CERTIFICATE OF DETERMINATION OF MEMBER  	

Citation:	
Jarvis v State of New South Wales (Northern Sydney Local Health District) & Ors [2023] NSWPIC 20 	
		
APPLICANT:	Juanita Jarvis	
		
FIRST RESPONDENT:	State of New South Wales (Northern Sydney Local Health District)	
		
SECOND RESPONDENT:	State of New South Wales (Southern NSW Local Health District)	
		
senior Member:	Kerry Haddock	
		
DATE OF DECISION:	18 January 2023	
		
CATCHWORDS:	WORKERS COMPENSATION - Claim for weekly benefits and medical expenses for psychological disease injury, pursuant to sections 4(b(i) and 4(b)(ii) of the Workers Compensation Act 1987 (1987 Act); applicant unreliable historian regarding previous psychological conditions and alcohol abuse; first respondent disputed that the applicant had given notice of injury and made a claim in accordance with sections 254 and 261 of the Workplace Injury Management and Workers Compensation Act 1998 (1998 Act); both respondents disputed injury; substantial contributing factor; main contributing factor; incapacity and necessity for medical treatment; Held – the applicant failed to give notice of injury to the first respondent in accordance with section 254 of the 1998 Act and did not establish that special circumstances applied; award for the first respondent; the applicant sustained the aggravation, acceleration, exacerbation or deterioration of a disease, pursuant to section 4(b)(ii) of the 1987 Act, in the employ of the second respondent; the applicant has at all material times had no work capacity; award for the applicant against the second respondent for weekly benefits and medical expenses.  	
determinations made:	1.	That there is an award for the first respondent. 
2.	That the second respondent is to pay to the applicant weekly compensation pursuant to s 37 of the Workers Compensation Act 1987 at the rate of $1,788.94 per week from 13 April 2020 to 13 June 2022. 
3.	That the second respondent is to pay, pursuant to s 60 of the Workers Compensation Act 1987, the applicant’s medical, hospital and related expenses.	

STATEMENT OF REASONS

BACKGROUND
1.	The applicant, Juanita Jarvis (Ms Jarvis) claims to have sustained psychological injury arising out of or in the course of her employment as a registered nurse (RN) with each respondent, State of New South Wales (Northern Sydney Local Health District) (first respondent/NSLHD) and State of New South Wales (Southern NSW Local Health District) (second respondent/SNSWLHD). 
2.	The first respondent was insured at relevant times by QBE Workers Compensation (NSW) Limited (QBE) and the second respondent by Employers Mutual NSW Limited (EML). 
3.	The second respondent completed an Injury Notification to EML on 13 December 2019. The date of injury was recorded as 18 October 2019 – “While working in Emergency Dept, this triggered off flash backs of past traumas experienced in ED and past negative dealings with management.” The respondent had been notified of the injury on 9 December 2019. 
4.	The applicant had ceased work on 21 October 2019. She had provided a medical certificate dated 7 November 2019, certifying her totally unfit for work to 20 December 2019, due to post-traumatic stress disorder (PTSD). 
5.	The second respondent’s Accident Investigation Form is also dated 13 December 2019. The description of the incident was “Staff member states suffering PTSD after working in the Emergency department, related to previous bad experiences in other facilities”. 
6.	The second respondent commented that the incident was related to the normal duties and responsibilities of an ED (Emergency Department) nurse. The applicant had not been in the role long enough to warrant a PPAD (Personal Performance Appraisal & Development). 
7.	The applicant completed a Worker’s Injury Claim Form (the claim form) on 23 September 2020. The date of injury was stated to be 18 October 2019. The claim form, which was not completed by the applicant, also stated that the injury/condition occurred from 2003 onwards. 
8.	The particulars of injury related to the applicant’s employment at Crookwell Hospital (Crookwell), where she commenced work on 19 September 2019. They are numerous, and I will summarise them. 
9.	The applicant referred to an “unsafe and unsustainable workload, lack of clinical support”; disregard for patient safety; unstable and unsafe rostering; lack of security or administrative support after office hours; hospital culture of “keep up and shut up”; cleaners bullied by patients; gossiping; poor morale (which she believed came from poor leadership); inadequate training and record-keeping; lack of provision for culturally appropriate treatment; and threats to staff by patients, which she was unable to monitor due to poor security.
10.	The claim form stated that “The build-up of these issues suffered by the claimant resulted in the manifestation of a psychological injury due to the nature and conditions of her employment.” The injury was claimed to be PTSD and Major Depressive Disorder (MDD). 
11.	The delay in reporting the injury was stated to be that “The claimant was unaware that the nature and conditions of her employment had caused a psychological injury until it manifested in October 2019.” 
12.	On 17 March 2020, EML issued the applicant with a notice pursuant to s 78 of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act). 
13.	EML maintained that the applicant’s “PTSD” was primarily due to traumatic incident exposure that took place prior to her employment with SNSWLHD. It was “of the view” that her condition was not sustained in the course of her employment with SNSWLHD, nor was employment a substantial contributing factor to such injury. The claim was declined on the basis of ss 4 and 9A of the Workers Compensation Act 1987 (the 1987 Act). 
14.	In the alternative, EML relied on s 11A of the 1987 Act, referring to the applicant’s roster. It regarded her seeking beneficial rostering arrangements as falling “well within the bounds of ‘provision of employment benefits’”. Liability was declined as her injury was caused by reasonable actions on the part of the employer in relation to her roster, or the provision of employment benefits. 
15.	On 23 April 2020, EML issued the applicant with a notice pursuant to ss 78 and 287A of the 1998 Act. It advised that it had treated an email from Ms Jarvis dated 9 April 2020 as a request for a review. 
16.	EML advised the applicant that she was no longer entitled to weekly compensation and medical and related services, effective from 9 April 2020 (the date on which the original decision took effect). 
17.	EML disputed that the applicant had sustained an injury and that employment was a substantial contributing factor to any injury. It maintained that her injury was classified as a disease, and her employment was not a substantial contributing factor to the aggravation, acceleration, exacerbation, or deterioration [of the disease], and therefore not compensable under ss 15 and 16 of the 1987 Act; and that her injury was wholly or predominantly caused by reasonable action taken or proposed to be taken by or on behalf of her employer with respect to transfer, demotion, promotion, performance appraisal, discipline, retrenchment, dismissal, or provision of employment benefits, and is therefore not compensable under s 11A of the 1987 Act. 
18.	EML maintained that the applicant had no total or partial incapacity for work as a result of a workplace injury, so that she had no entitlement to weekly compensation; and any further medical treatment was not reasonably necessary. 
19.	On 25 May 2021, the applicant’s solicitor completed a Notification of Injury/Illness to NSLHD. It stated that the date of injury was 18 October 2019. The injury was claimed to be PTSD, MDD. 
20.	The incident was described as “cumulative traumatic stress throughout nursing career”, for NSLHD and SNSWLHD between 2008 and 2019. The applicant’s manager/supervisor was informed on 29 April 2021 that she wanted to claim workers compensation. 
21.	On 2 June 2021, QBE issued the applicant with a notice pursuant to s 78 of the 1998 Act, with respect to injury on 18 October 2019. 
22.	QBE disputed that the applicant had sustained injury; that her employment was a substantial contributing factor the injury; and that her employment was the main contributing factor to the aggravation, acceleration, exacerbation or deterioration of her disease injury. 
23.	QBE also disputed that the first respondent was the applicant’s last employer in employment to the nature of which her disease injury was due; or in employment that was a substantial contributing factor to the aggravation, acceleration, exacerbation or deterioration of the disease. 
24.	QBE maintained that the applicant had failed to give notice of her injury and to make a claim for compensation, as required by ss 254 and 261 of the 1998 Act. It disputed that she was entitled to payment of either weekly benefits or medical expenses. 
25.	QBE stated that the applicant’s employment with the first respondent commenced on 26 February 2015 [sic] and ceased on or before 15 October 2015, and her employment was terminated on the basis that she had not worked in six months. 
26.	On 6 October 2021, the applicant’s solicitors requested a review of QBE’s decision. They advised that it was her position that she developed PTSD in the course of her employment with NSLHD, which was asymptomatic and undiagnosed until she commenced work at Crookwell. 
27.	The applicant’s solicitors submitted that her failure to give notice of the injury was occasioned by ignorance of the fact that she had suffered a recognised psychiatric injury. She was not aware that she was suffering from PTSD until late 2019. Her failure to make a claim was also occasioned by ignorance. She was suffering “serious and permanent disablement”. Her injury was taken to have been received when she made the claim against SNSWLHD, on or about 12 December 2019
28.	On 14 October 2021, QBE issued the applicant with a notice pursuant to s 287A of the 1998 Act. It had reviewed and maintained its decision to dispute liability. 
29.	On 22 April 2022, EML issued the applicant with a notice pursuant to ss 78 and 287A of the 1998 Act. The date of injury was stated to be 4 December 2019. 
30.	EML disputed that the applicant had sustained injury; that employment was the main contributing factor to the contraction of, or aggravation, acceleration, exacerbation or deterioration of a disease injury; and that employment was a substantial contributing factor to the injury. 
31.	EML maintained that the applicant’s injury was wholly or predominantly caused by the second respondent’s action with respect to transfer and/or the provision of employment benefits. It disputed that she was entitled to payment of either weekly benefits or medical expenses. 
32.	On 3 May 2022, QBE issued the applicant with a further notice pursuant to s 287A of the 1998 Act. It had again reviewed and maintained its decision to dispute liability. 
33.	The applicant lodged an Application to Resolve a Dispute (the Application) on 9 August 2022. 
34.	The applicant claimed to have sustained a disease, deemed to have occurred on 18 October 2019. The only description of the injury was that she sustained a psychological injury during the course of her employment as an emergency ward nurse. 
35.	The Application claimed weekly benefits from 9 April 2020 to 2 June 2022; and medical expenses of $2,526.60. 
36.	The first respondent lodged its Reply on 23 August 2022. 
37.	The second respondent lodged its Reply on 31 August 2022. 
ISSUES FOR DETERMINATION
38.	The parties agree that the following issues remain in dispute:
First respondent:
(a)	whether the applicant gave notice of injury and/or made a claim for compensation within the appropriate time period/s;
(b)	whether the applicant has sustained injury arising out of or in the course of employment; 
(c)	whether employment was a substantial contributing factor to any injury; 
(d)	whether employment was the main contributing factor to a disease injury; 
(e)	whether the applicant is entitled to an award of weekly benefits;
(f)	whether the applicant is entitled to an award in respect of medical expenses, and
(g)	whether it was the last employer in employment to the nature of which any disease injury is due.

Second respondent:
(a)  	whether the applicant has sustained injury arising out of or in the course of employment;
(b) 	whether employment was a substantial contributing factor to any injury; 
(c)  	whether employment was the main contributing factor to a disease injury; 
(d) 	whether the applicant is entitled to an award of weekly benefits;
(e)  	whether the applicant is entitled to an award in respect of medical expenses, and
(f)  	causation. 
PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION (the Commission)
39.	The matter was listed for preliminary conference on 7 September 2022. Ms Butcher appeared for the applicant, who was present. Mr Galea appeared for the first respondent; and Ms Watts appeared for the second respondent. Ms Le Paige of QBE and Ms Khanna of EML also attended. 
40.	The Application was amended to plead that the deemed date of injury is 20 October 2019; and to claim weekly benefits pursuant to s 37 of the 1987 Act from 13 April 2020 to 13 June 2022, as the applicant was paid weekly benefits by the second respondent for 17 weeks. The applicant and the second respondent agreed that her pre-injury average weekly earnings (PIAWE) were $2,236.17. 
41.	The matter was listed for conciliation/arbitration hearing on 14 November 2022. Ms Balendra of counsel, instructed by Ms Butcher, appeared for the applicant, who was present, with her two daughters. Ms Goodman of counsel, instructed by Mr Galea, appeared for the first respondent. Mr Adhikary of counsel, instructed by Ms Jenkins, appeared for the second respondent. Ms Le Paige attended. Ms Mitreva of EML proposed to attend by Teams, but both she and Ms Le Paige were excused. They were both available to provide instructions had they been required. The applicant was at various times excused and absented herself from the hearing.  
42.	Ms Balendra advised that the applicant relied on both ss 4(b)(i) and 4(b)(ii) of the 1987Act. 
43.	The second respondent withdrew its reliance on s 11A as a defence to the claim. 
44.	I am satisfied that the parties to the dispute understand the nature of the application and the legal implications of any assertion made in the information supplied. I have used my best endeavours in attempting to bring the parties to the dispute to a settlement acceptable to all of them. I am satisfied that the parties have had sufficient opportunity to explore settlement and that they have been unable to reach an agreed resolution of the dispute. 
EVIDENCE
Documentary evidence
45.	The following documents were in evidence before the Commission and considered in making this determination: 
(a)	the Application and attachments;
(b)	first respondent’s Reply and attachments;
(c)	second respondent’s Reply and attachments;
(d)	Application to Admit Late Documents dated 2 November 2022 and attachments, filed by the first respondent, and
(e)	Application to Admit Late Documents dated 8 November 2022 and attachments, filed by the second respondent. 
Oral evidence
46.	There was no application by any party to cross-examine any witness or call oral evidence.
FINDINGS AND REASONS 
Evidence of the applicant, Juanita Jarvis 
47.	Ms Jarvis’s statement is dated 23 June 2021. It is lengthy and detailed, and I do not intend to reproduce it in full. 
48.	She was employed by the first respondent at Hornsby Ku-ring-gai Hospital (HKH) as a RN, and by the second respondent at Crookwell as a registered emergency nurse. 
49.	She had previously had “situational mental health concerns”. In 2007, she was going through financial and family stress and was drinking more than normal. Her general practitioner (GP), Dr Sally Tsin, referred her to a psychologist, Vicky Richards. Her records indicate she attended two counselling sessions. After leaving her husband, and being under care and counselling, her health improved substantially, and she did not require ongoing counselling. 
50.	Throughout 2010 and 2011, she went through a period of depression. She was stressed due to being unable to return to HKH after long service leave. She was considering starting a relationship with her ex-partner, which had caused her to drink more than usual. She was also struggling to cope with events that happened at HKH. 
51.	She was able to rectify this after seeking advice from Dr Tsin. She is aware that her medical records indicate Dr Tsin considered a diagnosis of bi-polar. Neither Dr Tsin nor any other medical professional had discussed this with her. 
52.	She met her partner a few months later, started tutoring and lecturing at UTS (University of Technology Sydney), returned to work at Royal North Shore (RNS) (NSLHD) and was promoted to CNE (clinical nurse educator) AMU-Division of ED. Her mental health improved vastly until she started work at Crookwell. 
53.	Her father took his own life when she was 30 years old. 
54.	She commenced full time employment with HKH as an emergency nurse in about 2003. She was there from 2003 until 2009. She started an antique and gift store in 2005. She continued to work permanent part-time at HKH in the ED ward, frequently taking overtime and extra shifts. 
55.	After 2010, she worked within NSLHD, including at Hornsby and occasionally RNS. The hours per week varied. She commenced employment with UTS as an academic, clinical facilitator and lecturer, on a casual basis, in 2010. She continued to work casually for NSLHD until 2016. 
56.	Between about November 2015 and February 2016, she was employed as a full-time teacher by Careers Australia. She left after it was closed and de-registered. 
57.	In about March 2016, she was employed at NSW TAFE, teaching the Diploma of Nursing. She worked for two years out of Ultimo, Western Sydney and Nepean. 
58.	Between 2015 and 2019, she worked on a casual basis as a nurse, first aid trainer, facilitator, researcher, assessor, and instructor for Healthcare Australia. It was a third party that allocated shifts to NSW Health staff. She was allocated shifts at various hospitals around North Sydney. 
59.	On 18 October 2019, during her employment at Crookwell, she sustained a psychological injury and lodged a claim. She had not returned to work since. 
60.	To the best of her recollection, she first started employment with HKH in about April 2003. She consolidated her service and in or about September 2009, it was calculated that she had 10 years’ service. She went on long service leave for six months. During this time, she and her family moved to Queensland, where she owned a house, which she renovated to get it ready for sale. They lived in Queensland for about six months. 
61.	In 2010 she returned to Sydney and was told there was no longer a position available in Emergency at HKH. She understands her medical records indicate she was hesitant to return to work there because she did not feel supported. 
62.	She was advised that if she did not return to the employment offered at HKH, she would be placed on the casual roster and could work at any hospital in the NSAHS (Northern Sydney Area Health Service). She worked in 2011 at RNS in the Acute Medical ED as a clinical educator and was happy to stay in that line of work.  
63.	During her employment with HKH, she witnessed numerous traumatic events. She had carried the experience with her ever since. She had frequently referred to them throughout her years as a clinical educator. She cannot recall the exact dates of these events but has provided dates where possible. 
64.	Since she started at Crookwell and throughout the claims process she had relived a lot of these experiences. She had always previously felt supported, respected, and purposeful at work. She thinks that part of the reason she has been so heavily impacted by her employment is that she associates a huge part of her identity with being a critical care nurse. 
65.	She has referred to incidents at HKH between 2003 and 2009, which I will summarise. 
66.	In about 2003, three children, whose mother had been murdered after a domestic violence incident, were brought in. The police said they had been subjected to a satanic ritual. They had been sexually assaulted and had faeces and urine on them. 
67.	The children needed to wait overnight for sexual assault testing. The nursing unit manager (NUM) instructed her to leave them overnight. She said she wouldn’t leave them on their own and stayed with them until the sexual assault team came in the morning. She found the incident confronting, particularly as a mother. She enquired about the children the next day and was told it wasn’t her business. She has often thought about them.
68.	In about 2008, she was caring for a baby who had asthma. She was really concerned that the baby wasn’t improving, and escalated her concerns to the doctor in charge of the ED. For hours, she suggested they call the Care Flight helicopter to take the child to Westmead Hospital (Westmead). The consultant did not support this. She eventually called Care Flight. They stated they needed the consultant’s approval, but she gave them information about the patient in preparation for transfer. 
69.	She rang the consultant at Westmead, who said she would speak to the other consultant. The baby’s condition continued to decline. Another doctor intubated the baby, who had stopped breathing. She was then flown to Westmead. 
70.	She knew the baby was not okay. She felt frustrated, angry, and scared that the child could have died. She put in an IIMS SACs1, which is a notification of a critical incident. It was recorded as a “near miss”. It was never mentioned to her again. 
71.	On another occasion, a woman rushed into the ED with a child, screaming that he was not breathing. The emergency nurse on duty “froze”. She told her to open the doors and let her in. 
72.	The mother rolled the child into her arms. He was cold and visibly blue. She put him onto oxygen, and she and the team commenced CPR (cardiopulmonary resuscitation). The child lived. Staff at HKH never mentioned the incident again. In her experience, meetings with senior staff were only held if something went wrong. 
73.	On another occasion, a psychiatric patient had been left by another nurse unsupervised. He had tried to hang himself, using a blood pressure cuff. She thinks he was successful. Her memory around this is particularly foggy. It really affected her. She thinks the nurse was demoted or deregistered. It made her highly anxious about leaving psychiatric patients with suicidal ideation unattended. 
74.	In or about 2008, she was working as a triage nurse in the ED at HKH. A man told her he had “cut himself”. She asked to look at the wound, and saw he had no testicles. He told her he “got a steak knife and cut it off”. His scrotum was “in the bin at home”. He was taken away for urgent medical attention. She continued working until the end of her shift. 
