symptoms. Pain and reduced arm agility limited his sporting activities and riding his motorcycle. Medical opinion was that, at 30 months post-accident there was 20% right shoulder disability which was likely to become permanent. Significant psychological symptoms of PTSD lasted 13 months (continuity of intrusive thoughts, helplessness, flashbacks and some avoidance) plus travel and general anxiety and low mood.

Prognosis was assessed as good for these residual psychological symptoms/injuries, following Cognitive-behavioural therapy, refresher motorbike lessons and social activity. He underwent seven sessions of CBT with resolution of symptoms 33 months after the accident. Award: General Damages of £24,000 (apportioned as to £8000 in respect of psychological injury and £16,000 in respect of physical injuries.

Commentary

a) Range of diagnostic opinion

Road traffic accidents can result in a range of psychological disorders which reflect the fear, anxiety and trauma of the index event. Trauma can be experienced variably by individuals depending on factors such as severity of physical impact, associated physical injuries, sense of liability, pre-existing predisposition or vulnerability to psychological and sense of exposure to threat of death or serious injury.

The range of diagnoses include PTSD (DSM.309.81), Acute Stress Disorder (DSM 308.3), Adjustment Disorders (DSM 309.89) or a generic label “other specified trauma – and stressor-related disorder” where the criteria for the above three trauma disorders are not specifically next but a significant disruptive traumatic reaction occured. Examples of this are delayed onset of symptoms, prolonged duration or persistent complex bereavement disorder.

In addition to the trauma-related diagnoses available, a common disorder found is of Specific Phobia (DMS 300.29) where a marked fear about a specific object, in the above case, motorcycling (general; high speed; motorway), which provokes indicate anxiety.

b) Duration, severity and residual symptoms

Where no medico-legal or civil litigation process is involved, the natural course of trauma-related symptoms in road traffic accidents is for a gradual decrease and resolution of symptoms where the individual gradually re-exposes him/herself to the travelling circumstances, in this case motorcycling. Where persistent avoidance occurs, the duration and resolution of psychological symptoms will be lengthened and less optimistic.

In most cases, there is a gradual resolving of the majority of symptoms with some residual and/or intermittent symptoms remaining.

Understandably, the ongoing process of the litigation with recurrent medical assessments and legal correspondence and discussion act as a reminder of the index event and associated distress, making fuller resolution of recovery problematic.

c) Therapy and other interventions

In the eventuality that traumatic – and associated psychological symptoms do not abate, then psychological therapy intervention can be highly effective. In the most typical circumstances where an individual has some level of recurrent anxiety about road travel (even with associated sleep disturbance and anticipating anxiety prior to journeys), then cognitive-behavioural therapy (CBT) on an individual basis is typically the treatment of choice, as it was in this case.

Trauma-focused CBT and Eye Movement Desensitization and Reprocessing (EMDR) are also considered when trauma-symptoms per se predominate.

An alternative to CBT when the psychological focus is more sleep disturbance, nightmares, flashbacks and emotional detachments or dissociation then Eye Movement Desensitisation and Re-Processing (EMDR) is considered.

A behavioural/practical adjunct to CBT is refresher motorbike (or driving) lessons whereby an instructor can reinforce the claimant’s skills and build up confidence to re-expose him/herself to the travel activity again incrementally.

d) Conclusion

A relatively straightforward case with positive outcome as reflected by the good reproach to rehabilitation and logical apportionment of damages

Prof. Hugh Koch, Dr Friso Jansen, Dr Helen Crowther-Green and Dr Ashley Francis.

Professor Koch is visiting professor in Law and Psychology at Birmingham City University (www.cv.hughkoch.com).

Jansen, F. J. (2016) Lower-back pain: the search for the optimal guideline – the creation of facts and the role of science. Presentation: University of Lancaster. Socio-Legal Studies Association Conference.

Koch HCH (2016) Legal Mind: Contemporary Issues in Psychological Injury and Law. Expert Witness Publications. Manchester.

Koch, HCH. (2018). From Therapist’s Chair to Courtroom: Understanding Tort Law Psychology. Expert Witness Publications. Manchester.

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