More reasons emerge for independent inquiry on ACC reforms

by Kevin Hague

I’m pleased Simon Collins at the NZ Herald has picked up on my blog post last month in which I released figures showing the number of people being moved off ACC weekly compensation onto welfare benefits increased to 1956 people in the latest June year from 764 two years earlier.

Collins also highlights some other worrying ACC statistics:

• Paid physio claims reduced by 23 per cent in the year to September.

• In the latest six-month period, ACC paid for 2385 fewer operations than it did two years ago, a reduction of 11 per cent.

• Applications for reviews of ACC’s decisions on claims shot up last year to 9182, from just under 6000 the year before, and the number of claimants whose review applications succeeded rose at the same rate

And most disturbingly, Collins reports two senior orthopaedic surgeons criticisms of ACC’s claims assessment practices:

[Orthopaedic surgeon Gary Hooper] cited a patient turned down for shoulder surgery after he grabbed at a railing when a ladder slipped while he was painting his house. The rotator cuff tendon was torn, a condition which can cause pain and decreased function.

It has a more than 90 per cent chance of cure if repaired surgically, but if left, the tear can increase in size and become inoperable. The patient was 87, but Mr Hooper said he “looks about 60 – physiologically he’s about 60″. ACC said he had underlying changes in his shoulder.

“There’s nothing on any radiology investigations that support that contention.

“The primary reason he was turned down is that he’s 87.”

A member of a group of surgeons negotiating with ACC to resolve the shoulder cover difficulties, [Orthopaedic surgeon Khalid] Mohammed undertook a comprehensive review of scientific studies to determine the reliability of x-ray and other imaging results which had been used in deciding whether shoulder changes were in fact longstanding or degenerative.

“Sometimes certain imaging findings … have been used as evidence to decline a case which I feel should have entitlement.

In 1994, an inquiry conducted by Judge Peter Trapski (PDF, 414kB) was damning of ACC’s then case management practices with regard to referrals to assessors who were perceived to have a bias in favour of the Corporation’s declining cover and entitlements.  In particular, Judge Trapski reported:

Corporation staff, I was told, had become fed up with clients who were seen to be “ripping off the system”. These people were therefore referred to a specialist who I was told, was unafraid of examining factors aside from the injury. I was told quite clearly that this was where Dr [Laurie] Gluckman’s usefulness lay, as he was a qualified physician, and a psychiatrist, and he had been used over a number of years as the Corporation’s “hit man”.

The revelations of orthopaedic surgeons Hooper and Mohammed raise suspicions that the referral and assessment practices Judge Trapski’s inquiry found were being used to wrongly disentitle claimants back in the 1980s and 1990s may again be prevalent at ACC.

It is time for another independent inquiry.