75.	In or about mid-2009, a woman who was having an allergic reaction had parked in the ambulance bay. The woman had treated her reaction and was improving. She asked the woman to move her vehicle in case of emergency. She was speaking and not at risk of immediate harm. 
76.	The woman made a formal complaint, and she was asked to attend a meeting with her supervisor on her day off. She was not supported for keeping other members of the community safe. To her knowledge, no disciplinary action was taken. She was told it would be on her record, and an apology to the patient was prepared on her behalf. 
77.	Shortly after, she discussed with her boss that she felt she needed a break and intended to use some of her long service leave. Her best recollection is that this was due to commence on 10 September 2009. She thought she was functioning well, but after the incident she did not feel supported. 
78.	On her last day of work, she was working as a triage nurse. She heard a loud bang that she thought was a gun shot. She was sure she could see a hole in the glass doors. It seemed like at the same time a man appeared on the other side of the glass. He put his hand under the slot (triage window) and showed her a bullet. She spoke calmly to him. He did not move or speak. 
79.	She pressed the code black buzzer. The man nodded but kept staring. She noticed he had a backpack. She started to move patients inside the emergency doors, as was the protocol. 
80.	She went back to triage shortly after and the police were coming through the ambulance doors. They were securing their weapons. The patient could not see through to the ambulance doors. The police indicated to let him in. They wrestled him to the ground and he was secured and sedated. They either took him to Mental Health Intensive Care [sic]. She believed at the time he remained under police guard. 
81.	Staff continued working. The after-hours director of nursing (DON) told her she had to report the incident. She got the impression she did not support her decision to call the police. She gave her a Swiss army knife and told her this was the weapon that was recovered. She pulled out the knife blade and observed it. She asked the DON jokingly if she was “Crocodile Dundee”. 
82.	She was grateful to be going on leave and could tell she was feeling more heavily impacted by events at work. She received no support following any incident. She was confused and scared. 
83.	She started long service leave on or about 10 September 2009. She was anxious and unwell and felt she needed a holiday. She had no experience of being supported. She was called by HKH management and asked to withdraw the SACs 1 IMMs. She was confused, as she had no access to the system. She moved to Queensland, tried to forget about work, and kept busy. 
84.	When she returned from long service leave in about March 2010, she returned to Dr Tsin. She had tried to reconcile with her husband, but the relationship was over. 
85.	By this time, she felt HKH would not support her in returning to the ED because of the code black incident. She started getting more work lecturing at UTS and took up a six month contract to work as a clinical nurse educator at RNS. She was still employed by NSAHS. 
86.	While working at HKH on a casual list in 2015, she noticed that a call sheet read “no ED”. This usually meant a nurse was not trained in ED. She raised this with the after-hours nursing manager, who had no explanation, except that she had seen it before and some staff had been targeted to “ease them out”.  
87.	After Careers Australia collapsed, she was excited to move to TAFE NSW in early 2016. Until this time, her employment was maintained on a casual basis at HKH. She approached it to increase casual work and was told there were no vacancies and no shifts. 
88.	She was able to access more clinical contact hours by working for a “tier one” agency, preferred by NSLHD. In 2016, her casual status at NSLHD was withdrawn, for reasons not known to her. 
89.	After that, she relied on employment with TAFE NSW and Healthcare Australia, across various Health districts, mainly in ED or ICU. She often still worked as a facilitator, supervising students, including at HKH ED. 
90.	Between 2015 and 2019, she was fine and happy. In hindsight, she was very hypervigilant. She always faced open doors and planned an escape should it be necessary. She did not recognise this as unusual and felt normal. After the Lindt Café siege and other incidents involving guns, particularly in hospitals, she became more vigilant, introduced more trauma training, and studied WHS protocol for dealing with armed and violent patients. 
91.	In January 2016, a service revolver was taken from a police officer in the ED at Nepean Hospital and three people were shot. Her fears about procedure not being followed came to fruition and she felt more justified in having been more cautious about the gun incident at HKH. 
92.	On 16 September 2019, she started employment as a full-time registered nurse emergency at Crookwell. She reported to NUMs Vanessa Chapman and Debbie Hay. 
93.	She felt she had the experience and qualifications to perform this job. Crookwell was a shock. She found it to be completely under-resourced and providing inadequate care. The attitude of some staff was very nonchalant, and she found this potentially dangerous and stressful. 
94.	There was no apparent roster system in place when she started. Initially, she would only find out she was working the day or night before a shift. She worked eight hour shifts on a seven day rotating roster, with rarely any breaks. She felt this was unsafe and unsustainable. There was inadequate staff and no security or administrative support. 
95.	The rostering left her feeling overworked, run down and sleep deprived. She had a low sense of energy, fatigue, and was feeling very overwhelmed. She tried to raise issues with the roster process with Vanessa Chapman. She said it would continue to be a seven day roster. It was explained this is sometimes referred to as “disaster rostering”. It is done so NSW Health can have as much flexibility as possible. However, staff are often tired and work-life balance is not considered. 
96.	The staff appeared sad, not cohesive, and frustrated. It felt unsafe and there was limited support. There were no enforced staff/patient ratios, which meant that, particularly on night duty, there was no ED support. There was no clerical, security, pathology, psychiatry, or cardiac staff in case of emergency. Staff morale was abysmal. [At] every handover, there were nurses crying from exhaustion. She wasn’t used to this and found it shocking. 
97.	She informally discussed with staff that these conditions were unacceptable. She mentioned that Coolamon Hospital was closed with only one RN on duty. She was told this was just the way it is in regional NSW. On 15 October 2019, Vanessa Chapman told her Debbie Hay wanted to speak to her about this conversation. She confirmed it was an informal conversation, taken out of context. 
98.	When she started at Crookwell, Vanessa Chapman called her “Bubbles” because she was always happy. Over the next few weeks, she became increasingly hypervigilant. She felt there was a lot of pressure on her and the nurses. 
99.	One night, a police officer brought in a man threatening suicide. The police officer was wearing his gun. She was concerned he was not following proper procedure by putting it in a safe that would normally be located in the ED. She had no idea if there was a gun safe, despite asking during her safety tour. 
100.	For the patient threatening suicide, the treatment was via Telehealth. He was in his forties, had lost his job and dog, and had no means of support. She questioned why a doctor was not treating him and was told that wasn’t an option. She was told to leave him alone in the Telehealth room. It made her anxious that she would not be able to supervise him. 
101.	The Telehealth room was essentially a storage room. The blood pressure cuffs were especially triggering as she became concerned the patient could try to commit suicide, as had happened at HKH. She started to feel he was unsafe, and if he used a blood pressure cuff to strangle himself, she would not be able to keep her registration. She felt unsafe. She is not sure what happened to him. 
102.	It was not uncommon for staff to be snide toward her, roll their eyes, or say there were things they could not do in a country hospital, or “you’re not going to get the same here as Royal North Shore”. She felt she was being admonished and unreasonable for wanting better patient care and safer workloads for staff who were unhappy, crying, and blaming each other. Many staff said there had been frequent changes in management and divided loyalties. Management staff were being promoted, demoted, and transferred to Goulburn. She was told this resulted in staff being uneasy about speaking out.
103.	She experienced various incidents that caused her concern. A non-compliant diabetic presented with high blood sugar. He continued to eat and drink. He was aggressive to staff and others and had a confusing care plan. She spoke to the doctors, who understood her concerns. There would be huge implications for her employment and the hospital if it followed an incorrect resuscitation plan. 
104.	The patient also smoked in the ambulance bay whilst connected to an oxygen tank. She asked him not to do this and told him he was blocking the bay. He became aggressive. She discussed this with other staff, who said “He always does that”. She felt she wasn’t safe and had no support. 
105.	On another day, or the same day, a man came in with his wife, yelling for Dr Velu (Dr Thangavelu), and that she needed to be admitted. She was afraid the patient wasn’t being assisted to dress or shower, suspecting possible neglect and/or abuse. She felt a safety check and home visit were appropriate, but when she discussed it with senior staff, they said things like “He’s always like that.”
106.	The complicity of staff made her start to doubt her interpretation of events. She felt she was starting to lose confidence in her judgment, which she had always relied on and been confident in. 
107.	On 19 October 2019, she returned to work and saw Dr Lisa (Opie). She told her she was struggling as there was a lack of staff to patient ratio and she was concerned she could not keep her registration for very long if this was not addressed. Lisa tried to provide some support, but there was not much she could do. 
108.	Later in the shift, a seven-year-old came in due to a drug overdose. Her foster mother/carer said she had recently been sexually assaulted by male carers. The child needed to be transferred from Crookwell. She spoke with Goulburn Hospital and the ambulance to arrange transfer. The mother requested female officers as the child was terrified of men. She requested at least one female officer. It was deemed an urgent ambulance request. 
109.	Two male officers arrived about 30 to 60 minutes after she made the call. They had not treated it as a priority. She raised these concerns with other nurses and prepared to do an IIMS. She was again told “You’re in the country now”. 
110.	After the child was transferred, she finalised the paperwork. This took some time, due to the computer system being old. She had worked an eight hour shift without going to the bathroom or taking a break. It was about 9.00pm and she still had other tasks. 
111.	The same nurses who had rolled their eyes at her earlier told her the EN had handed over and they “knew everything”. One mentioned a cannula she had inserted the day before had “blown”. The patient’s veins were “temperamental”. The cannulas were an older version she had not used in about 10 years. The environment felt unsupportive and the tone unprofessional. 
112.	As she completed the roster book, the RN said if she wrote the time she finished, she would have to ring the general manager (GM), because she was supposed to call before overtime as they were “cracking down” on overtime payments. She wrote in the book the time she finished and ran a copy of the memo to take with her. She dialled the GM but there was no answer.  
113.	She left about midnight. She felt strange during the drive home. The car felt like it was floating, and she was unable to focus. She had never felt anything like it before. Her head felt like it was splitting. When she got out at home, she wet herself as she stood up. She felt ashamed and embarrassed. They live “off-grid” so she couldn’t shower and wash her clothes at the same time. She can’t remember anything else from that night, or recall going to bed. 
114.	The following morning, she felt like her legs were made of lead. She couldn’t move or stop crying. She thought she might be run down or have a virus. She had broken out in shingles and had rashes over her upper right leg and buttock. Her lips were covered in cold sores, she vomited bile all day, and couldn’t eat. She kept trying to make herself go to work but couldn’t. 
115.	She couldn’t call work. She felt so ashamed, scared, and sad. She didn’t know why. Her hands were sweating so she felt she couldn’t hold a phone. She felt she couldn’t breathe, much less speak. She was terrified. 
116.	On 24 October 2019, Vanesa Chapman called to see if she was coming in. She told her she had diarrhoea and vomiting and would not be coming in. She was told to get a medical certificate. She started to feel ashamed she was not coping. 
117.	On 25 October 2019 she saw Dr Godfrey in Goulburn. He told her she could not go to work because of the diarrhoea and cold sores. He wrote a certificate for three days. She returned to him but was told to go to her usual GP, as this may be a WorkCover claim, which he “didn’t do”. She thinks she was given a referral to a psychiatrist. 
118.	She saw Dr Tsin on 7 November 2019. She gave her a certificate for seven days off work and suggested she re-think her employment. 
119.	She had three Employment Assistance Program (EAP) sessions. The EAP psychologist told her she had PTSD and to consult her GP. Dr Tsin suggested she may have PTSD, and she was referred to a psychiatrist. 
120.	The psychiatrist to whom she was referred by Dr Godfrey did not “do WorkCover” . The secretary of the doctor’s office phoned to tell her the psychiatrist she had been referred to could not see her due to being employed by SNSWLHD for insurance. She did not understand and cried. 
121.	On 20 November 2019, she received a letter from NSW Health needing support for her ongoing absence and threatening to terminate her employment. She consulted Dr Tsin and lodged a claim on 9 December 2019. 
122.	She saw Dr Shen via Skype on 21 January 2020. He told her she had PTSD and suggested she start taking medication. She was deemed unfit for work from 21 January 2020 to 28 February 2020. 
123.	Her claim was assigned to EML. It denied liability on 17 March 2020. On 24 March 2020, EML called and told Dr Tsin that it had withdrawn liability due to a note in her medical record relating to HKH. 
124.	Her solicitor from New Law did not want to dispute the claim [sic]. She did not offer any further advice. She changed solicitors in August 2020 after a recommendation from her daughter. EML continued to deny the claim, stating that as the injury occurred at HKH, she should apply there. 
125.	Her new solicitors lodged a claim against HKH in early May 2021 and she went through the claims process again. 
126.	As regards the delay in making the claim, she was not aware she had PTSD until she was diagnosed in or about December 2019. Whilst on long service leave in Townsville, she was functioning quite well. In her years as a clinical educator, she had less exposure to trauma and was not responsible for care of patients. She only became ill after feeling she did not have the support or resources at Crookwell to look after patients effectively. 
127.	Her treating doctors, EAP counsellors, the Nursing and Midwifery Help Line, and independent examiners are of the opinion that her current mental health state is the result of PTSD from employment with HKH. In hindsight, she had been hypervigilant and more anxious since working there. 
128.	She is undergoing counselling with Melinda Gemmell, funded by Victims’ Services. This started in June 2021. This has been the most effective treatment. 
Evidence of Lesley Hills
129.	Ms Hills is an administration officer with Crookwell. Her statement is dated 31 January 2020. 
130.	She had known the applicant since 19 September 2019, when she commenced at Crookwell as a registered nurse in the ED. Until recently, they only had RNs working on a rotational basis through ED. She believes the applicant’s position was advertised as an emergency nurse. 
131.	She described the applicant as pleasant, yet she seemed to be highly strung. She always wanted to chat, but there was no time for this. She did not believe the applicant was as good as she said she was, as she did not appear confident, and made simple errors. 
132.	One of the RNs had advised the applicant she was not doing an ECG correctly, and she “showed her the hand”. The applicant stated she was an experienced RNS nurse and knew what to do. The other nurse said it was not how it was done in Crookwell, “and for starters you have one of the pads upside down”. She was aware the nurse did not wish to be interviewed. 
133.	At times when there was a break in ED, the applicant would run around getting everyone a bottle of water, saying “hydration, hydration, hydration.” 
134.	The applicant never spoke to her about any issues she may have been experiencing. She was never seen to be crying or angry at work. 
135.	The applicant repeatedly made simple errors when entering patient documentation in the system. She said she knew the way she had been told to do it, but was rushed and made errors. The applicant then wanted her to fix the problem. 
136.	The applicant was not happy with working more than five days in a row. She worked eight hour shifts. Sometimes staff attach an ADO to their days off if they end on a night shift or come back on a late shift. 
137.	Patients come through the front door or the ambulance bay, so the applicant would know they were there. If via ambulance, there are two officers, and if they walk in, they know to press the green button and take a seat. The applicant had requested an ED clerk and appeared to have some problems with the admin work. 
138.	To her knowledge, the applicant just didn’t turn up one day, and everyone had to scramble to fill her shifts. This was upsetting and difficult for a rural hospital with the bare minimum of staff.  
139.	The applicant came across as extremely chatty, happy, and full of confidence, but she feels she may not have worked well under pressure. She was not confident in the applicant’s skills. The applicant had no real emergencies, for example, no heart attacks or motor vehicle accidents “etc” whilst she was there. 
140.	There is no way the diabetic male alcoholic would have been allowed to take the oxygen bottle outside, and he is not allowed to smoke in the ambulance bay. Patients usually go out the front to a different area outside the grounds to smoke. 
Evidence of Benjamin Burnett
141.	Mr Burnett is an RN with Crookwell. His statement is dated 30 January 2020. 
142.	He got talking to the applicant about two to three weeks before she commenced. He asked if she had any ED experience, as he was aware Crookwell was looking for ED nurses. She said she had experience as an educator and ED experience at RNS. She sounded like she was keen to apply. 
143.	He saw the applicant leaving the hospital a few weeks later. She said she had just had an interview and was looking forward to starting work. 
144.	He usually got 48 hours off on his two rostered days off, or added this as an RDO, which is usually the case after a night shift. They usually work seven on, two off, three on, two off. Most are tired after working seven days. However, this is usually in their contract from the outset. 
145.	Some hospitals do 10 hour shifts x four for night shift, with overlapping staff. That does not occur there, and it is not a high dependency unit or overloaded with patients. They get busy, but not to the extreme. Some procedures that occur during the day do not happen at night, to keep the load lighter. 
146.	The expectation is that if there are no patients in ED, the RN will go to the ward to assist. His experience, from a placement of seven weeks, is that ED is not busy 24/7. ED staff are seen as the most experienced, to be “in charge”, and paid accordingly. There is only one NUM, Vanessa Chapman. 
147.	The diabetic alcoholic is a frequent patient and they have a good idea of how to manage him. Dr Thangavelu told them to give him some orange juice. The applicant was confrontational with the patient and his wife. She took it away from him, got in his face, and said “Do you want to live or do you want to die?” This was unprofessional and not the way they spoke to patients. 
148.	The applicant stated she would not lose her registration over the patient’s actions. He was shocked and the patient’s wife looked shocked. The next day he apologised to them and asked them to complete a complaint form. 
149.	The day before, the applicant took the patient’s orange juice from the table and told him he could not be having it. The patient is usually in for weeks and they are very familiar with him. He is non-compliant with his care. It was as if the applicant needed to be right and was not interested in what was right for the patient. 
150.	He could not believe how abrasive the applicant was in a community driven area when they were all welcoming, helpful, and supportive. 
151.	A patient came weekly for a blood transfusion. The applicant put the cannula in and didn’t get blood coming as you should. The patient was still bruised from elbow to shoulder. He complained it was hurting, so the applicant moved the cannula to his right arm, with the same result. 
152.	There was another incident when the applicant had an issue with the iStat machine. She said no one had ever told her she needed to take blood out of the green tube to use the machine. Donna, their educator, signed him off on it and it was stressed how important this was at the time. 
153.	Staff must be signed off to use the machine. He phoned Donna and asked her to follow up with the applicant on how to use it. She had been working in ED for over a week, and this was a pretty important procedure. A student told him the applicant had been getting her to do the testing as she was not a pathologist and shouldn’t be doing it. To have a student do this is a risk.  
154.	It appeared the applicant had not understood things are different in the country, and resources are different. He could not speak highly enough of the staff there now and when he did his placement training. He had received nothing but encouragement and support 
155.	As he and Rose (McDonald) were handing over to the applicant on night shift, Rose had a patient with significant mental health issues. She suggested they put the patient in contact with a mental health specialist.  
156.	The applicant raised her arms and crossed them over her forearms in a “no deal” type movement, whilst saying “No, no, no, that’s not what we do here, we don’t get involved in that”. She cut Rose off, and it turned out they were saying the same thing. It was over the top and unnecessary. The applicant was unprofessional and was supposed to be the role model. 
157.	He worked a double shift to cover the applicant the day she left. He answered the call and she said she was sick and couldn’t come in. 
158.	The applicant mentioned a few times she was going to the union about the hours “etc” but that was in their contract. They have mature aged nurses that work long hours and nights and seem to manage. They all work similar hours. 
159.	He was not aware of any significant ED incidents that would have caused any trauma. He did not believe the claim was genuine. 
Evidence of Deborah Hay
160.	Ms Hay is a senior nurse manager at Crookwell. Her statement is dated 31 January 2020. 
161.	She had known the applicant since 19 September 2019, when she commended work at Crookwell as a RN, primarily to work in ED. However, all nurses are required to work in all areas if necessary. She was part of the interview panel, and reference checks appeared positive. 
