Guest post was written by ERIK MAGRAKEN on .
Adding to this site’s archived posts of judicial criticism of expert witness advocacy, reasons for judgment were published today by the BC Supreme Court, Vancouver Registry, finding that an ICBC hired expert witness’ opinion was “of little to no assistance to the Court“.
In today’s case (Tench v. Van Bugnum) the Plaintiff was injured in two collisions that the Defendants admitted fault for. The Plaintiff presented evidence that the collisions resulted in chronic Thoracic Outlet Syndrome (“TOS”) resulting in significant impairment. The Defendant’s insurer, ICBC, hired a doctor who did not examine the Plaintiff and provided an opinion rejecting the diagnosis. In dismissing this opinion as being of ‘little to no assistance‘ Madam Justice Fleming provided the following reasons:
 In this case, the conflict in the expert evidence regarding the diagnosis of TOS is easily resolved based on the much superior expertise and experience of Drs. Salvian and Caillier in diagnosing and treating TOS. Further, the strength of Dr. Karim’s opinion is significantly undermined by the fact that he did not examine Ms. Tench. There is no suggestion here that her TOS symptoms are susceptible to proper assessment by objective measures alone. Drs. Salvian and Caillier’s evidence made clear that their examinations and clinical testing of Ms. Tench played an important role in their diagnoses of her TOS. In any event, Dr. Karim’s opinion ultimately is of little to no assistance to the court, because it offers no explanation, prediction or recommendations with respect to any of Ms. Tench’s ongoing and significant symptoms.
 Therefore, I accept the entirely consistent expert opinions of Drs. Salvian and Caillier, along with their examination findings. I also largely accept the opinions and findings of Ms. Black regarding Ms. Tench’s functional capacity prior to the second accident.
In assessing non-pecuniary damages at $120,ooo the Court made the below findings and provided these further reasons:
 Without limiting the factual findings that flow from this acceptance, my findings include:
1. The first accident caused injuries to the soft tissues of Ms. Tench’s neck, shoulder girdle and back as described by Dr. Caillier, resulting in acute and significant pain in those areas, as well as neurologic TOS, likely the result of ongoing spasm and tightness in the scalene muscles. Her condition involves significant sensory symptoms including numbness and tingling and some pain in her arms and hands. Her pain and TOS symptoms improved somewhat but were chronic by the time of the second accident.
2. The first accident also caused the emotional and psychological symptoms Ms. Tench has experienced since then. In other words, I reject the defendants’ assertion her psychological complaints are not causally linked to the accident and are perhaps attributable to other potential causes, namely a genetic predisposition. I note that in cross-examination Ms. Tench was asked to confirm that two particular family members suffer from anxiety or depression, which she did.
Regarding factual causation, Ms. Tench is required to prove on a balance of probabilities that the defendants’ negligence was not the sole or predominant cause, but a cause of her injuries and loss, applying the “but-for” test: Athey v. Leonati,  3 S.C.R. 458 at paras. 13–17. It is well-established and must be remembered that cause in fact is determined in a “robust common sense fashion”. Scientific proof is not required. Inferences drawn from proven facts may suffice: Clements v. Clements, 2012 SCC 32 at para. 9; and Athey at para. 16.
Applying the but-for test, the opinion evidence of Dr. Caillier and the fact evidence of Mr. Smith, Ms. Buhler and Ms. Tench amply establish that the emotional and psychological symptoms she has experienced after the first and second accidents were caused by them. The causal mechanisms likely included the impact of the accidents themselves, her ongoing pain and sensory symptoms and their consequences for her, including poor sleep.
3. Ms. Tench’s physical symptoms interfered with her ability to work at Rona, prevented her from continuing to work at Starbucks, and significantly affected how she carried out her ESL teaching and TA responsibilities. Her symptoms also undermined her participation in graduate school. Whether or not the grades she obtained were significantly lower than they would have been absent her injuries, it is clear her pain and TOS symptoms prevented her from focusing, concentrating, reading and typing for sustained periods, undermining her ability to keep up with preparation and course work.
4. For the most part, I accept Ms. Black’s opinion about Ms. Tench’s functional vocational and non-vocational capacity shortly before the second accident. Based the fact evidence, I find Ms. Tench could not have worked more than she was at that time or by the time of the trial. It is clear that working as much as she did left her with little energy for anything else including her marriage and her relationships with family and friends. In other words, she was essentially exhausting herself.
5. Accepting Ms. Tench’s TOS symptoms were somewhat, but not significantly better before the second accident, I also accept that she had learned to better manage all of her symptoms and was experiencing less emotional distress and preoccupation with her physical condition by then.
6. Based on the clinical findings of Dr. Salvian and Dr. Caillier, and the evidence of Ms. Tench and Mr. Smith regarding her pain and TOS symptoms since the second accident, I am satisfied it significantly aggravated both conditions and she has not been able to durably perform anything other than light housekeeping, working as much as she has been. Although antidepressant medication has lessened her anxiety and allowed her to feel more calm, she is easily overwhelmed and her outlook is quite pessimistic. Her psychological and emotional symptoms include not just low mood but also reactivity.
7. Given the aggravation of her chronic pain condition and chronic TOS caused by the second accident, and accepting Ms. Tench was struggling to manage the demands of working part-time at three ESL positions while completing three prerequisite courses at the time of the trial, I find that her functional capacity deteriorated after the second accident.
8. Botox injections provide temporary relief from some of her neck and TOS symptoms but limited improvement in function. Although she is better able to carry light objects without the same fear of dropping them, she must still avoid aggravating her condition by engaging in the problematic activities and postures identified by Dr. Salvian, Dr. Caillier and Ms. Black.
9. Ms. Tench’s prognosis is poor. Her chronic myofascial pain syndrome and chronic TOS are likely permanent. Accepting it is probable she will improve to where she was before the second accident, this outcome would still leave her with significant ongoing pain in her neck and shoulders, that will fluctuate in intensity based on her activities, and intermittent but significant symptoms of numbness and tingling in her arms and hands, along with some pain. She also faces an increased risk her conditions will worsen, and is vulnerable in particular to an aggravation of her TOS caused by further injury to her neck or even ongoing scalene spasm as explained by Dr. Salvian. I also accept however that implementing many of the recommendations of Dr. Salvian, Dr. Caillier and Ms. Black, and working less than full-time will allow Ms. Tench to better manage her conditions.
 Once a thriving, dynamic, energetic young woman with very bright future, Ms. Tench has been left struggling to manage chronic, significant pain and TOS symptoms that have cast a shadow over all aspects of her life. Since the accidents she has worked and studied in significant pain, discomfort and distress. Coping with her physical symptoms and the demands of work and school have left her with little energy for anything else.
 Accepting her condition played some role in her decision not to pursue a PhD, she lost the chance to fulfill her dream of a richly intellectual work life.
 Her relationship with Mr. Smith has been deeply affected. Even physical affection causes her difficulty. She fears being unable to care for the children they hope to have in the future. No longer able to contribute much at home, Ms. Tench has lost the sense of fulfillment she derived from cooking, baking, decorating and entertaining, and maintaining her own fastidious standards. She is also unable to participate meaningfully in almost all of her other previous hobbies and activities. Close to her family, extremely social and very active in her church before the accidents, Ms. Tench is now quite isolated.
 Sadly, her pain and TOS conditions are permanent. Although Botox injections offers serial temporary relief of some of her symptoms, they are not a cure. The prospect of some improvement although probable is less than certain. She could improve to the point she reached prior to the second accident, but she also faces the risk of worsening symptoms. Better management of pain is the most realistic scenario.