162.	The applicant stated that she had been an educator and believed she could work five days, when that was not how the roster was there. She confirmed from her referees that she was an educator. She completed a pre-injury [sic] questionnaire and “ticked no to everything indicating there were no prior issues.” 
163.	From her observations, the applicant had reasonable clinical experience. If she had been an educator, she may not have the acute clinical skills. They had a complaint that she had hurt a patent during a cannulation. 
164.	She described the applicant as very pleasant, bubbly, and enthusiastic when she applied, which was at times a little excessive. She was open about being on her third relationship and did not mention any issues in her personal life. 
165.	The applicant worked 18 days at Crookwell. She worked one weekend double shift, which she offered to do, as they were in a staffing crisis. RNs usually work seven on, two off, three on, two off, and this is normal. After the seven days, staff usually have an ADO in addition to their two days off. 
166.	She could not understand why the applicant wanted to work 10 hour shifts, when complaining she was tired working eight hours. Ten hour shifts have to be approved by the union, and other staff have to agree. The most patients the applicant saw on any shift was 11, so she was not overloaded with work. 
167.	Crookwell is an 18 bed acute facility with a two bay ED, and an average of 13 patients. The ED is only funded to be staffed on a morning shift, and on an afternoon shift there are three nurses for the whole hospital. One is allocated to the ED. 
168.	There is a doorbell in the ED waiting room so there was no need to rely on watching the CCTV. 
169.	Overtime was being monitored and required approval. It was rarely declined, as it was usually for clinical reasons. 
170.	It was after a seven day stretch that the applicant called in sick. When she returned to work on 15 October 2019, she came to see her and nurse manager Vanessa Chapman to advise she couldn’t possibly work seven days straight as this didn’t fit with her work/life balance. This had been discussed in her interview and she agreed it would not be a problem. 
171.	They advised the applicant the roster was appropriate for a full-time staff member and met award requirements. They asked her to provide a roster that would better suit her. They advised set days could not be supported, as this would not be fair to other staff or business needs, and would require approval of the GM. They suggested she might like to reduce her hours, and this would require approval from higher management. She never asked for a reduction in hours. 
172.	The applicant freely voiced her opinion on the roster and had no issue speaking with her or Vanessa about these concerns, so she is surprised to be advised she blamed the workplace for her injury. She had phoned and asked the cleaner to pass the message that she would not be coming in. She knew better than to do this. 
173.	She had been made aware that the applicant stated she had PTSD as a result of the workplace and her date of injury was 18 October 2019. She was not aware of any significant incidents that occurred in ED whilst the applicant worked there. 
174.	There were a few complaints by patients that the applicant had spoken offensively to them. She did not appear to have any filter or awareness of what was appropriate when speaking with patients, in particular in rural areas. One elderly male patient stated she had been judgmental and very sarcastic toward him, telling him he should have called an ambulance. He believed ambulances were for emergencies and didn’t want to jeopardise the service. 
175.	There were a lot of elderly patients in the area, and after December 2018, the GP clinic closed. There was only the health care clinic next door, and Dr Velu, who was nearing retirement. A lot of locals came to the ED as a result, some travelling up to two hours, plus the Christmas influx. The majority of ED patients were level three. 
176.	The applicant never spoke about having any flashbacks. She was offered EAP. 
Evidence of Serina Lynch
177.	Ms Lynch is a RN. Her statement is dated 31 January 2020. 
178.	The applicant commenced on 19 September 2019, primarily in the ED unit. Most of those who work there assist in other areas when ED is not busy. The applicant may have had knowledge but was not demonstrating this well. It was her impression the applicant had sat at a desk too long, or been teaching, and had lost some of her clinical application skills.  
179.	She described the applicant as pleasant, very flighty, overly friendly, and chatty, with an intense personality. She was intense about everything she did, which was a bit off putting. 
180.	She conducted the applicant’s first orientation day, and she took a long time to do things. It was as if she wanted to do a head to toe assessment, when they don’t have that time in ED. She had the doctors offside from the beginning, by her personality and manner. 
181.	She came on a morning shift after the applicant had been on night shift. The applicant apologised for not completing the paperwork, as she had forgotten her glasses. She was shocked, as she could have gone home to get them. 
182.	The applicant often made comments about putting her registration at risk. This would be on handover when she said there was not enough staff “etc”. They are expected to remain professional and this was not the way the applicant was behaving. 
183.	On occasion, the applicant came into the dining room, which is situated where the patients can hear what is being said. She stated in a loud and emotive voice that she was putting her registration at risk, was upset about lack of staff and skills mix, and [staff] were inadequately educated, but that was not an issue, as that was what she was there to do, she was going to the union, and in her opinion the hospital should be closed immediately until these things were sorted out. 
184.	She was shocked by this verbal tirade and reported it to Vanessa Chapman, as she loved the hospital and had worked there for over 40 years. It was an older hospital, but they all worked well together as that is what they had to do. 
185.	The applicant did not want to work seven days in a row and requested to work less and more specific days. Although they have flexible working hours, this was not doable. 
186.	As a CNE, she was on the floor all the time with her students, demonstrating and observing, so she wondered why the applicant was not demonstrating a high level of skills on the floor. The applicant appeared to work OK and not sit around much, but she did not have much opportunity to observe her. She was a constant talker and invaded personal space. She had outbursts of frustration and possibly had borderline personality disorder. 
187.	A lot of hospitals have 10 hour shifts, where there is an overlap at either end, but this was not feasible with their staffing levels. 
188.	The applicant seemed to find it difficult to manage the fast pace of an ED where she couldn’t prioritise workloads or levels of illness. She commented that she was tired due to the workload and lack of staff. She had worked in a bigger hospital, things were better there, and staff were more educated, but she was coming there to save the place. This offended a lot of staff, and they already had an educator. They don’t have onsite doctors and are required to manage things until the doctors arrive. This seemed to frighten the applicant. 
189.	Dr Opie is a senior doctor who had major issues with the applicant. However, she is difficult to work with at the best of times.
190.	The applicant was slow at attending to patients and was not using her clinical judgment to manage what the patient came in for. 
191.	She was not aware if the applicant had any personal issues, as she only chatted about her experience and knowledge, not her personal life. Crookwell has four doctors next door to the hospital and two others in town, so she did not know why the applicant needed to go outside the town to see a doctor. 
Evidence of Rose McDonald 
192.	Ms McDonald is an enrolled nurse. Her statement is dated 31 January 2020. 
193.	She had known the applicant since 19 September 2019, when she commenced work at Crookwell, She would describe her as a split personality, where she would be in her face, swearing and aggressive, then become over the top friendly. 
194.	She was once given instructions from a doctor to perform a task. The applicant said she was not competent to do it and it was less straightforward than she thought. The task was simple and very straightforward. It was as if the applicant wanted to belittle her in front of somebody else, this time the patient. This was embarrassing. It was passive aggressive and unprofessional. 
195.	During a handover, she suggested they give a patient with concerns about their mental health caseworker a number to call. The applicant walked over with her arms raised and forearms crossed, stating “No, we don’t do that here, little old Crookwell Hospital isn’t going to help anybody.” She kept interrupting, saying “No, we don’t do that here”. This was in front of five other staff and was very demeaning and bullying. She started making notes to complain about the applicant to Vanessa Chapman. 
196.	She recalled a number of patient complaints. She was concerned the applicant had a mental health condition as she was very unpredictable, which was demonstrated in front of and toward patients. 
197.	The applicant “went off at a diabetic patient.” She grabbed the orange juice from him, and said with a raised voice, “Do you want to die?” The patient was in shock and his wife was very upset. The wife made a complaint. She thinks it was at this time that the applicant had stopped coming to work. 
198.	The applicant came in to cannulate a long time patient, who ended up with bruising from his forearm to his shoulder for weeks and wanted nothing more to do with her. She did not believe the applicant had been clinical for a long time, as she ignored what the patient said. She did not follow usual procedure. 
199.	The applicant got right up in her face and swore at her when she had only been there a week. She turned up the next day all bright and overly friendly. She thought the applicant was crazy and wondered how long it had been since she had actively been a nurse. 
200.	The applicant said she had been an educator and studied law etc but didn’t talk about her last clinical position. She repeatedly stated how dangerous and illegally the hospital ran and how she was going to do something about it. This felt intimidating. 
201.	The applicant would look through the roster and say she was not doing night shifts. She then phoned in sick on those shifts. Not long after, she stopped turning up for work. 
202.	She was not aware that the applicant had any personal issues, as she was very vague about her personal life. She kept things professional after the way the applicant treated her, and minimised contact with her. 
203.	As they needed staff, she held off making the complaint about the applicant. She could tell in the second week that she was not working with others, and she started writing notes. When she finally made the decision to put forward her complaint, the applicant stopped coming to work. 
204.	She does not believe the claim is genuine. There were no overly traumatic cases during the period the applicant worked there. The applicant caused more trauma to the staff. 
Evidence of Vanessa Chapman
205.	Ms Chapman is acting nurse manager. Her statement is dated 31 January 2020. 
206.	The applicant commenced work as an RN on 19 September 2019, primarily to work in ED, but was required to work in other areas when required and when ED was quiet. The night shift works on the ward. She had mentioned historically working permanent night shift and told one doctor she would be seeing more of him, given she would be working nights. 
207.	Within the first day of the applicant working there, she nicknamed her “Bubbles”, as she was so effervescent and positive, stating she was there to help, happy to be there, and was going to make such a difference. She was employed to be a team player and support the locum doctors. 
208.	The applicant was bombastic, and “would speak at you rather then with you”. She was advised of the environment she would be coming into and was asked to approach things softly but did the opposite. 
209.	The applicant was usually there at 6.00am or 6.30am and remained an hour after her shift. She advised her to go home and pace herself, not take on too much and run herself into the ground. She would say she was there to help and was told to concentrate on what she had to do. She interrupted conversations with trainees and other staff, and it was as if she wanted to insert herself into everything. She saw her try and hug someone she had never met, and the person was taken aback. 
210.	The applicant repeatedly stated she was an ED nurse, educator, manager, and had done it all. It was very much a self-focused conversation. 
211.	The applicant’s work was not as good as she would like them to believe. Her knowledge was dated, and it appeared she was not current in her clinical presentation. She was considering what was needed to get her up to speed. The applicant didn’t stay there long enough, as “the roadblocks started to go up”. 
212.	After the first week, the applicant started telling her and others that things needed to change and pointed out the areas. She advised the applicant they had limited resources. The applicant would say the workload was too much and she had concerns about staff and their capacity. She didn’t see certain things as her role and at one point asked for the GM’s phone number. 
213.	If they had a student, the applicant constantly tried to tell them things. They had a CNE to do this. The CNE is very personable and they all tried to approach the applicant’s concerns. However, they needed to continue with what they were doing. She wanted a wards person on her shift, and a PA to enter her patients onto the system. 
214.	The applicant had said the hospital was like working in a third world country and she was contacting the union, who would close it down. This was very distressing for the staff and said in an area where patients may have heard. 
215.	She and “Deb” spoke to the applicant about this. She stated she had spoken to the union, “but the thing is that I should hear what the staff talk about me”. She said she did not want to know that, and the conversation was about the applicant’s comments. 
216.	The applicant kept deflecting and changing the topic to avoid answering. She would say, “But you have to understand…” and “I am passionate about this…” This was within the three weeks she worked there. She also had three names, and they had to work out which one to use. 
217.	On one occasion the applicant asked to meet with her and Deb Hay, yet when she came in, she just sat there. She stated she had spoken to the union about her time off between shifts, and they confirmed it was fine. She was upset about this. 
218.	The applicant’s first shift was 16 September 2019 and her last was 20 October 2019. On 9 October 2019, she phoned at 6.30am and advised the cleaner she would not be coming that night. It took them many hours to contact her to ask if it was just one shift. She took three night duties off. She did not provide certificates and had no sick leave accumulated.
219.	The applicant returned for six shifts. On 23 October 2019, when she was on night duty, she phoned at 8.30pm to advise she was not coming in. It was after this that it became difficult to contact her to find out what was happening. 
220.	They had conducted a review of all ED patients since the applicant’s commencement, and no life threatened patients were identified. 
221.	The applicant complained about her shifts, and they asked her what a suitable roster would look like for her. She wanted to reduce her hours to three days per week – Tuesday, Wednesday, Thursday – as this would allow her to continue with educational pursuits. This was escalated to the GM, who was unable to provide set days. 
222.	On 6 October 2019, the applicant emailed to advise that, due to a prior arranged event, she was unable to perform night shift on 10 and 11 October 2019. On 9 October 2019, she phoned to say she was not coming in. The prior event had never been mentioned. 
223.	She asked what they could do to support the applicant, and was preparing this, but she never returned. 
224.	It was interesting that after all the years the applicant stated she had been in the nursing environment or a nurse, she had never seen a roster where staff work seven days. This is common in nursing. It appeared she was used to working day shift, Monday to Friday. 
225.	It was only once Workforce became involved that medical certificates were provided. The applicant attended several doctors, and when things appeared to become more serious, she went to her GP in Sydney. 
226.	Staff had reported some incidents in relation to the applicant’s behaviour. This was towards the time she left, and they didn’t get time to discuss them, given she was only there a few weeks. 
227.	The applicant presented as manic at times. Her approach was racy and overwhelming at times. She commented to Deb Hay that things did not seem right. 
228.	Angry outbursts appeared to have been toward other staff. However, she witnessed outbursts of “oh my God, this is wrong, you’ve got to understand”. The applicant seemed to limit her behaviours for a time, but this was not sustainable. 
229.	She had had reports that the applicant had bailed staff up and sworn at them. She spoke openly in a raised voice in the dining room, telling everyone the union were coming in and the place would be closed down. She had told a very experienced nurse what she was doing was wrong. 
230.	She was aware of client complaints and a client showed her the evidence of her clinical skills, for example, bruising. She was aware the applicant was not able to perform point of care testing, which was a major part of working there. 
231.	An elderly gentleman complained that the applicant was dismissive toward him, and he left without being seen. A patient complained that they were spoken at and not listened to by the applicant. She challenged doctors in their treatment and would not necessarily do enough observations. The doctors would work around the applicant and come back to her later. 
232.	She is aware that the applicant has stated she has PTSD as a result of the workplace and stated her date of injury as 18 October 2019. During the interview, she was asked to complete a form that asked if she had any pre-existing illnesses or injuries that could affect her capacity to work, and she said no.
233.	It was as if just because the applicant could not get what she wanted, she went off sick, when she was well aware of the policies and rostering. All they wanted was for her to be honest and professional. She has been seen around town and at the swimming pool.
234.	There are plenty of medical practices in Goulburn where the applicant could have attended. She had stated she wants to return to work but had avoided contact with them. She was offered EAP.
235.	She was not aware of any current personal issues the applicant may have. She was aware she had been in several relationships, as her names had changed. The applicant told her she was passionate about mental health and had a daughter with a mental health condition. 
Evidence of Shayne Abernethy 
236.	Mr Abernethy is the roster systems administration manager. His statement is dated 30 March 2020. 
237.	He had never met the applicant and had no professional or personal relationship with her. 
238.	After review, there appeared to have been no breaches of award conditions in relation to the applicant’s rostering since she commenced employment. 
239.	The applicant was never rostered to work more than seven consecutive shifts and there were no “quick shifts” where she was asked to work more than seven days in a row. Night duties were rostered appropriately and minimum breaks between shifts were observed. 
240.	He had been provided by Samantha Allen with a timeline of the shifts and times worked by the applicant since she commenced, and agreed it was correct. He provided a copy. 
Emails between the applicant, Ms Chapman and Ms Hay
241.	On 6 October 2019, the applicant emailed Ms Chapman. She advised that due to a previous arrangement, she was unable to do night duty on 10 October and 11 October. She would be happy to discuss replacing those shifts, “however, to be totally honest, the roster currently does not allow a lot of wriggle room”. She was “Happy to discuss further”. 
242.	On 8 October 2019, Ms Chapman emailed the applicant, copying Ms Hay. 
243.	Ms Chapman thanked the applicant for identifying a conflict of the roster and personal need. At the time, they were potentially unable to support her request, due to a directive from the Executive. In discussion with Ms Hay, any leave requests post-roster publication needed to be approved by the Cluster GM. The prerequisite was that they could still staff the service, which at that time they could not satisfactorily do. 
244.	They could support shift swaps, which it was the applicant’s responsibility to source, but it appeared she had identified “not a lot of wriggle room”. Due to the newness of her contract, she also did not have any leave to support the request. LWOP (leave without pay) must also be approved by the Executive. 
245.	Ms Chapman was “Happy to discuss to source a positive resolve [sic] and to consider and support future requests were [sic] able. Thank you for your consideration in this matter.” 
246.	On 22 October 2019, the applicant emailed cdhadaministration@health.nsw.gov.au, and copied Ms Chapman. The subject line was “Discussion of Roster Meeting Tuesday October 15.” 
247.	The applicant thanked Ms Chapman and Ms Hay for making time to discuss a resolution of her roster. She would like to reduce her hours from full time to part time, consisting of three consecutive days per week. She was flexible with 24/7 rostering. This would allow the applicant to further her educational opportunities, which would support her role at Crookwell. 
248.	The applicant was working three consecutive shifts, commencing on Wednesday 23 October 2019. She could “happily do three consequent [sic] days” in the week commencing Tuesday 29 October 2019, and three consecutive days in the week commencing 12 November 2019. 
249.	She did not have a copy of the roster from 18 November 2019 to 15 December 2019 but would like three consecutive days per week. The new roster issued to her on 15 October 2019, start date 16 December 2019 to 12 January 2020, reflected this request. 
250.	On 23 October 2019, Ms Chapman responded, copying Ms Hay, “…Acknowledged – this will need to be raised to Executive Level for consideration.” 
251.	Later on 23 October 2019, Ms Hay sent the applicant an email, copying Ms Chapman. She advised that she had discussed with “Denis” that morning, and unfortunately, the request had been declined, as they could not support set days. They had to roster according to the needs of the facility. 
Factual investigation of M & A Investigations 
252.	The first respondent commissioned a factual investigation, and M & A Investigations reported on 27 April 2022. 
253.	I do not intend to refer in detail to the report. Relevantly, the investigator reported that the applicant could not provide exact dates of the incidents she claimed to have occurred at HKH. The investigator was able to locate one person from the first respondent who may have been able to provide information, Ms Leonie Hillard, retired NUM. 
254.	Ms Hillard provided a draft statement, which she later declined to sign and return. It is not attached to the report. 
255.	The investigator was also provided with contact details for Mr Bryan McKee Hata, who may have been able to assist, but who did not respond to calls or emails. 
256.	The first respondent was unable to find a record of any incidents reported by the applicant, absent further information such as patient names or a better time frame. Without that information, it was not possible to locate potential witnesses. 
257.	The first respondent confirmed that the applicant was “separated” from NSLHD on 15 October 2015, as she had not worked in more than six months. That employment does not appear to have been at HKH. 
Medical evidence 
Berowra Family Medical Practice 
258.	The clinical records commence in 2003. It is not my intention to refer to every entry. 
259.	On 2 November 2006, Dr Tsin recorded “Exhaustion last month – closed shop. Helped by a bit of rest. Exhausted again since reopening shop. Not too stressed”. 
260.	On 6 November 2007, Dr Tsin recorded that the applicant was stressed with managing her shop and working in A & E. She ran into debt and wanted to spend more time in her business pre-Christmas to make up for losses. She was doing night shifts and having to leave her kids at home. She had to consider getting back with her “ex” for financial reasons. She would like to see a psychologist. 
261.	On 13 November 2007, Dr Tsin recorded that the applicant was stressed with business, work as an RN, both ex-husbands and her 15-year- old son, who was seeing a doctor for suicidal ideation. 
262.	The applicant had financial problems “will lose house. Chaotic life. No time to self”. She was depressed, anxious, tired, worried, had sleep problems, her appetite was increased, weight gain. Dr Tsin recorded “Suicidal ideation - wants to escape. No plans b/c of kids”. 
263.	The applicant’s father suicided. He was an alcoholic and “bipolar untreated”. Her mother was depressed, not treated, “ETOH (ethyl alcohol) more recently”. “Poverty. All her siblings were taken away and adopted out”. 
264.	The applicant was drinking six standard drinks on a day drinking alcohol, which she did three to four days a week (although it is also recorded that she drank six or more standard drinks on one occasion “weekly”). She was concerned about drinking. 
265.	Dr Tsin recorded a referral to Vicki Richards. 
266.	On 27 November 2007, Dr Tsin recorded that the applicant had tried to get a loan. She would consider selling her house. Her boss was uncooperative with her roster, especially being rostered for Christmas Day. She planned to close the shop in January. She had stopped ETOH. 
267.	On 30 April 2008, Dr Tsin recorded that the applicant was working night duty. “Less stress.” She had shut the shop, refinanced the house, and was debt free. She was getting a divorce from Shane. 
268.	On 4 November 2008, Dr Tsin recorded that the applicant had tried education and hated it after three weeks. She was getting burnt out with work in A & E.  
269.	On 29 January 2009, Dr Tsin recorded that the applicant had applied for a nurse management course “finally”. She wanted to get out of clinical nursing. 
270.	On 5 March 2009, Dr Tsin recorded that the applicant had been off Duromine for one week. She “felt great” on it. She had more energy and motivation. She had stopped alcohol. She used to feel tired and down, tearful, felt overwhelmed. She was frightened of night duty. She had started to feel similar symptoms since stopping Duromine. 
271.	On 13 May 2009, Dr Tsin recorded that the applicant had to have dental work. She hadn’t been able to go to work. Her close elderly ex-husband’s grandmother had died suddenly of her AAA (abdominal aortic aneurysm). She was depressed “+++”, numbed, amotivated and stopped caring. She was drinking more ETOH. She would like to restart Duromine – “felt good, lost wt and didn’t need ETOH”. 
272.	On 7 July 2009, Dr Tsin recorded that while the applicant was in the waiting room, a teenage patient aggressively threw a chair towards her for no reason. “Stressed. Teary”. 
273.	On 22 April 2010, Dr Tsin recorded that the applicant had quit her job at HKH because of stresses in A & E, especially with poor management of psychiatric patients at triage. She had renovated a house in Townsville. She had realised she had been neglecting herself. Duromine helped her stop binge eating and drinking alcohol. 
274.	The applicant met up with Shane in Townsville, had sex with him and “started feeling again”. He had moved on and was moving to Melbourne. She was staying with him at his place. She had opened an antique shop with her daughter. Dr Tsin noted “Teariness ++ Poor focus. More forgetful. Ups and downs and lots of fluctuations. Confusion. Restart alcohol”. 
275.	On 13 May 2010, Dr Tsin recorded the applicant had stopped drinking alcohol. She started AA when she realised alcohol was controlling her. She felt supported in the group. She focused on positive things. Shane left for Melbourne. She had to pack his stuff and found an eviction notice. She had been offered a job managing retrievals of patients from overseas. She had decided against opening a shop and would auction most of the antiques. 
276.	Dr Tsin wrote a referral to Dr Adrienne Gould. “As discussed on the phone”, she suspected the applicant may suffer from bipolar disorder. She had been turning up every so often to see Dr Tsin, “often in crisis or on a high”.
277.	The applicant’s flighty decisions included opening a shop that failed badly and “2(?) bad marriages”. Dr Tsin had not talked to her about bipolar disorder yet. Her concern was that the applicant needed treatments, most were weight gaining, “and she’ll miss the highs”. 
278.	There is a handwritten note to Dr Tsin, dated 25 May 2020, stating that the applicant did not turn up for her appointment. 
279.	On 9 June 2020, Dr Tsin recorded that the applicant had ceased Duromine because she couldn’t afford it. She also couldn’t afford to see Dr Gould and had to sell her car. Shane moved to Melbourne. The landlord let her stay one week for free. The electricity was cut off. 
280.	The applicant tried to get her first ex-husband to look after one daughter. He got abusive. Her other daughter got cranky with her for trying to get together with Shane. The job offers fell through. She had “hit rock bottom with debts building up”, 
281.	The applicant had tried to get work through Hornsby Hospital. She had been charged with dereliction of duties when she didn’t return to work after long service leave that ran out in March 2010. She had tried to contact her boss, who did not respond. She had been told she needed to write a letter to remove the charge. She needed to go back to Townsville to sort out the sale of her property. She was still going to AA and stopped alcohol.
282.	On 11 August 2010, Dr Tsin recorded that the applicant was living in Lavender Bay in a four bedroom waterfront house. “Loving it. Walking the dog”. She didn’t sort the problem at Hornsby Hospital and decided not to work in the public hospital system. She was going to do business with her daughter. She was “not too worried about getting a job yet. May look into working in a clinic”. She wanted to get well emotionally and [have a] stable home life. 
283.	On 26 August 2010, Dr Tsin recorded that the applicant had started markets and online selling. She had stayed off alcohol. She stopped and started Duromine because it caused agitations and racy thoughts. 
284.	The applicant was reading up on CBT and attending psychology lectures with her daughter. Ongoing contact with Shane kept her hooked. She wanted to stay married to him to give a measure of comfort. 
285.	On 15 February 2011, the applicant’s daughter rang Dr Tsin. She was “[C]oncerned about mum’s behaviour in the last year. Erratic behaviour with restarting smoking and drinking caffeine +++ and drinking alcohol++. Spending money +++. Not working. Irritable and argumentative. Losing more weight”. 
286.	Dr Tsin advised her to bring the applicant to her. If she resisted, to talk to the MH (mental health) team. If she was getting aggressive, she needed to call the police. If the daughter’s health was in danger, call DOCS. She needed to recognise that “mum” may not have insight into her problems and may resist help. She needed to get external help. 
287.	On 12 May 2011, Dr Tsin recorded that the applicant had opened a shop with her mother. It didn’t work out as “Mum was too controlling”. She lost the rest of her savings. “Mum doesn’t talk to her”. 
288.	The applicant had done some work for “Corporate triage” for a few months but was dismissed when she refused to sign the contract one month ago. She was lecturing part time at UTS. She would hopefully get more work in July. She wrote a letter to Hornsby admin and didn’t hear back. 
289.	The applicant was living with two of her children. Her other daughter was “very demanding with her high expectations”. The applicant was feeling good and positive about her future. She did not want to work the long hours she used to do, “doing things for everyone and gaining.” She was eating badly, smoking and drinking again in the last month when mum and her daughter hassled her again.
290.	The applicant saw a counsellor through “Emotional Intelligence”, who helped her make some changes in her life. She had had a boyfriend for three weeks. “Known him for ages”. 
291.	Dr Tsin recorded the reason for contact as mental health review, and noted “?Bipolar affective disorder.”
292.	On 11 November 2011, Dr Tsin recorded that the applicant was smoking again, drinking too much. “Wants to stop”. Her relationship was going well. She was working at RNS teaching nursing students and tutoring at UTS. She had applied for work at RNS A & E. 
293.	On 9 December 2011, Dr Tsin recorded that the applicant had started Duromine, quit smoking, and stopped alcohol. She finished teaching today and would be doing casual shifts at RNSH. She was very happy in her relationship. It was very normal, “with no manipulations or co-dependence”. 
294.	On 30 June 2013, Dr Tsin recorded that the applicant was lecturing at Uni and doing clinical facilitation. She and her partner were planning to buy a place together. Shane still owed her money from his credit card debts. 
295.	On 7 February 2014, Dr Tsin recorded that the applicant went back to nursing at RNS in 
A & E because of lack of work during the Uni break – “12 hr shifts”. Most of the experienced nurses had quit. “Stressful. Eating too much”. 
296.	The applicant would go back to teaching next week. There was financial stress because her kids were with her, and the house was too small. She was paying rent and mortgage. 
297.	On 5 June 2014, Dr Tsin recorded menopausal symptoms. “Very moody. Loves her job”. 
298.	On 8 July 2014, Dr Tsin recorded that the applicant’s moods improved with Estalis. She was “stressed with mum who’s nasty/negative”. 
299.	On 19 March 2015, Dr Tsin recorded that the applicant had stopped smoking and drinking. She lost work with UTS after a confrontation with the manager. She also lost her casual work with UTS. She had to go through an agency and got work but it took two months. She was working in various hospitals and getting more confidence. 
300.	On 24 February 2016, Dr Tsin recorded that the applicant got a job with Careers Australia teaching EN. “Bad pay and more flexibility”. 
301.	On 3 March 2016, Dr Tsin recorded that the applicant lost her job after the three months’ probation period. 
302.	On 10 March 2016, Dr Tsin recorded that the applicant had right elbow pain that she claimed started since she had to do long hours of marking papers. She worked now in ICU but had been advised not to come in due to pain. 
303.	There are several entries related to the applicant’s right elbow injury. 
304.	On 22 July 2016, Dr Tsin recorded that the applicant got onto Headspace after her daughter had a breakdown at school, and disclosed she had been sexually assaulted. The police were involved but she could pursue it when she was ready. The applicant was working two days a week at TAFE – “loves it”. 
305.	On 18 April 2017, Dr Tsin recorded that the applicant was feeling better. She had more alcohol and chocolates over Easter. She was working four days a week at TAFE. “More assertive at work”.
306.	On 14 October 2017, Dr Tsin recorded that TAFE was cost cutting – “reduced wages by change of title”. The applicant was looking for other work. 
307.	On 28 March 2018, Dr Tsin recorded that the applicant found TAFE disorganised and dodgy. They didn’t pay her for lots of work. She told them she was too unwell to come to work. She was still on their books as a casual. She was working on a research project with Wollongong Uni until 1 May 2018. Her daughter had drunk too much, felt depressed and started cutting herself. 
308.	The applicant thought of selling up and moving to the country to semi-retire. She was sick of struggling with finances and dealing with nursing work. 
309.	On 21 August 2018, Dr Tsin recorded that the applicant’s working hours at TAFE were cut. She was not working. She did a research project on nursing homes and felt “despaired” by the bad treatment of residents. She put in negative reports and was taken off the research. 
310.	The applicant asked her union for help and told it more action was needed to get her rights met. “They told her to go away”. She couldn’t work in the local hospitals because she was blacklisted. Her cousin’s daughter committed suicide after being discharged from a psychiatric hospital. She was “sick of seeing how bad the system is”. She told the bank she could not pay the mortgage. She decided to sell up and move to the country. She was tearful and irritable. 
311.	Dr Tsin recorded the reason for contact as adjustment disorder (chronic) with depressed and anxious mood. She issued the applicant with a Centrelink medical certificate. 
312.	On 7 November 2019, Dr Tsin recorded that the applicant moved to Wayo in May. She saw work as a full time ED nurse on 25 September 2019. She felt distressed and cornered when management made her work seven days on, two days off, then three nights on and two days off. She asked for a change of roster to be “more friendly” but was told there were no other options. 
313.	The applicant didn’t cope with the confrontation. It triggered past traumas “with the system”. She had stopped work on 15 October 2019. She tried to get help from the union and nursing and midwife support. She was feeling burnt out and sick, overwhelmed, and “wants to run away”. She was anxious and irritable and was thinking of accessing her superannuation. 
314.	Dr Tsin recorded adjustment disorder with depressed and anxious mood. 
315.	On 4 December 2019, Dr Tsin recorded that the applicant had been getting EAP, which was helpful. She recommended she get assessed by a psychiatrist. She felt she suffered from a form of PTSD (it is not clear who “she” is, probably the EAP counsellor). 
316.	The applicant saw a GP in Goulburn, who referred her back to her regular GP. That GP could only give her a certificate for three days. She had worked in the ED for about five weeks. Her symptoms started three weeks into her work and escalated. Working for seven days straight caused her more distress and increasing dread of returning to work. She thought she was just exhausted. The feelings worsened, despite the days off. 
317.	The applicant had been anxious and teary. She had ruminations about fixing all the problems in the running of the hospital, given her past experiences. She had flashbacks of past traumas working at HKH – dead babies, patients threatening to shoot her, three children subjected to satanic rituals. 
318.	Nightmares were affecting the applicant’s sleep. She was frightened all the time that she might make a mistake or forget to do something. She was hypervigilant and overthinking simple things. She could not focus or concentrate, and was feeling dead, but didn’t want to die or harm herself. She had made new friends at Crookwell but felt she failed them by not being able to work there. 
319.	Dr Tsin diagnosed PTSD and issued a WorkCover certificate. 
320.	On 18 December 2019, Dr Tsin recorded that the applicant had submitted an incident form with her WorkCover claim. She had used up her five EAP sessions. The counsellor was concerned about her mental health and wanted to contact her unofficially. 
321.	A friend had recommended the applicant see Dr Michael Robertson, who was not taking new patients. Dr Yu-Tang Shen did teleconference consultations and would see WorkCover patients. 
322.	On 7 January 2020, Dr Tsin recorded that the applicant was getting help from the Nurses and Midwifery Helpline. She was avoiding being with people because she got too irritable. News items on TV could trigger her past traumas and frustrations at the health system problems. She was ruminating about past wrongs and injustices. She felt like she needed to prove herself and felt threatened. She had lost her identity and felt her “name is mud in her town”. 
323.	On 21 January 2020, Dr Tsin recorded that Dr Shen had confirmed the applicant had PTSD. She had been sent to a factual investigator and was stressed about this. She was sick of trying to prove her case was genuine. She was ruminating about past experiences with the incompetence of health management and the system. She was frightened about even going in as a patient. “Negativity and catastrophising”. 
324.	On 4 February 2020, Dr Tsin recorded that the applicant had been interviewed by a factual investigator. She tried to explain that her previous traumatic experiences at work had been triggered by her experiences at Crookwell. She felt more traumatised and exhausted after the interview. 
325.	On 18 February 2020, Dr Tsin recorded that EML wanted the applicant to see a GP in Goulburn, but she had tried two GPs and one psychiatrist, who all rejected treating her under WorkCover. 
326.	On 17 March 2020, Dr Tsin recorded that the applicant was assessed by Dr Martin Allen. She turned up and found it was a house in Annandale. She “freaked out” and contacted EML to find that the rooms are in a house. It was the same company of psychiatrists that consults in Goulburn and rejected her because she was under WorkCover. She felt they should have declared their conflict of interest. She “was a mess” and could not remember the consultation or the drive home. 
327.	There is a notation of a phone case conference, where EML advised the claim had been declined because the applicant’s employment with SNSWLHD did not aggravate her PTSD caused by her previous employment at HKH. She was told to seek legal advice and get help through WIRO to appeal the decision. She was very distressed, teary, and angry. She felt abandoned and desperate. 
328.	On 31 March 2020, Dr Tsin recorded that the investigator and psychiatry report said the rostering was not enough justification for her WorkCover. The PTSD was caused by the applicant’s previous employment. She had contacted WIRO and the union. The union had “taken on her case and got onto a good lawyer through the union”. 
329.	On 7 April 2020, Dr Tsin recorded that the interviews with the applicant’s colleagues implied she had overreacted to the patients. “But this was in the context that some patients had poorly controlled conditions. The incidents are taken out of context”. The thought of going back to work horrified her. Her lawyer needed to read through her case. 
330.	On 22 April 2020, Dr Tsin recorded that the applicant talked to the lawyer very briefly two weeks ago and was told to wait. She had left the lawyer a message and emailed, with no response. She was more confused. She could not trust the system, especially after reading all the comments about her. She was still feeling traumatised by her past experiences, still thinking about all the poor care and outcomes. 
331.	On 5 May 2020, Dr Tsin recorded that the lawyer called the applicant, wanting her full medical record. The lawyer was concerned insurance could “cherry pick her medical record to suit them”. She tried to explain her condition as being PTSD. She kept thinking about all the bad things that had happened. 
332.	On 22 May 2020, Dr Tsin recorded that the applicant hadn’t talked to her lawyer since the last consultation. Her full record had been sent to the lawyer. She felt too overwhelmed to talk to the lawyer because she told the applicant she had worked with the psychiatrist she was sent to by the insurance company, and he was “an eminent lawyer” [sic].
333.	The applicant was feeling anxious, fearful, and overwhelmed. She was ruminating over what had happened to her. She felt enormous pressure from NSW Health to resign. 
334.	On 11 June 2020, Dr Tsin recorded that the applicant’s lawyer had reviewed her medical records and “agrees with the insurance’s verdict”. She knew this would happen, given her past attempt at explaining her situation to the lawyer. Her daughter, who was studying law, told her to find a new lawyer, stop fighting this on her own and get some help, as it was affecting their relationship. 
335.	On 30 June 2020, Dr Tsin recorded that the applicant felt rejected by the system and the lawyer. She could not trust the system. She would like to seek another lawyer. She still had the WIRO funding. 
336.	On 29 July 2020, Dr Tsin recorded that the applicant was a bit angry and frustrated about the lack of treatment locally. She “doesn’t care anymore”. Her daughter had linked her with a compensation lawyer in Wollongong. She had sent her all her info. 
337.	On 26 August 2020, Dr Tsin recorded that the applicant “got a new lawyer last Monday who is getting onto a barrister.” She felt it was clearly PTSD dating back to her employment with HKH from 1984. She was talking about being shut down when she raised issues about poor management of patients, poor support by the system and being neglected with poor/no care. 
338.	On 22 September 2020, Dr Tsin recorded that the applicant was happier with her new lawyer who understood her and was taking her seriously. 
339.	On 6 October 2020, Dr Tsin recorded that the applicant was trying not to think about her case and leaving it to the lawyer, who also submitted paperwork for the TPI claim. She had her first EMDR (Eye Movement Desensitisation and Reprocessing) treatment at Goulburn. She had had so many past traumatic experiences. 
340.	On 4 November 2020, Dr Tsin recorded that the union had asked the applicant to contribute her experiences at Crookwell as part of advocacy for rural nursing. She watched a Zoom recording of other ED nurses’ experiences of being overwhelmed with no support. It triggered off her experiences. She contacted the union and asked to speak to the nurse running the program. They were going to call back. 
341.	The applicant was thinking about the stupidity and futility. It was not getting better. She worried about the nurses. She had seen so much, could not trust the system, and was scared of people who don’t care about patients’ welfare. They discussed ideas about the applicant getting into politics. 
342.	On 18 November 2020, Dr Tsin recorded that the applicant had realised there was no effective help for her condition. “WorkCover is all about money”. She had to help herself. She had looked into the legislation. She had not done anything wrong and was being persecuted. She did not trust the system. She was ruminating about all her past traumas in ED. Her lawyer was not responding to her. She wanted her to write a statement. She felt too traumatised. 
343.	Dr Tsin reported to the applicant’s solicitors on 22 April 2022. 
344.	The applicant’s diagnosed injuries were PTSD, MDD, general anxiety, and a cracked tooth, due to grinding as a side effect of anti-depressant. The cause was recurrent exposure to traumatic events working in ED, aggravated by stressful environment, poor management, and poor support at Crookwell. 
345.	Dr Tsin opined that the applicant had been totally unfit for work since 7 November 2019. She has been the applicant’s GP since 2003. She had shown resilience and flexibility with her past challenges. 
346.	Dr Tsin felt that the poor management and decline of the applicant’s “legitimate WorkCover claim” had caused significant and chronic decline of her mental health. It was “clear” she suffered from PTSD. It appeared that the shift of responsibility between her employers was causing more damage to her mental health. As her condition is complex, it was difficult to determine the one source of her injury. 
Dr Yu-Tang Shen – psychiatrist 
347.	Dr Shen reported to Dr Tsin first on 15 January 2020. 
348.	He recorded that the applicant started work on 14 September 2019 as an ED nurse. “Nothing happened, just normal ED presentation. Walked out 21 October 2019”. They were desperate for an ED nurse. 
349.	The applicant started getting cold sores, blisters in her mouth, pain in her spine and HPV virus. She was run down and just tired. She thought she was used to working full time, and just went to the doctors and couldn’t return. She couldn’t pinpoint. Then she developed gastrointestinal symptoms. 
350.	She went to the doctor. “Made her out to feel she was nothing and was going for something or made a criminal mistake”. She returned to Dr Tsin, who suggested she do something else. 
351.	The applicant felt she was covering up NSW Health. She was making sure she was compliant with triage and thorough. It was at cost to her career. She felt “if she made a mistake, she’s never make [sic] a mistake, and can never make a mistake”. Something catastrophic would happen and a patient would die. This had happened before, but she’d never made the mistake, she’d had to fight for patients. 
352.	The applicant then started to ruminate on the past, “where something innocuous at Crookwell. A million things come up, past things of patients, where mistakes made, and she has to fight for the patient and go over top of head, otherwise patients would die”. 
353.	The applicant went in, did seven days straight, “then need a roster and management”. Then she had two days off, then three nights, then two days, then seven days again. She struggled with it and talked to the union. She spoke to management – “look that that’s the way it is, and no resolution”. 
354.	Dr Shen recorded that the applicant had no prior mental health issues. Her GP said she had depression at one stage. She did not recall it. There were no manic episodes. She had had no previous treatments. She had used EAP over the years. 
355.	“Something happened” at work in 2015, regarding management. The applicant didn’t do anything wrong. As a clinical facilitator, she interviewed patients after students had treated them. One patient complained of sexual assault, which she reported to the NUM, who reported to the Uni that she interrupted him, “off his ward”. There was a meeting with high-level executive, and she had one strike for interrupting a board meeting. 
356.	The applicant’s whole person was involved in nursing, “part of her personality”. It was hard to trust clinicians. She put a lot of emphasis on [her] qualifications. Her sister is bipolar. 
357.	Dr Shen recorded that the applicant was groomed, engaged well. Her mood was low and anxious, with teary and restricted affect. She was articulate and logical, with no suicidal ideation. She had ongoing flashbacks and guilty ruminations. There was no paranoia, she was alert, with reasonable insight. 
358.	Dr Shen opined that the applicant had PTSD, arising from difficult work-related experiences that had been re-activated by a stressful work environment from a new job.  
359.	On 26 February 2020, Dr Shen added that the applicant had developed MDD. 
360.	On 24 June 2020, Dr Shen reported that the applicant had ongoing depression, anxiety, and PTSD, exacerbated by a rejection of her claim. The diagnoses were MDD, MDE, (major depressive episode) and PTSD, vicarious type. She had hypersensitivity to expectations not being met. 
361.	On 7 June 2021, Dr Shen reported to TAL United Health Group. 
362.	He opined that the applicant’s diagnoses were PTSD, with MDD. She had not made any significant progress. She required further treatment, but her prognosis was unlikely to improve, and she had reached maximum medical capacity. 
Dr Martin Allen – consultant psychiatrist 
363.	Dr Allen was qualified by EML and reported first on 10 March 2020.
364.	The applicant told Dr Allen she had never been diagnosed with any psychological conditions in the past, and never received medication. She appeared to have had contact with EAP a number of years ago, due to what she regarded as a “sexual assault”, involving a patient. She tried to report the complaint to the NUM, but a complaint was raised against her. Any stress she experienced appears to have been relatively brief and short-lived. 
365.	The applicant said she had never had an alcohol problem and had not drunk alcohol since July 2019. She had a sister who was healthy. Her father died from suicide when she was 30. He “died of shame” following a divorce from her mother. He had no prior mental health issues. 
366.	The applicant’s stressors at Crookwell related predominantly to rostering issues. She described significant concerns about the nature of the roster, and when she initially worked there it became apparent there was no roster. She would simply be told on one day if she was working the next. She could not plan ahead and found this extremely frustrating. 
367.	The applicant was buddied with another nurse for the first few days, but overall was “the only emergency nurse on”. She described an extremely busy position. She had repeatedly raised the rostering problems with her NUM, but this was seemingly not addressed quickly enough. 
368.	By the end of her time at Crookwell, a roster had been put in place, but not before, Dr Allen understood, the applicant had spoken to Fair Work Australia and been told it was a legal but unusual roster, given its “seven days on” nature. 
369.	The applicant had spoken to a junior nurse “who looked tired” and asked about the rostering. The applicant said, “I don’t think it’s legal”. She made comments about pursuing it but felt her colleagues’ attitude was “good luck with that”. She did not feel they anticipated much would change. 
370.	Due to the rostering issues, the applicant was “not sleeping”. She felt low energy and fatigue. By the middle of October, she had been at Crookwell for three weeks. On her day off, she “froze” and thought “what am I doing?” She felt overwhelmed. One concern was that the [CC]TVs were behind her. 
371.	The applicant referred to the case of the child who had been admitted with an overdose, and the paperwork involved. She was quite late in finishing her shift. The next day she received an email from the GM stating she should have requested approval to stay. On reflection, she said “when the fuck would I have had time to call the general manager?” 
372.	The applicant had discussed her issues with a doctor at the hospital. She said “I’m fit. I don’t need education. I’m a clinical nurse educator in clinical care but this roster is relentless. I have no sleep. I get nervous thinking about what I’ve forgotten to do”. 
373.	Dr Allen recorded that, seemingly in response to the significant stress the applicant felt due to the rostering and pressure of working at Crookwell, memories of past traumatic jobs she was exposed to many years ago were rekindled. She had never been troubled by or thought about them. She described the matters she has referred to in her statement.
374.	In the context of the Crookwell stressors, the applicant described having gone from a state of psychological wellbeing to finding herself distressed, depressed, ruminative, and pre-occupied with the difficulties there. She felt overwhelmed and frustrated and unable to complete her work satisfactorily. Symptoms she had never experienced developed, including nightmares of past traumatic events from many years ago, apparent flashbacks to traumatic events, and intrusive thoughts. She denied any trauma-related symptoms prior to working at Crookwell. 
375.	Dr Allen had been provided with the factual investigation and referred to that evidence. There was “a picture of Ms Jarvis being deeply dissatisfied with the working practices and rostering situation” at Crookwell. There appeared to be various disciplinary issues regarding her conduct. It was again emphasised in the information provided that her dissatisfaction with the rostering was hugely stressful for her.  
376.	The applicant appeared somewhat disorganised and overwhelmed. At times her answers were off topic. She took a phone call from EML. Her speech lacked prosody and was slowed. She appeared distracted. There was no evidence of psychosis, and she showed no signs of hallucinations. She did not report thoughts of self-harm or suicide. Her affect was restricted. 
377.	Dr Allen opined that the history indicated a diagnosis of MDD and PTSD. However, the trauma did not occur at Crookwell but related to historical events over 15 years ago, which Ms Jarvis denied caused her any symptoms before. 
378.	The stress at Crookwell appears to have surrounded rostering and concerns about the applicant’s interpersonal differences with others. Dr Allen opined that she was clearly not coping with the requirements of the position, which did not appear to be particularly onerous or unusual. Her mental health deteriorated due to the stressors of the workplace, but they appeared to be typical stressors of such a role, rather than unexpected or atypical. The rostering issues and the demands of her position were the predominant cause of the deterioration in her mental health. 
379.	Ms Jarvis had no work capacity at that time. Dr Allen had no evidence to suggest she was feigning her condition, or of any inconsistency. Her prognosis was guarded. She remained fixated on her difficulties at Crookwell and had PTSD symptoms related to long-term issues that did not cause ongoing symptoms for many years until her recent breakdown. 
380.	Dr Allen’s supplementary report is dated 20 March 2020. He had been provided with clinical notes, certificates, and correspondence. 
381.	Dr Allen noted extensive reference to multiple issues affecting the applicant over the years, which had, on repeated occasions, been described as causing psychological symptoms. There was reference to mental health issues dating back to 2007, and to counselling, psychological referrals, and prescription of antidepressant/anti-anxiety medication. 
382.	There were also notes of financial and family issues, relationship difficulties, and apparent alcohol dependence. Dr Allen opined that clearly these were all significant contributors to the applicant’s longstanding psychological difficulties, which predated her time at Crookwell by some years. 
383.	Dr Allen noted the long term use of Duromine, a medication for weight loss. Common side effects include sleeplessness, diarrhoea, anxiety and nervousness, headaches, and palpitations. It is possible that in the long term, some of the applicant’s symptoms attributed to her mental health difficulties were simply side effects of the Duromine.
384.	The reference to an adjustment disorder in a Centrelink medical certificate dated 21 August 2018, along with numerous other factors, led Dr Allen to change his opinion on causation. The applicant had denied ever having a problem with alcohol use and said she had never been diagnosed with any conditions and never received medication. This was clearly incorrect. 
385.	Dr Allen reported that there was evidence of the applicant having longstanding issues, typically regarded as “depression” by her GP. She had an enduring psychological condition, likely consistent with MDD. Whilst there may have been some alteration in her symptoms in recent months, Dr Allen did not regard the time at Crookwell as causing the development of any psychological condition. Rather, the stress associated with the rostering, which she was unhappy with, caused a slight exacerbation in her longstanding difficulties. 
386.	While Dr Allen noted cross-cutting features of PTSD, he did not regard it as an appropriate diagnosis after reviewing the GP’s notes. He regarded the applicant as having a longstanding MDD. The evidence indicated an alcohol use disorder, in remission, with some cross-cutting features of PTSD. 
387.	Dr Allen noted the absence of any reference to traumas or trauma-related psychological issues over the years. He did not believed PTSD was an appropriate term.
388.	Dr Allen did not believe Crookwell caused any particular difficulties for the applicant, aside from her concerns about the roster. It certainly did not cause her to develop PTSD. He attributed 90% of her difficulties to her longstanding problems, and 10% to any recent exacerbation that occurred through the rostering concerns. She was clearly dissatisfied with the set up at Crookwell. This caused her concern and led her mental health to deteriorate somewhat, but her longstanding issues were in evidence and clearly documented. 
389.	Dr Allen again reported on 5 March 2021, having re-examined the applicant. He had been asked to comment on the report of Ms Alicia Tyler, psychologist. He was respectful of her report but felt that neuropsychological testing had not fully described the applicant’s clinical picture very clearly, failing to take account of potential Criterion A stressors of PTSD.
390.	Dr Allen opined that management of the applicant’s condition would typically focus on anxiety and depressive symptoms, which covers the significant extent the diagnosis of dysthymia and generalised anxiety disorder (GAD) [sic].
391.	The applicant’s employment had been terminated. She felt deeply ashamed and continued to feel grossly persecuted by recurrences [sic: occurrences] at work. She stated she had not reached a point of fitness in the last year that had seen her able to pursue alternative employment. 
392.	The applicant was being treated by Dr Tsin. She had been seeing a psychiatrist, but this was discontinued. She had seen a psychologist for five sessions through EAP but was “dumped”. Her GP had been trying to provide some cognitive behavioural therapy. She had “failed” EMDR and had possibly been under the impression it would lead to improvement in anyone suffering from the kind of symptoms she had. She had been considered for transcranial magnetic brain stimulation, but it had not occurred. 
393.	The applicant’s symptoms remained acute. It was his “passive face” at the initial review that triggered something that made her recall previous encounters at HKH. When she looked in his eyes it made her “think of Hornsby”. It may have been triggered by his lack of “compassion”. 
394.	Dr Allen asked about symptoms of PTSD, such as nightmares and flashbacks. The applicant said they continued seemingly daily, with nightmares consumed by things she experienced and witnessed at Crookwell. In addition, she felt generally overwhelmed. She lacked trust and had become isolated. She was depressed, felt like a “failure”, and described feelings of worthlessness, helplessness, and hopeless ideation. 
395.	Dr Allen felt the applicant was distressed. She cried several times. At times, her responses were somewhat off topic, and she needed redirection. She appeared depressed and her affect was flat. 
396.	Dr Allen opined that symptoms of MDD and PTSD remained present, and he made no change in his diagnosis. The applicant referred to various traumatising situations at various hospitals as now forming part of her thinking, but there was no evidence of any enduring psychological condition over time. Rather, it was the difficulties at Crookwell that seemed to have triggered her mood issue and post-trauma symptoms. The diagnosis was PTSD and MDD, in large part attributable to the alleged difficulties she experienced at Crookwell. 
397.	This was a “she said/she said scenario” where there were various views of events that led to the applicant’s condition. Dr Allen was “agnostic” about the veracity of the statements, but from the applicant’s perspective, the circumstances of a traumatising nature at Crookwell triggered distress like she had never experienced before and led to her current diagnosis. 
398.	Dr Allen did not regard the applicant’s work situation at Crookwell as having triggered her pre-existing condition. Rather, she developed her condition as a result of the triggering impact of her experiences whilst working at Crookwell. Some of her concerns related to past places of work, but these were memories that formed part of her nightmares and flashback type experiences, along with her ruminative distress. Dr Allen did not regard her past experiences as having caused her condition. Rather, the alleged difficulties at Crookwell led to her condition as diagnosed. 
399.	The aggravating effects of the work injury persisted. The applicant had failed to tolerate medication trials. She was not having psychological support or seeing a psychiatrist. She remained distressed at the impact of her experiences at Crookwell on her ability to work. Dr Allen could not predict when the aggravation would cease. 
400.	Dr Allen opined that the work-related incidents described by the applicant and her subjective experiences at Crookwell appear to have led to her psychological conditions. Asked to opine on the application of s 9A of the 1987 Act, he said he had considered her time at Crookwell, the nature of her symptoms, and the issues she reported having observed in the workplace in making the diagnosis. He noted the other stakeholders had a different view of her performance and experience in the workplace. 
401.	Dr Allen opined that the applicant was fully incapacitated from [sic] work. He saw no evidence to suggest she was exaggerating or feigning her condition. He did not discover any inconsistency. Her prognosis was poor. She was not having any treatment, which was entirely inappropriate. 
402.	Dr Allen noted significant reference by the applicant’s GP to PTSD, and some of the symptoms Ms Jarvis experienced he considered consistent with that diagnosis. Predominantly, it was her mood issues that caused the main problems in her level of function and led to the diagnosis of MDD. She saw her symptoms all together and recognised she did not fit clearly into any “one box”. 
403.	From a diagnostic perspective, Dr Allen thought the applicant had MDD and PTSD, and those were the clinical issues that needed to be addressed. 
404.	Dr Allen had reviewed the psychometric testing, with the diagnosis of somatic symptom disorder, GAD and dysthymia. This was not the clinical picture that came forward when the applicant explained her symptoms. She had significant somatic symptoms, but they were either the effects of medications or associated with depressive or PTSD symptoms, and not a distinct condition in themselves. 
405.	Dr Allen did not regard the applicant as having generalised anxiety. She had specific concerns that led to her having anxiety as part of her PTSD and mood symptoms. Her dysthymia did not sufficiently describe the severity of her depression, hence his diagnosis of MDD. 
406.	Dr Allen did not find any significant inconsistency in the applicant’s account, based on the two occasions he had seen her, and the history given. There had been no difference in his diagnosis, but he noted that different stakeholders had provided different views of her experiences at Crookwell. This was a significant inconsistency that was noted in the context of his assessment. Who had provided the most accurate account was beyond his area of expertise, but certainly the applicant’s view of events indicated a concerning workplace that led to her developing her diagnosed conditions. 
407.	The statements had not led to Dr Allen altering his opinion and diagnosis, causation, and incapacity for work. 
408.	Dr Allen provided a supplementary report dated 7 June 2021. 
409.	Dr Allen described the criteria for PTSD. The history the applicant provided, particularly at his first review, was of stressors at Crookwell related predominantly to apparent rostering issues. She had, furthermore, observed concerns but had been unable to plan her personal life. She described a swift deterioration of her mental health in the early weeks of working at Crookwell. She felt the expectations of her at work were “overwhelming”.
410.	Dr Allen referred to the applicant’s evidence about gunshots, which would meet the criteria for PTSD. This incident occurred at HKH. 
411.	 Dr Allen was advised that the applicant attended the workplace at Crookwell for only 20 days. He opined that, overall, the information provided to him left a picture that she had enduring difficulties that predated her time at Crookwell. Her experiences there may temporarily have exacerbated her difficulties, due to the stress she perceived experiencing due to rostering issues. “For example,” her condition was not caused by any experiences at Crookwell. Rather, the mild exacerbation occurred while she was there, and any exacerbating effect of her time there should be considered as having resolved. 
412.	Dr Allen then referred to his supplementary report dated 20 March 2020. There were extensive other issues in the background of the claim, that he considered led to psychological difficulties. The applicant’s previous issues, including the incident at HKH, indicate her psychological condition had its origin prior to Crookwell, due to various stresses she had been exposed to over the years. 
413.	Dr Allen had noted the presence of nightmares and flashbacks. They had continued daily. The diagnoses remained MDD and PTSD, based on the symptoms reported to him. PTSD remained present. They were punitive in their origin in the events where she was exposed to trauma. Most notably, on her first assessment, was “the Hornsby issue”, which seemed to be one of the most pertinent issues in her history regarding previous exposure to difficulties. 
414.	The applicant was acutely unwell, clearly needing ongoing care. Her PTSD had its origin in the prior workplace, and the stress in regard to various issues over the years appeared to have given rise to psychological difficulties, including ongoing mood issues. 
415.	Dr Allen opined that a temporary exacerbation of these conditions occurred due to difficulties at Crookwell. It appeared, with Ms Jarvis no longer being there, the exacerbating effect of her difficulties could be regarded as having ceased. This did not mean her psychological distress was not real. It remained of concern, and [there was] a need for ongoing treatment, but given the brief period and the nature of her difficulties at Crookwell, and taking into account the background history, which referred to multiple other difficulties in the background, it appeared clear that the evidence indicated enduring psychological problems prior to her entering into the workplace at Crookwell. 
Associate Professor Michael Robertson – consultant psychiatrist 
416.	A/Prof Robertson was qualified by the applicant and reported first on 2 February 2021. 
417.	A/Prof Robertson recorded a consistent work history. The applicant began work at Crookwell in September 2019. She ceased duties in late October 2019, after she experienced dissociative episodes and “went home having pissed my pants”, stating “my brain split in two”. 
418.	The applicant had been exposed to multiple traumatic events throughout her career. This included completed patient suicides; being threatened by patients; exposure to children who had been sexually abused and neglected; and the aftermath of adverse outcomes involving patients. 
419.	A/Prof Robertson reported that the applicant experienced several difficulties in the course of her employment. He referred to the letter of instruction, which is not in evidence. It apparently referred to disputes over the management of a patient suffering pseudo seizures; dealing with a suicidal patient; failure to recognise the severity of the spouse of a patient demonstrating severe neglect; the lack of what she considered adequate staffing or appropriate policies and procedures; inadequate policies regarding administration of paediatric medication; and patients being allowed to behave in a manner that was a risk to staff and patients. 
420.	The applicant was “long aggrieved” that the hospital lacked adequate security, creating what she considered to be an unsafe environment. She believed the administration was “not up to the task”, and lack of adequate internet connection or Telehealth compromised patient care to a point where she felt incapable of working to her professional expectations. 
421.	The applicant’s mental state deteriorated rapidly, and she evolved symptoms, including intrusive recollections of multiple traumatic events she had encountered, manifesting as nightmares and occasional flashbacks. She experienced hyperarousal, hypervigilance, diminished self-worth, irritability, and multiple dissociative symptoms, including periods of derealisation, and an exaggerated startle reflex, leading to several instances of loss of continence. 
422.	The applicant denied any past psychiatric history. A/Prof Robertson noted her previous history of heavy alcohol use, and the referral from Dr Tsin to Dr Gould dated 13 May 2010, with its references to her attending Alcoholics Anonymous and bipolar disorder. He also noted that her father committed suicide and her sister has bipolar disorder.
423.	A/Prof Robertson recorded that the applicant was agitated and emotionally labile, particularly when discussing her frustrations with her former employer. Beyond this, there was no evidence of current hypomanic or mixed affective state. There were no psychomotor changes evident. The applicant denied being suicidal.
424.	A/Prof Robertson agreed with the substance of Dr Allen’s opinion, in that the applicant’s presentation was significant of PTSD and there was a concurrent MDD. A “closer read” of the information provided indicated there may have been psychopathological disturbance pre-dating her commencement at Crookwell, although there was no indication that there was an actual diagnosed psychological injury or psychiatric disorder. 
425.	There “seem[ed]” to have been a history of previous heavy alcohol use and given that the applicant’s GP had sought to explore her psychopathological state, that is, suspected bipolar disorder, it is likely she was experiencing psychological distress at the time, but had not endorsed it. 
426.	A/Prof Robertson saw no evidence of bipolar disorder on this assessment, nor was there any indication from the applicant’s history of any categorical periods of hypomania. Given the extensive family history, this required consideration. 
427.	“In the final analysis”, A/Prof Roberson opined that the applicant had a long career in nursing and had accumulated a considerable store of traumatic stress. He suspected there were subclinical manifestations of a post-traumatic mental health syndrome that reached its full flourishing in the context of a series of comparatively minor stressors over a very brief period of employment at Crookwell. He viewed the nature and conditions of her employment at Crookwell as being a precipitant, rather than cause, to her current psychological injury.
428.	 A/Prof Robertson, “taking a wider view”, opined that the applicant’s PTSD, ostensibly of delayed onset, emerged throughout the nature and conditions of her employment, particularly given some of the critical incidents she described at HKH. 
429.	A/Prof Robertson did not believe the applicant had had adequate treatment, or that her injuries were stable. The diagnoses were chronic PTSD, albeit of delayed onset, and concurrent MDD. There was a previous alcohol use disorder. The prognosis was guarded. The applicant had a long-standing psychological injury and was likely to encounter barriers to accessing treatment. Prospects of her returning to nursing or any form of paid employment were minimal.
430.	A/Prof Robertson provided a supplementary report dated 16 March 2022. 
431.	A/Prof Robertson opined that the applicant had suffered a psychological injury arising from her employment at Crookwell – the injury was first clinically evident during her employment there. There was more likely than not traumatic stress exposure during her employment at HKH. However, there was not irrefutable evidence of a psychological injury at that point. This component of her working life was more likely than not a pre-existing vulnerability to later psychopathological disturbance. 
432.	A/Prof Robertson opined that there was no evidence of a psychological disorder prior to the applicant’s employment at Crookwell. Pre-existing vulnerabilities to a psychiatric disorder, attributable to aspects of her employment prior to the period working at Crookwell, were aggravated, accelerated, and deteriorated into the workplace injury during her employment at Crookwell. That employment was the main contributing factor to the aggravation, acceleration, exacerbation or deterioration of the psychological disease injury. 
Ms Alicia Tyler Tyler – psychologist 
433.	Ms Tyler was qualified by the first respondent. She assessed the applicant by way of psychometric testing on 25 January 2021 and reported on 12 February 2021. Her report is replete with tables, graphs, and statistics. It is not my intention to discuss those aspects in detail. I have already referred to Dr Allen’s comments. 
434.	Ms Tyler reported that “[i]f one were to trust the clinical examination alone”, the applicant presented as someone who was distressed by what has allegedly occurred and has consequently had a decrease in her ability to function. As she had passed the malingering scales, this was taken at face value.
435.	On clinical interview, the applicant impressed as someone who was having a genuine mental illness, which, depending on how the assessor interpreted the alleged stressor, would suggest adjustment disorder or PTSD, if there was no pre-existing mental illness. However, “[j]ust because a person appears one way on interview does not mean that is an accurate assessment of how they are”. 
436.	Ms Tyler opined that testing had identified that the applicant had GAD, dysthymia and somatic symptom disorder. The diagnoses were generated by software. The applicant “cannot” have a valid diagnosis of PTSD, as Criterion A had not been established or reported. 
437.	Criterion A requires exposure to death, threatened death, actual or threatened serious injury or actual or threatened sexual violence. Ms Tyler opined that there was no such event ever reported as an alleged cause of injury. In criterion A’s absence, the diagnosis cannot be given. This diagnosis needs to be reviewed. 
Dr John Albert Roberts – psychiatrist 
438.	Dr Roberts was qualified by the first respondent. His first report is dated 31 August 2021. He reported that he had not been provided with the factual investigation of events at Crookwell. 
439.	Dr Roberts recorded that the applicant’s last shift with NSLHD was on 2 October 2015. It was important to note that she denied any history of psychiatric/psychological problems prior to her employment at Crookwell. 
440.	The applicant stated she had been unhappy at HKH in 2008 and was told to find out what was wrong. She commented she had been shot at and a patient showed her a bullet and a gun. She had been attacked by patients who were psychiatrically unwell. Dr Roberts described her account as being associated with a degree of pressure of speech, disjointed and incoherent. Her presentation was consistent with cognitive difficulties. 
441.	Dr Roberts recorded a history that the applicant had used the Nurses and Midwifery Help Line and had had no previous psychiatric difficulties. If she had had PTSD for 17 years, “I would have discussed it”. 
442.	Dr Roberts recorded the suicide of the applicant’s father, and her sister’s bipolar 2 disorder diagnosis. The applicant denied having been diagnosed with bipolar disorder. Dr Roberts noted that her presentation was associated with symptoms associated with bipolar 2, including a degree of thought disorder, flitting from one topic to the other, and pressure of speech.  
443.	Dr Roberts opined that the most likely diagnosis was bipolar 2 disorder. The applicant’s misinterpretation of events, if such is assumed to have occurred in relation to her employment at Crookwell, suggested a differential diagnosis of a schizoaffective disorder. It was “imperative” that the allegations regarding the circumstances at Crookwell be confirmed. 
444.	Dr Roberts opined that the applicant’s statement that she had no psychopathology before her employment at Crookwell negated a claim that she developed a condition at Crookwell due to pre-existing events at HKH. He noted A/Prof Robertson’s reference to her exposure to multiple traumatic events – “[s]uch would be universal experience of doctors and nurses in hospitals”. The same past psychiatric history had been given to all the independent medical assessors. 
445.	Dr Roberts did not consider the diagnosis of PTSD was tenable if it was assumed, as alleged by the applicant, that she was free of symptoms prior to her employment at Crookwell. None of the Criterion A circumstances occurred at Crookwell. The assertion that the main problem related to rostering (which was the history recorded by Dr Allen) and that could give rise to PTSD is untenable.
446.	The applicant’s behaviour at Crookwell, as quoted by Dr Allen would, in Dr Roberts’ opinion, indicate the presence of a mental illness. A mood disorder was far more consistent with her presentation than PTSD. 
447.	It was Dr Roberts’ impression that the applicant was unwell, and the possibility of a bipolar 1 [sic] disorder would be a matter for consideration. Her presentation to A/Prof Robertson and Dr Allen was not as disturbed as it was when he assessed her on 17 August 2021. 
448.	Dr Roberts did not consider that the circumstances and conditions of the applicant’s employment had given rise to a condition. It could not be asserted that the circumstances and conditions of employment at Crookwell, even assuming roster difficulties, were of such a nature that they could have precipitated a mental illness. In his view, Ms Jarvis has never suffered from PTSD. Her condition has neither been caused nor aggravated by her employment. 
449.	Dr Roberts again reported on 13 June 2022. He referred to the applicant’s statement. 
450.	Dr Roberts noted that the applicant’s statement that she had no history pf psychopathology before her employment at HKH was an error of fact. She indicated that on her last day before going on long service leave in 2009, she heard a loud bang that she thought was a gunshot. He understood it was never shown that a gun was fired.
451.	Dr Roberts referred to the evidence of the second respondent’s lay witnesses. The applicant’s behaviour was not consistent with mental normality and was characteristic of a mentally ill person attempting, and failing, to function in the workplace. Having regard to her brief period of employment at Crookwell, mental illness would inevitably have been in evidence prior to her employment there. 
452.	Dr Roberts noted references in the clinical records of Berowra Family Medical Practice to frequent prescriptions for Duromine and alcohol excess. Duromine is contraindicated in the case of psychiatric illnesses.
453.	Dr Roberts opined that the applicant had a long history of mental illness, for which she was predisposed by her family history. Her behaviour, in terms of her grandiosity, aggressivity [sic], and expressed elevated opinion of herself and status, is consistent with the presence of a bipolar disorder. Potentially that behaviour was aggravated by the lengthy prescription of Duromine. In addition to fulfilling the provisional diagnosis of bipolar disorder, the applicant would also fulfil the potential diagnosis of a substance use disorder, relating to alcohol and Duromine. 
454.	Dr Roberts agreed with Ms Tyler’s assessment to the extent that it negated the diagnosis of PTSD arising from the circumstances and conditions of employment. He did not consider they were a matter for consideration, either as causative or aggravating factors. He did not consider that employment was the main contributing factor to either the contraction of, or the aggravation, acceleration, exacerbation or deterioration of any psychological condition. In the event of PTSD being considered, it was related to the suicide of the applicant’s father. 
455.	None of the further evidence caused Dr Roberts to alter his opinion that the most likely diagnosis was bipolar mood disorder, complicated by substance use. 
456.	Dr Roberts provided a further report dated 14 September 2022. He had been directed to the clinical records, confirming a significant past psychiatric history, with an initial presentation on 22 April 2010.
457.	Dr Roberts referred to various entries in the records. He commented that it is in stark contrast to the applicant’s assertion that she had no history of psychopathology before her interaction with Crookwell. 
458.	Dr Roberts noted that Dr Allen appeared to perceive a connection between past alleged traumatic events that appeared to have no impact until the applicant arrived at Crookwell, when the environment resulted in reactivation of past traumatic events. He referred to a review of studies that confirmed that symptom onset of PTSD is almost never delayed. He quoted from Kaplan and Sadock’s “Comprehensive Text-book of Psychiatry” 9th edition: 
“In some rare cases a person may develop symptoms that fall just short of meeting full   criteria for PTSD that a worsening of symptoms several months later may result in the person finally qualifying for the diagnosis. At first glance, this would appear to constitute a delayed onset of the PTSD syndrome, but it is not as if the person has been wholly asymptomatic during the period following the trauma and prior to meeting full criteria…”
459.	Dr Roberts opined that the assertion that the applicant’s experiences involving roster and administration at Crookwell could give rise to PTSD is untenable and contrary to definition. He maintained his view that she had never suffered from PTSD. He also considered that she was an unreliable historian. A/Prof Robertson’s reference to psychological injury being first clinically evident during her employment at Crookwell is incorrect. 
460.	The applicant’s statements of having been in a state of psychological wellbeing prior to Crookwell is negated. Her claim would be considered under the heading of inappropriate attribution, which is the attributing of symptomatology to a potentially compensable situation, when it was not, on psychiatric grounds, compensable. If this is done purposively, it is a subtype of malingering. 
461.	Dr Roberts “totally” agreed with Ms Tyler. The probability was that the applicant was suffering from a mood disorder. He agreed with Dr Allen that there was no evidence of any condition arising from Crookwell but disagreed that any exacerbation occurred. The totality of the claim was untenable on reasonable psychiatric grounds. 
462.	Finally, Dr Roberts reported on 4 October 2022. 
463.	Dr Roberts was of the view that the applicant did not sustain injury as a result of her employment with Crookwell. He again referred to the clinical records. 
464.	A bipolar disorder is a genetic condition. It is defined as “A primary disorder of mood characterised by periodicity”. Periodicity implies an inherent tendency to relapse, regardless of circumstances. Dr Roberts opined that it is probable that, regardless of circumstances, the applicant would have experienced mental difficulties. 
465.	Dr Roberts opined that Ms Jarvis had a bipolar 2 disorder and a substance use disorder. Because of her non-work related mental illness, her perceptions were an expression of that mental illness, and not substantially determined by the circumstances and conditions of her employment, either at HKH or Crookwell. 

SUBMISSIONS
466.	The parties’ submissions have been recorded and I will therefore summarise them only briefly.
Applicant 
467.	The applicant did not resile from the fact that there have been incidences when she needed psychological assistance for various matters. 
468.	The applicant submitted that of particular relevance is her employment between 2010 and 2019. She had been exposed to a number of traumatic stressors. Following particular incidences in 2010 she went on long service leave. She then commenced work in other roles but continued working in clinical practice as well. 
469.	The applicant’s employment before 2019 was almost all in major metropolitan centres, with a large degree of resources and staffing. In 2019, she commenced work in a regional hospital, which was the first time she had worked in a hospital that was not staffed and resourced to that capacity. 
470.	The applicant submitted that during the course of her employment at Crookwell, she was subjected to a number of incidents, each of which, on its own, was relatively innocuous. However, they, in combination with what had occurred at HKH, caused her to suffer a significant psychological injury. There seems to be basic agreement that she is now incapacitated for work. 
471.	The applicant submitted she was anxious and unwell when she commenced long service leave. She returned in about March 2010 and had some concerns about returning to HKH. She worked at UTS and then took a six month contract in about 2011 to work as a clinical nurse educator at RNS. She had a number of placements at major metropolitan hospitals. 
472.	The applicant submitted that she was relatively psychologically stable and had continued ability to work in those roles. She referred to what occurred at Crookwell. There were issues in relation to rostering. 
473.	The applicant submitted that the date on which she decompensated to such an extent that she was no longer able to return to work was 19 October 2019, on which date there was an incident involving a young child. This raised particular concerns for her. She had considerable psychological symptoms on the way home. Her evidence is that she had never felt anything like it. There is nothing in the evidence to suggest she had ever had these feelings or reaction. 
474.	Dr Shen provided an early diagnosis of PTSD. The applicant referred to his evidence as to her capacity for work. She submitted in his opinion she has a condition that precludes her from returning to work. 
475.	The applicant referred to A/Prof Robertson’s reports. He diagnosed PTSD, albeit of delayed onset. There was concurrent MDD and previous alcohol use disorder. He opined that there were psychological vulnerabilities caused by her employment at HKH, but they did not manifest until she commenced work at Crookwell. 
476.	The applicant submitted that Dr Allen’s reports seem somewhat of a “moving [sic] feast”. Of particular interest is his diagnosis of PTSD and MDD. His opinion that her PTSD symptoms related to long term issues many years ago that did not cause symptoms until her recent breakdown accords to some extent with the opinion of A/Prof Robertson. She submitted the one consistent thing he said was that she is fully incapacitated for work. While the diagnosis appears to be consistent, he is unable to provide a clear opinion on attribution. 
477.	The applicant submitted that the neuropsychological report contains new diagnoses, but there is a confirmed depressive condition that is at least consistent across the reports. 
478.	The applicant referred to her evidence that she felt some anxiety about returning to HKH, and how she felt before going on long service leave. She submitted these possible psychological symptoms did not conform with particular psychopathology, but indicated she experienced some pre-clinical anxiety following her work with HKH. 
479.	The applicant referred to Dr Roberts’ opinion that her presentation was consistent with bipolar disorder. She submitted that he did not consider she was exaggerating and, in general consistency with the other reports, considered she was totally incapacitated for work. She submitted it is difficult to reconcile his diagnosis with the multitude of other reports, but he seemed to be of the opinion that she was suffering some sort of mental illness at Crookwell. This conformed with his opinion that certain behaviours were characteristic of a mentally ill person attempting to function in the workplace, and failing to do so. 
480.	The applicant submitted that what I had before me was one who had worked in various roles until she began working at a regional hospital, which she felt was both understaffed and under resourced. She had difficulty from working there and suffered psychological injury to such an extent that she was no longer able to return to work. Injury and incapacity were both established. 
481.	In reply to the first respondent, on “notice” and “claim”, the applicant submitted that she initially lodged her claim with EML, in relation to the second respondent, in August 2020. She changed solicitors and her new solicitors lodged a claim with HKH in early May 2021. She was not aware she had PTSD until she was diagnosed in or about December 2019. Her evidence is that during long service leave she was functioning quite well, and she only became ill after feeling that she did not have support or resources at Crookwell.
482.	The applicant submitted it is evident that she was unaware of her diagnosis. It was only after receiving, in particular, the reports relating her current symptoms to HKH, that she became aware that there was any possibility of an alternative employer being responsible for the injury. It was also only when she changed solicitors that the claim was made, and that aspect investigated. 
483.	The applicant submitted she was “ignorant”, within the meaning of s 254(3)(b) of the 1998 Act. It was not until 2019 that she was even aware there was an injury significant enough to make that particular claim. 
484.	The applicant submitted that HKH had pointed to no prejudice in relation to dealing with her claim. Her claim fell within the special circumstances under s 254 of the 1998 Act, or the failure to give notice appropriately should not bar her claim. 
485.	As regards her evidence that she became aware she had PTSD in December 2019, the applicant submitted that on 9 December 2019, she lodged a claim with EML in relation to the second respondent, and a factual investigation was completed on 8 February 2020. 
486.	The applicant referred to her evidence that her then solicitors did not want to dispute EML’s denial of liability and did not offer her any further advice. She changed solicitors in August 2020. EML continued to deny her claim, stating that since the injury occurred at HKH she should apply there. 
487.	The applicant submitted that, until she received further advice from her new solicitors, she was advised that she did not have a proper claim against the second respondent and was not advised of the appropriateness of bringing a claim against the first. It was only after changing solicitors and obtaining the report of A/Prof Robertson, dated February 2021, that the claim was lodged in May 2021. She was unaware of her rights and her previous solicitors indicated she did not have a claim. 
488.	As regards A/Prof Robertson’s evidence, the applicant submitted he was provided with all her GP’s records, which provided her whole history, and it is evident that he applied his own clinical understanding of their significance to determine a diagnosis. She submitted that what he was saying was that she was not accepting that psychological indications were in existence. She had never been diagnosed with bipolar disorder, and there is only one report, not by a treating doctor, that suggests she has it. 
489.	The applicant urged caution in the weight to be given to every entry in the GP’s notes, referring to Mason v Demasi [2009] NSWCA 227 (Demasi). She was not just going to this GP for a diagnosis or treatment but discussed virtually every aspect of her life and things that were relatively innocuous. The GP had referred her only twice to a psychologist or therapist before 2019, in 2007 and 2010. 
490.	The applicant submitted that throughout 2011 and onwards, there was no indication that she required any psychological treatment. The continued discussions of various aspects of her life, without elevating these matters to clinical significance, continued until she went to work in 2019. It was not until then that the GP considered she had PTSD and provided a referral to a psychologist and psychiatrist. Prior to that, there was no referral, despite the applicant making various complaints and the GP at least considering (in 2018) that there was an adjustment disorder. 
491.	The applicant submitted that her GP has perhaps the best history of all the doctors. In her opinion the applicant has PTSD, and the cause is recurrent exposure to traumatic events during her employment in an ED, aggravated by a stressful environment, management, and poor support at Crookwell. A psychological injury only occurred in 2019. 
492.	In reply to the first respondent’s submissions on the issue of prejudice, the applicant submitted that all the information she relied upon can be found in the historical notes she has produced. 
Second respondent 
493.	The respondents agreed that the second respondent would make its submissions first. 
494.	The second respondent submitted that what the applicant’s symptoms may have been, or their severity, does not answer the question of causation raised by s 4(b) of the 1987 Act. 
495.	The second respondent submitted that the submission that there was no psychopathology or pre-clinical anxiety following the applicant’s work with HKH was not actually accurate. The applicant was certainly diagnosed with psychological issues prior to the time she was employed by the second respondent. 
496.	The second respondent submitted that I would not be satisfied that the applicant has sustained an injury that is referable to it. One of the main reasons is that she isn’t a reliable historian, and her evidence is contradicted by the treating reports. The second respondent referred to the GP’s clinical records. It submitted they recorded quite significant psychological issues, which weren’t limited to employment with the respondents. There were issues with other work and issues with her family. The Centrelink medical certificate dated August 2018 contained a diagnosis of adjustment disorder with depressed and anxious mood, and there was a period of incapacity referable to the psychological condition. 
497.	The second respondent submitted that it was not the case that the applicant, between employment with the respondents, had been able to travel without issues. She had these issues, she had them diagnosed, and they prevented her from being able to work. 
498.	The second respondent referred to the reports of Ms Richards dated 28 December 2007 and 29 February 2008. It submitted the matters weren’t innocuous. They clearly warranted treatment with a specialist, and the applicant agreed to a CBT approach. Ms Richards’ evidence showed that the applicant’s evidence that she wasn’t previously diagnosed with a psychological condition is not accurate, and I ought not to accept it. 
499.	The second respondent submitted that the history provided to the medicolegal doctors is not consistent with the above matters. The evidence the applicant relies on hasn’t been provided in a fair climate – Paric v John Holland (Constructions) Pty Ltd [1985] HCA 58; (1985) 59 ALJR 844; Paric v John Holland Constructions Pty Ltd [1985] 2 NSWLR 505. It submitted the evidence ought therefore to be given no weight. 
500.	The second respondent submitted that A/Prof Robertson’s reports are internally inconsistent. He first found that the applicant was suffering from a pre-existing psychological condition, and then that there were no psychological issues, and therefore, she sustained an injury with the second respondent. A/Prof Robertson had not reviewed the GP’s records sufficiently or had regard to the issues to which the second respondent had referred. 
501.	The second respondent submitted that it was not just that the applicant had not provided a full history, but she disavowed the history recorded in the clinical records. The past psychological, drug and alcohol history is more extensive than was recorded in the GP’s letter in May 2010, to which A/Prof Roberson referred. 
502.	The second respondent submitted that A/Prof Robertson’s opinion that what happened, or the component of the applicant’s life while she was employed with the first respondent was more likely than not a pre-existing vulnerability to a later psychopathological disturbance, is not correct. There was already a psychopathological disturbance at that stage, as noted by the evidence.  
503.	The second respondent referred to Dr Allen’s evidence. The history that the applicant had never been diagnosed with any psychological condition or received medication was not correct. It is inconsistent with the evidence. There are similar inconsistencies in the drug and alcohol history. The difficulties in the workplace were innocuous. 
504.	The second respondent submitted that Dr Allen’s opinion was two-fold. First, the applicant’s issues were referable to employment with the first respondent, but second, there’s a disavowal by the applicant of issues related to the first respondent troubling her up to this point. It submitted that is not correct. 
505.	The second respondent submitted that I would not accept Dr Allen’s opinion in his first report that there was no diagnosed pre-existing condition, because it is based on the history provided by the applicant, which was corrected in his second report. He had changed his opinion regarding causation. 
506.	Dr Allen cavilled with the diagnosis of PTSD, because there was an absence of trauma or trauma-related psychological issues. After reviewing the GP’s records, the evidence indicated longstanding MDD, alcohol use disorder, in remission, but there were some cross-cutting features of PTSD. 
507.	The second respondent submitted that the opinions expressed in Dr Allen’s report of 5 March 2021 do not detract from those in his report of 20 March 2020. It is apparent that he has not had proper regard to his own second report, or his own findings as recorded in that report. It submitted the opinion canvassed is based on the examination on that date alone. 
508.	The second respondent submitted that Dr Allen’s conclusion under diagnosis and opinion is inconsistent with both his own opinion and the treating records. it submitted there had been some miscommunication by the doctor in providing this opinion, which shouldn’t detract from his earlier opinion. This is “made clear as day” in the final report. He opined that if there was an exacerbation by the second respondent, it was temporary and had ceased. 
509.	The second respondent referred to Dr Roberts’ reports, in which there was a consistent history of the applicant denying her prior psychological problems before commencing with it. Dr Roberts noted that the diagnosis of PTSD is not tenable, and the applicant suffers from bipolar disorder. It submitted there are acceptable reasons why that is so.  
510.	The second respondent submitted that none of the medico-legal doctors is aware that the applicant took long service leave as a result of what she encountered (with the first respondent) or having symptoms such as hypervigilance. It submitted she was clearly already symptomatic during her employment with the first respondent, and she needed time off work. The history she provided to Dr Shen was also inconsistent with the GP’s records. 
511.	The second respondent submitted that, if I find, notwithstanding the significant reliability issues, that she applicant has sustained an injury, the cause of the injury pre-dates her employment with it. 
512.	The second respondent asked whether the applicant alleged injury pursuant to s 4(b)(i), which her submissions and the evidence would suggest, or an injury pursuant to s 4(b)(ii)? It submitted if I found injury, it would be pursuant to the latter section. Based on the withholding of evidence, proper assessment of it can’t be undertaken, where I could be satisfied that the main contributing factor to the aggravation was employment with the second respondent. 
513.	The second respondent submitted that there was a theme of trauma pertaining to the allegations of injury. It submitted there was no trauma to which the applicant was exposed that was causative of the injury. There were rostering issues and the general day to day affairs of the ED. 
514.	Dr Allen opined, the second respondent submitted fairly, that the circumstances that exacerbated the applicant’s injury, which also existed, were not caused by the second respondent. It referred to its lay evidence with respect to exposure to trauma. There was no suggestion the applicant was exposed to trauma. There is support for Dr Allen’s opinion that her injury is referable to employment with the first respondent in the opinion of Dr Shen. 
515.	The second respondent submitted that, if I find injury, its cause is referable to the first respondent. It referred to the applicant’s evidence of the trauma to which she was exposed. She needed a break and utilised her long service leave. She was grateful to be going on leave, as she could tell she “was feeling more heavily impacted by events at work”.
516.	The second respondent submitted that the applicant was clearly symptomatic prior to her employment with it. The first hurdle she needs to surmount is that she hasn’t provided this history to any medico-legal doctor. She not only had issues, but she also needed time off work and treatment, and was having ongoing symptoms for a number of years. 
517.	If an injury is found, the second respondent submitted that the substantial contributing factor isn’t employment with it, because one injury had already been sustained. Noting that the nature of the injury is PTSD or an exacerbation of PTSD, the nature of the work the applicant was doing couldn’t have brought on such a condition. She may have encountered rostering and other issues, but what brought about the exacerbation was her memory of the trauma with the first respondent. 
518.	As regards incapacity, the second respondent relied on Dr Allen’s final opinion. If I find there was an aggravation-type injury, it submitted the aggravation had ceased. This is supported by the GP’s opinion that what renders the applicant totally and continually incapacitated is not referable to the injury, but more to other issues. 
519.	The second respondent submitted the applicant has the capacity to work in other than a hospital setting. She could utilise her qualifications, and there is no reason why she could not work in an administrative capacity. She wanted to set up an advocacy agency in 2022, and to run for the Senate. She attended and was able to express herself in public during the nurses’ strike and went to the local member’s office. She was also considering volunteering or working as an Aboriginal Liaison Officer. 
520.	In reply to the applicant, the second respondent submitted that, having correctly referred to the circumspection that would normally apply when considering clinical notes, she had then asked me to place on them an interpretation that is simply not available as to what was recorded or the circumstances around them. 
521.	The second respondent submitted that the significance of the entries in the clinical notes has been emphasised by Drs Roberts and Allen. They are clearly clinically significant. The fact that the level of treatment might not have been significant is of no moment, when two psychiatrists have had regard to the records and clearly place clinical significance upon what they demonstrate. 
First respondent 
522.	The first respondent adopted most of the second respondent’s submissions. 
523.	The first respondent referred to the applicant’s evidence regarding financial and family stress in 2007. She saw Dr Tsin and was referred to Ms Richards. There is no suggestion of anything occurring during her employment with the first respondent. Her evidence is that she had depression in 2010 and 2011. She was not employed by the first respondent during that period. Her last working day was 2 September 2009. She went on long service leave on 10 September 2009. Her period of employment was from 2 January 2004 to a date in 2009. She tried to come back to work in March 2010, but there was no longer a position, and she never returned. 
524.	The first respondent submitted there was trauma involved with the applicant’s employment at Crookwell, on her own evidence. For example, a child had taken an overdose and been sexually assaulted. The applicant herself made nothing of the events that occurred with the first respondent, and did not report them to her doctor until, as the doctors have suggested, it was triggered by traumatic events at Crookwell. 
525.	The first respondent submitted that, if anything, the second respondent is liable, because what happened with the first respondent became a pre-existing vulnerability and nothing more, but did not materialise until something happened with the second respondent. 
526.	The first respondent submitted that even the second respondent’s doctor referred to the applicant’s condition as a disease. The applicant had pre-existing problems and problems with other employment between employment with the respondents, the history of which has not been put to any of the medico-legal doctors. Their reports are not made in a fair climate. 
527.	The first respondent submitted that I would not be persuaded by the applicant’s evidence of having suffered injury with either respondent, but in particular with the first. A/Prof Robertson had no history of her difficulties in 2007, 2010 and 2011. It submitted I would give his opinion no weight. He does not appear to have any history regarding the child brought to Crookwell. 
528.	The first respondent submitted that, in opining on “substantial contributing factor” and “main contributing factor”, A/Prof Robertson does not appear to have taken into account the financial and family matters, and those that had nothing to do with the applicant’s employment. He referred to bipolar disorder and knew her treating doctor was considering it as a diagnosis but said there was no evidence of it on his consultation and he “just knocks it on the head”. 
529.	A/Prof Robertson concluded there was no evidence of psychological disorder prior to employment at Crookwell. The first respondent referred to the second respondent’s submission that there was an earlier diagnosed psychological condition, but submitted it was in the context of family and financial difficulties, and the relationship the applicant continued to have with her ex-husband. The first respondent submitted I cannot accept that the applicant’s condition was just attributable to her employment, because no analysis was done of her pre-existing problems.   
530.	The first respondent submitted that, if I were to accept the applicant’s evidence, which would be very difficult, if there was an injury, it was with the second respondent. There were no complaints about incidents that might have occurred. She wasn’t complaining of nightmares or anything else. That only came after the condition was triggered by her employment with the second respondent. 
531.	The first respondent referred to the history recorded by Dr Shen that the applicant had no prior mental health issues, which was not correct, and it relied upon the second respondent’s submissions. It also relied upon those submissions with respect to incapacity. 
532.	As regards “notice” and “claim”, the first respondent submitted that the applicant’s employment finished in about 2009, or perhaps 2010. During that time, no issues or incidents were reported. The applicant eventually put in a claim form, but it nominated a date of injury of 18 October 2019. There is nothing about her employment with the first respondent. She must have put in a claim against the first respondent because there is a s 78 notice dated 2 June 2021 and a review notice. 
533.	The first respondent submitted that the applicant did not give notice at the time of the injury, that is, when she went on long service leave, or indeed later, when according to her, she tried but was unable to return to work. 
534.	The fact that the applicant has not made a claim is not a complete bar to receiving compensation, so long as she can show ignorance, mistake, or being outside the State. The first respondent submitted there is no evidence from the applicant that she didn’t know she had an injury with it until it was triggered by something that happened with the second respondent. 
535.	The first respondent referred to Unilever Australia Ltd v Petrevska [2013] NSWCA 373 which says an injury does not occur until such time as there is medical evidence to support injury. It submitted this would occur on 18 October 2019, the date of injury with the second respondent, but again there was no claim made or notice given. The s 78 notice refers to notice being given on 29 April 2021, perhaps two and a half years after the injury. 
536.	The first respondent submitted there is no evidence from the applicant as to why it took her until 29 April 2021 to either give notice or make a claim. Her claim is barred because there is no explanation of why ss 254 and 261 of the 1998 Act have not been complied with. 
537.	In reply to the applicant’s submissions on “notice” and “claim”, the first respondent submitted that there must be evidence directly from her dealing with ignorance, or whatever the excuse may be, and there is not, particularly in respect of the period between when she said she knew she had PTSD, that is December 2019, and May 2021, when she made a claim.
538.	The applicant, through her counsel, said she changed solicitors in August 2020, but what happened between August 2020 and May 2021? A/Prof Robertson doesn’t attribute any liability to the first respondent, so there would be no reason to wait for his report to decide she should make a claim against it as well. 
539.	The first respondent submitted there is also no explanation as to what happened between December 2019 and August 2020. For instance, when did the applicant see the solicitors, and what did they say? There is some evidence that they didn’t support her claim, and she therefore went to another solicitor. When did she see the other solicitor? What advice was given? Why did it take until May 2021 to make the claim? 
540.	The first respondent submitted they are very serious matters that need to be addressed in a statement by the applicant, which they are not. In addition, in circumstances where the applicant last worked for it in 2009, and the claim was made 12 years later, in the circumstances described in the factual investigation, there is certainly prejudice to it. 
541.	The first respondent submitted the applicant had not discharged her onus where ss 254 and 261 of the 1998 Act are concerned, and they should remain a bar to her receiving compensation. 
SUMMARY
542.	As the second respondent submitted, the applicant is not a reliable historian, and I have approached her evidence with some caution. While she submitted that her previous symptoms did not rise to such a level that she required psychological treatment on other than rare occasions, this does not in my view explain the inconsistencies in her evidence. 
543.	As was held in Demasi and cases such as Davis v City of Wagga Wagga [2004] NSWCA 34, care must be taken when relying on clinical records. However, unlike some practitioners, Dr Tsin has taken detailed records over many years. Indeed, the applicant submitted that she had discussed with Dr Tsin various aspects of her life, while also submitting that I should be cautious in the weight to be ascribed to her records. 
544.	Dr Shen, who was treating the applicant, recorded a history of no prior mental health issues, that Ms Jarvis did not recall having had depression, there were no manic episodes, and she had no previous treatment, other than EAP. Dr Allen recorded that she had never had an alcohol problem and had not drunk alcohol since July 2019. The latter may be the case, as she appears to have periodically given up alcohol, but it is manifestly not the case, from a review of Dr Tsin’s records, that she had never had a problem with alcohol. The applicant denied any past psychiatric history. 
545.	The applicant also denied any past psychological issues to both A/Prof Robertson and Dr Roberts. That is clearly incorrect. However, the qualified practitioners were provided with factual evidence and/or the clinical records, allowing them a more complete history than that provided by the applicant. It is not apparent that Dr Shen is in the same position. 

Notice and claim 
546.	As regards the claim against the first respondent, it is appropriate that I deal first with the issues of notice and claim. If the applicant does not satisfy the requirements of ss 254 and 261 of the 1998 Act, or establish that she is exempted from those requirements, it is not necessary to further consider the claim against the first respondent. 
547.	Section 254 of the 1998 Act provides as follows:
“(1) 	Neither compensation nor work injury damages are recoverable by an injured worker unless notice of the injury is given to the employer as soon as possible after the injury happened and before the worker has voluntarily left the employment in which the worker was at the time of the injury.
(2) 	The failure to give notice of injury as required by this section (or any defect or inaccuracy in a notice of injury) is not a bar to the recovery of compensation or work injury damages if in proceedings to recover the compensation or damages it is found that there are special circumstances as provided by this section.
(3) 	Each of the following constitutes special circumstances--
(a) 	the person against whom the proceedings are taken has not been prejudiced in respect of the proceedings by the failure to give notice of injury or by the defect or inaccuracy in the notice,
(b) 	the failure to give notice of injury, or the defect or inaccuracy in the notice, was occasioned by ignorance, mistake, absence from the State or other reasonable cause,
(c) 	the person against whom the proceedings are taken had knowledge of the injury from any source at or about the time when the injury happened,
(d) 	the injury has been reported by the employer to the Nominal Insurer in accordance with this Act,
(e) 	the employer has contravened section 231,
(f) 	the injury has been treated in a first aid room at the place of work,
(g) 	if the employer is the owner of a mine--the injury has been reported by or on behalf of the employer to an inspector of mines or an inspector under the Work Health and Safety Act 2011 .
(4) 	In addition, if the employer is the owner of a mine or quarry, or the occupier of a factory, workshop, office or shop, each of the following constitutes special circumstances--
(a) 	the summary referred to in section 231 has not been posted up in accordance with that section or the employer has otherwise contravened that section,
(b) 	the injury has been reported by or on behalf of the employer to an inspector of mines or an inspector under the Work Health and Safety Act 2011 ,
(c) 	the injury has been treated in a first aid room at the mine, quarry, factory, workshop, office or shop.”
548.	Section 261 of the 1998 Act provides as follows: 
“(1) 	Compensation cannot be recovered unless a claim for the compensation has been made within 6 months after the injury or accident happened or, in the case of death, within 6 months after the date of death.
(2) 	If a claim for compensation was made by an injured worker within the period required by this section, this section does not apply to a claim for compensation in respect of the death of the worker resulting from the injury to which the worker's claim related.
(3) 	For the purposes of this section, a person is considered to have made a claim for compensation when the person makes any claim for compensation in respect of the injury or death concerned, even if the person's claim did not relate to the particular compensation in question.
(4) 	The failure to make a claim within the period required by this section is not a bar to the recovery of compensation if it is found that the failure was occasioned by ignorance, mistake, absence from the State or other reasonable cause, and either--
(a) 	the claim is made within 3 years after the injury or accident happened or, in the case of death, within 3 years after the date of death, or
(b) 	the claim is not made within that 3 years but the claim is in respect of an injury resulting in the death or serious and permanent disablement of a worker.
(5) 	The failure to make a claim within the period required by this section is not a bar to the recovery of compensation if the insurer concerned determines to accept the claim outside that period. An insurer cannot determine to accept a claim made more than 3 years after the injury or accident happened or after the date of death (as appropriate) except with the approval of the Authority.
(6) 	If an injured worker first becomes aware that he or she has received an injury after the injury was received, the injury is for the purposes of this section taken to have been received when the worker first became so aware.
(7) 	If death results from an injury and a person who is entitled to claim compensation in respect of the death first becomes aware after the death that the death resulted or is likely to have resulted from the injury, the date of death is, for the purposes of the application of this section to a claim by that person, taken to be the date that the person became so aware.
(8) 	In a case where 2 or more persons are liable or partly liable in respect of compensation (whether or not that liability arises from the same or from different injuries), a claim is for the purposes of this section taken to have been made when a claim is made on any one of those persons.
(9) 	When particulars of any injury received by a worker are entered in a register of injuries kept by the employer under this Act, the making of that entry suffices for the purposes of this section as the making of a claim for compensation in respect of the injury.”
549.	The onus is on the applicant to establish that special circumstances, including the absence of prejudice, exist: Gregson v L and MR Dimasi Pty Ltd [2000] NSWCC 47; 20 NSWCCR 520 (Gregson); and Westlake v Sydney Symphony Orchestra Subscribers Committee [2009] NSWWCCPD 12 (Westlake). 
550.	As s 254(3) of the 1998 Act provides that “each of the following constitutes special circumstances”, even extreme prejudice to the employer is irrelevant where the applicant is able to prove any other of the special circumstances applies. Deputy President Roche said in Zheng v Xie [2011] NSWWCCPD 58 from [193]-[197]:
“[Section 254] does not provide that prejudice to the employer is a defence against a late claim. It states that one of the special circumstances in which the failure to give notice of injury is not a bar to the recovery of compensation or work injury damages is where the person against whom the proceedings are taken has not been prejudiced.” (at [196]). (Emphasis added.)  
551.	The applicant submitted both that there had been no prejudice to the first respondent, and that she was “ignorant”, in that she was unaware of her diagnosis of PTSD, and until 2019 was not even aware that there was an injury significant enough to make a claim against HKH. 
552.	I do not accept that the first respondent has not been prejudiced by the failure of the applicant to give notice of the injury. Mere effluxion of time forms a reasonable basis upon which a presumption of prejudice can be made (Westlake). However, in Camden Council v Hancock [2005] NSWWCCPD 6 Byron DP said:
“I do not agree that lengthy delay alone must always give rise to prejudice and injustice. Actual injustice must be demonstrated, not merely potential injustice (see Holt v Wynter [2000] NSWCA 143)”.  
553.	In my view, the report of the factual investigation is sufficient to establish that the first respondent has been prejudiced by the applicant’s failure to give notice of injury. However, that is not the end of the matter, if she is able to establish that one of the other special circumstances exists. 
554.	Both s 254 and s 261 of the 1998 Act provide for exemption from the time limits for giving notice of an injury or making a claim if the failure to do so was occasioned by ignorance, mistake, absence from the State or other reasonable cause. The case law with respect to this exemption that deals with s 261 of the Act is therefore also relevant to s 254. 
555.	While the applicant referred in her submissions to reliance on s 254(3)(b) of the 1998 Act, and in particular her “ignorance” of her diagnosis, it appears that she also relied on s 261(6) of the Act, in that she claims to have become “aware” of the injury some time after it occurred. 
556.	His honour Judge Burke held in Gregson that “ignorance” means ignorance of legal rights and obligations, including ignorance of time limits. His honour said:
“[t]he ignorance referred to is ignorance of the rights deriving from the Act and the obligations imposed by it. Effectively the Court is required to be satisfied that the applicant was unaware of those rights and obligations and thus failed to make the requisite claim...” (at [61]). 
557.	The chronology of events appears to be that the applicant ceased work with HKH in 2009, although she had some later employment with the first respondent. She commenced work at Crookwell on 19 September 2019 and claims to have sustained a psychological injury with the deemed date of 20 October 2019.
558.	The applicant’s Notification of Injury/Illness to the first respondent is dated 25 May 2021. She apparently advised it on 29 April 2021 that she wanted to claim compensation. 
559.	The applicant has given evidence that she had three EAP sessions, and the psychologist told her she had PTSD. This appears to have been in or about November or December 2019. On 7 November 2019, Dr Tsin certified her as unfit for work and suggested she re-think her employment. She also suggested the applicant may have PTSD. 
560.	In January 2020, Dr Shen reported that the applicant had PTSD from difficult work-related experiences that had been re-activated by a stressful work environment from a new job. 
561.	EML disputed liability for the claim on 17 March 2020. It is not clear from either the s 78 notice or the review notice dated 23 April 2020 that it provided a copy of Dr Allen’s report dated 10 March 2020, but the report was referred to in the review notice. 
562.	EML stated that Dr Allen had opined that the applicant was suffering from PTSD as a result of her employment with HKH. It is likely that this was the first time the possibility that her condition was related to her employment with the first respondent had been clearly articulated to her. Her evidence is that EML told Dr Tsin it had disputed liability due to a note in her medical records about HKH. 
563.	The applicant had obtained legal advice at least by 31 March 2020, when Dr Tsin recorded that she had been assisted by the union to find a lawyer. There is evidence in the clinical records that she was in contact with the lawyer in April and May 2020. 
564.	The applicant changed lawyers in August 2020. The first respondent was notified of the injury on 29 April 2021. 
565.	The applicant has given no evidence that she was unaware of her rights and obligations regarding giving notice of injury. She has given no evidence that she was “ignorant” of the time limits, or that her lawyers did not advise her of such limitations. Her lawyers have given no evidence in this regard.  
566.	The applicant made no submissions on whether there was any “other reasonable cause” for her failure to give notice of the injury as soon as possible after it happened. 
567.	The applicant did not give notice of the injury as soon as possible after it happened. She has not established that her failure to do so was occasioned by ignorance, or that the first respondent has not been prejudiced by that failure. 
568.	The applicant is therefore not entitled to recover compensation from the first respondent, as she has failed to comply with the requirements of s 254 of the 1998 Act. It is unnecessary that I consider whether she has failed to comply with the requirements of s 261 of the 1998 Act. 
Injury
569.	Section 4 of the 1987 Act provides as follows:
“In this Act--

‘injury’ --
(a) 	means personal injury arising out of or in the course of employment,
(b) 	includes a ‘disease injury’, which means--
(i) 	a disease that is contracted by a worker in the course of employment but only if the employment was the main contributing factor to contracting the disease, and
(ii) 	the aggravation, acceleration, exacerbation or deterioration in the course of employment of any disease, but only if the employment was the main contributing factor to the aggravation, acceleration, exacerbation or deterioration of the disease, and
(c) 	does not include (except in the case of a worker employed in or about a mine) a dust disease, as defined by the Workers' Compensation (Dust Diseases) Act 1942 , or the aggravation, acceleration, exacerbation or deterioration of a dust disease, as so defined.”
570.	The applicant claims to have sustained a disease injury, deemed to have occurred on 20 October 2019. She relies on ss 4(b)(i) and 4(b)(ii) of the 1987 Act. A psychological injury may be a “disease injury” – Federal Broom Co Pty Ltd v Semlitch [1964] HCA 34; (1964) 110 CLR 626. 
571.	As I have noted, the applicant is not a reliable historian. She clearly had a long history of psychological issues, dating back to at least 2007, on the evidence of the GP’s clinical records. 
572.	I do not accept that, because the applicant may have been referred for treatment only twice before 2019, her previous psychological history was not of clinical significance. Dr Tsin’s records suggest otherwise. That does not mean she has not sustained a psychological injury in the course of her employment. 
573.	The applicant’s evidence is that when she took long service leave from HKH in September 2009, she felt that she needed a break, and was feeling anxious and unwell. I accept that, as an ED nurse in a busy hospital, she would have been exposed to stressful events. 
574.	Dr Tsin noted in November 2008 that the applicant was getting burnt out with work in A & E, and in January 2009 that she wanted to get out of clinical nursing. She had quit her job in April 2010 because of stresses in A & E. 
575.	After leaving HKH, the applicant’s employment appears to have been largely outside a clinical setting, although she did some shifts at HKH and RNS. She did some shifts in ED and ICU. While she was “fine and happy” between 2015 and 2019, she feels that in hindsight she was very hypervigilant. 
576.	It appears that the circumstances of the applicant’s employment at Crookwell were very different to those she was used to in city hospitals. She was once again working full-time in a clinical setting, and primarily in ED. 
577.	The applicant was confident, perhaps over-confident, in her abilities, to the extent that she felt she was coming into Crookwell to “save the place”. The staff with whom she worked did not share her confidence, feeling that she lacked both clinical skills and awareness of how to interact with them and with patients in a rural hospital. 
578.	It appears to me that the applicant’s concerns with her roster were due to her inability to manage the workload (variously described by the second respondent’s witnesses as “fast pace[d]” and having “no real emergencies”). 
579.	I have found little assistance on the issue of causation from Dr Shen’s reports. As well as containing an inaccurate history, his reports are quite brief. However, he did record that the applicant had started to ruminate on the past and had ongoing flashbacks. He diagnosed her with PTSD arising from difficult work experiences that had been re-activated by a stressful environment in her new job. (Emphasis added).
580.	Dr Shen’s conclusion is similar to those of Dr Allen (at least in his first two reports) and A/Prof Robertson. 
581.	Dr Allen’s reports are, as the applicant submitted, somewhat of a moveable feast. For that reason, I am not greatly assisted by his evidence.
582.	Dr Allen initially opined that the applicant had MDD and PTSD, related to historical events. She was clearly not coping at Crookwell, and her mental health deteriorated due to the “typical stressors” there. 
583.	After being provided with the applicant’s clinical records, Dr Allen became aware of her previous history of psychological symptoms and alcohol dependence. He then opined that the stress associated with rostering at Crookwell caused a slight exacerbation of her longstanding difficulties. He no longer believed PTSD was an appropriate diagnosis. He attributed 90% of her difficulties to her longstanding problems, and 10% to the recent exacerbation. 
584.	When Dr Allen next reported, he appears to have overlooked or failed to review his second report. He again opined that the applicant had MDD and returned to his diagnosis of PTSD. They were in large part attributable to her alleged difficulties at Crookwell. On this occasion, he did not regard her past experiences as having caused her condition. 
585.	Dr Allen opined that the aggravating effects of the work injury (at Crookwell) persisted. The applicant’s subjective experiences there appear to have led to her psychological conditions. Her view of events indicated a concerning workplace that led to her developing MDD and PTSD. 
586.	In his report dated 7 June 2021, Dr Allen, having been advised that the applicant attended the workplace at Crookwell for only 20 days, opined that the mild exacerbation of her condition while she was there, and any effect of the exacerbation, should be considered as having resolved. Her PTSD had its origin at HKH. 
587.	In my view, the duration of the applicant’s attendance at Crookwell is not relevant, given the nature of the alleged injury and, in any event, Dr Allen recorded a history in his report dated 10 March 2020 that she had worked at Crookwell for three weeks, so he was aware of that matter. The duration of her employment also does not appear relevant to the duration of the exacerbation of her condition. 
588.	Dr Allen opined that, as the applicant was no longer at Crookwell, the exacerbating effects of her difficulties could be regarded as having ceased. However, her psychological distress remained of concern. It appeared clear she had enduring psychological problems before commencing at Crookwell. 
589.	While Dr Allen referred to the conflicting evidence about what occurred at Crookwell, it should be noted that much of the applicant’s evidence was confirmed by the second respondent’s lay witnesses, albeit that they viewed the events differently.
590.	The applicant clearly had issues with her roster, which she had made known. She did have concerns about a diabetic patient (and appears to have expressed them inappropriately), and about a patient whom she suspected may be being abused by her husband. 
591.	The applicant’s evidence about a patient threatening suicide and a child having taken an overdose of drugs after having been sexually assaulted, has not been refuted by the second respondent’s evidence. 
592.	Roche DP extracted the following from the authorities, in Attorney-General’s Department v K [2010] NSWWCCPD 76; (2010) 8 DDCR 120 (citations omitted): 
(a) 	employers take their employees as they find them. There is an “egg-shell psyche” principle which is the equivalent of the “egg-shell skull” principle;
(b) 	a perception of real events, which are not external events, can satisfy the test of injury arising out of or in the course of employment;
(c) 	if events which actually occurred in the workplace were perceived as creating an offensive or hostile working environment, and a psychological injury followed, it is open to the Commission to conclude that causation is established;
(d) 	so long as the events within the workplace were real, rather than imaginary, it does not matter that they affected the worker’s psyche because of a flawed perception of events because of a disordered mind;
(e) 	there is no requirement at law that the worker’s perception of events must have been one that passed some qualitative test based on an ‘objective measure of reasonableness’, and
(f) 	it is not necessary that the worker’s reaction to the events must have been ‘rational, reasonable and proportionate’ before compensation can be recovered. 
593.	The medical evidence suggests that the applicant had an “egg-shell psyche” when she commenced work at Crookwell. Real events that occurred there, while they may have been perceived by her colleagues as routine, were perceived by her as creating an offensive or hostile environment. Her perception may have been flawed because of her already “disordered mind”, but her reaction to the events need not be rational, reasonable, or proportionate. 
594.	I have found A/Prof Robertson’s evidence of most assistance in this matter. 
595.	While the applicant denied to A/Prof Robertson any past psychiatric history, he recorded in his report dated 2 February 2021 that she had a history of heavy alcohol use, the referral to Dr Gould in May 2010, the reference to bipolar disorder, and her family history. He was therefore aware of events of which he may not have been advised by the applicant. 
596.	A/Prof Robertson agreed with the diagnosis of PTSD and MDD. He concluded that the applicant had subclinical manifestation of a post-traumatic syndrome that reached its full flourishing in the context of comparatively minor stresses at Crookwell. He saw no evidence of bipolar disorder, but this required consideration, given the family history. 
597.	Specifically, A/Prof Robertson opened that the applicant had a pre-existing vulnerability to a psychiatric disorder (that is, an “eggshell psyche”), which was attributable to aspects of her employment prior to working at Crookwell. They were aggravated, accelerated, and deteriorated into the workplace injury at Crookwell. That employment, in his opinion, was the main contributing factor to the aggravation, acceleration, exacerbation or deterioration of her psychological disease injury. 
598.	When the lay and medical evidence is considered, it appears to me that A/Prof Robertson’s conclusion is supported by that evidence and is most likely to be the correct one. 
599.	Ms Tyler accepted the applicant “at face value”, and that she had a genuine mental illness, but not that she had PTSD. The applicant had not been exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. At the same time, she recorded that Ms Jarvis had been shot at, punched in the face, and spat at. 
600.	The actual diagnosis may be in dispute, but Ms Tyler did not suggest that the applicant did not have diagnosable psychological conditions. Dr Allen was respectful of her opinion, but ultimately appears to have returned to his diagnosis of PTSD (and MDD). 
601.	Dr Roberts opined that the applicant had either bipolar disorder or a schizoaffective disorder. Her disavowal of psychopathology before she began work at Crookwell, in his view, negated a claim that she developed a condition due to pre-existing events at HKH. 
602.	Dr Roberts reported that exposure to traumatic events would be the universal experience of doctors and nurses. That is the case that the applicant and A/Prof Robertson advance – that she was exposed to trauma at HKH. 
603.	The applicant may well not have been aware that she had a psychological condition when she commenced work at Crookwell. However, having reviewed the evidence of the second respondent’s lay witnesses, Dr Roberts opined that her behaviour was characteristic of a mentally ill person attempting, and failing, to function in the workplace. 
604.	I agree that the applicant was clearly psychologically ill when she commenced work at Crookwell. Her behaviour could by no stretch of the imagination be described as normal. However, I do not accept that she had bipolar disorder or a schizoaffective disorder. I prefer the diagnoses of Dr Shen, who has treated her since January 2020, Dr Allen, and A/Prof Robertson, that she most likely has PTSD and MDD. 
605.	Dr Roberts opined that the assertion that rostering issues could give rise to PTSD was untenable. I agree, but in my view the applicant’s preoccupation (and virtual obsession) with her roster and “work/life balance” were merely manifestations of her inability to cope in the workplace. 
606.	Dr Roberts also initially opined that the diagnosis of PTSD was not tenable if the applicant was free of symptoms before she commenced work at Crookwell. He later recorded that her statement that she had no pre-existing psychopathology was an error. 
607.	Dr Roberts noted that a review of studies confirmed that the onset of PTSD symptoms is almost never delayed. However, the study he quoted referred to cases where it might appear there is a delayed onset of PTSD, but the person has not been wholly asymptomatic during the period after the trauma and prior to meeting full criteria for the condition.
608.	It may be assumed that Drs Shen and Allen and A/Prof Robertson are aware of the studies referred to by Dr Roberts, but they diagnosed the applicant with PTSD. A/Prof Robertson thought bipolar disorder should be considered, but ultimately did not diagnose it. I prefer their opinions on the diagnoses of the applicant’s condition. 
609.	I am satisfied on the balance of probabilities that the applicant sustained injury in the employ of the second respondent due to the aggravation, acceleration, exacerbation, or deterioration of a disease, pursuant to s 4(b)(ii) of the 1987 Act. A/Prof Robertson, whose evidence I accept, opined that employment was the main contributing factor to the aggravation, acceleration, exacerbation, or deterioration of her psychological disease injury. The injury is deemed to have occurred on 20 October 2019, the first date of incapacity. 
Incapacity 
610.	The applicant submitted that she was unable to return to work. The second respondent submitted that, if there was an aggravation of her condition, it has ceased. She has the capacity to work in other than hospital settings. It referred to her plans, for example, to run for the Senate, and her attendance at the nurses’ strike. 
611.	I do not accept that the applicant has had, at any relevant time, any capacity for work. She certainly has the qualifications to work in other than a hospital setting and has experience as an educator. However, the medical evidence is to the effect that she has a significant psychological condition, or conditions. None of the doctors who has treated or examined her has suggested she has any capacity for work. It does not appear that she has had optimal treatment. 
612.	The fact that the applicant may believe she has the capacity to, for example, enter politics, does not mean she has the ability to do so. In Boral Recycling Pty Ltd v Figueira [2014] NSWWCCPD 41, Acting President Roche, as he then was, held that, even if a worker’s subjective view is that he or she is fit for certain jobs, this had to be weighed against other evidence, including in respect of the nature of the injury, its consequences, and the medical evidence. 
613.	The applicant may believe that she has the ability to enter politics. That needs to be weighed against the other evidence, which in my view establishes that she has had no capacity for work since she ceased work with the second respondent. Her belief in her own abilities is similar to her misguided beliefs that she was there to “save” Crookwell, and that her clinical knowledge was superior to that of her colleagues. It does not appear to be based in reality. 
614.	The applicant’s PIAWE are agreed to have been $2,236.17. The claim for weekly benefits is made pursuant to s 37 of the 1987 Act from 13 April 2020 to 13 June 2022.
615.	The second respondent is therefore to pay to the applicant, pursuant to s 37 of the 1987 Act, weekly benefits at the rate of $1,788.94 per week (80% x $2,236.17) from 13 April 2020 to 13 June 2022. 
616.	The applicant, having succeeded in her claim, is entitled to a general order for payment of medical and related expenses, pursuant to s 60 of the 1987 Act. 
617.	The orders are as set out in the Certificate of Determination.