Brain injury victim gets ACC cover back but psychiatrist says no post-concussion syndrome

Erica Quayle lost her ACC entitlements after a psychiatrist and a neurologist said her symptoms were functional disorders rather than from a concussion. Photo / Supplied

It was supposed to be a fun team-building exercise with colleagues.

But an exhilarating white-water rafting experience turned into an ongoing nightmare for Erica Quayle when she was tossed from the raft, submerged and concussed.

Now the 49-year-old mother-of-two is in a battle with ACC to fund treatment for symptoms specialists can't seem to agree the cause of.

The Auckland woman says she suffered symptoms of a brain injury after the accident in March 2018 but had her ACC entitlements cut when a neurologist diagnosed a "functional disorder".

Functional neurological disorder, also coded by hospitals as dissociative or conversion disorders, is a mental disorder where the person has physical symptoms that no medical condition, physical examination or testing can explain.

While Quayle was without ACC cover she was left with $15 a day from a disability benefit - compared with $43 from ACC - to feed herself and her son and daughter, aged 15 and 11, after paying rent, power, petrol and phone.

"It's just so frustrating because once I'm back off ACC and on to a disability benefit I'm back to going to churches for food and being in poverty.

"Not only is it a huge amount of stress, which isn't good for brain recovery, but I won't be able to afford the osteopath treatment or the treatment from the eye specialist."

Quayle, a former developer of NZ Qualifications Authority training programmes, had to quit work after the accident.

The mild traumatic brain injury left Quayle unable to concentrate for long periods and her brain requiring regular rest.

She suffered severe double vision and was unable to do mundane tasks without the help of her children.

"It's upsetting that I can't do normal things. I'm getting better at finding words and putting words together but still sometimes struggle to find words. It's exhausting."

She has to set an hourly alarm to remind her what she is doing. Sometimes, a drive to school to pick up her children ends with Quayle stranded, unsure where she is going and why.

In October 2018, ACC sent Quayle to a psychiatrist for review, despite a report from her chiropractor explaining that her inability to maintain a smooth eye-tracking motion was the result of an injury to her brain stem and cerebellum.

"I can unequivocally report her symptoms are not psychiatric in nature," the chiropractor stated in the report.

But ACC asked the psychiatrist to assess whether Quayle presented with significant psychological or psychiatric symptoms.

Quayle objected to the psychiatrist's diagnosis of somatic symptom disorder - an over-reaction to her symptoms. ACC sent her to a clinical psychologist in June last year who stated she was depressed at the time of her accident, which both Quayle and her GP dispute.

ACC then sent Quayle to a neurologist who diagnosed her with functional disorder and recommended she be denied treatment.

It stopped cover in November last year despite criticism from Quayle's psychotherapist who wrote to ACC saying somatisation disorder was often applied as a diagnosis of last resort.

"... applied when symptoms persist too long, cannot be clearly confirmed through diagnostic imaging, appear overly complex or atypical, or when patients don't respond quickly enough or achieve sufficient benefit within the prescribed time frame."

She was equally critical of the functional disorder diagnosis.

"It is my opinion that there has been relatively minimal focus on the likely trauma of the accident itself by the preceding assessments and a larger assessment focus has been placed on proof of concussive injury."

At a conciliation meeting in March, ACC agreed to reinstate Quayle's entitlements with back pay while it sought another psychiatrist's assessment to explore whether there was a causal link between her covered injury and her "mental condition".

Erica Quayle appealed an ACC decision to suspend her entitlements after a neurologist said her symptoms were a function disorder. Photo / Michael Craig

It also asked the neurologist to clarify his diagnosis and provide an opinion on whether Quayle was suffering from post-concussion syndrome.

In May, Quayle was diagnosed with post-concussion syndrome by her optometrist who said it could be treated. He said Quayle's autonomic nervous system was out of balance as a result of the accident trauma and any notion Quayle's eye problems were consciously driven was not true.

"The speed at which Erica cross fixates and changes fixation means her movements are not coming from any conscious effort as they occur too quickly for this notion to be plausible."

However, a psychiatrist's assessment last month ruled out post-concussion syndrome, saying while Quayle probably suffered concussion at the time of the accident, that injury was in remission when she continued to report fatigue and memory loss.

The psychiatrist said Quayle did not present with any clear features indicating a traumatic brain injury and instead appeared to be "resorting to ACC to meet her financial obligations".

Now she fears her entitlements are about to be cut again.

"I just want to get fixed so I can go back to work."

An ACC spokeswoman said CT and MRI scans on Quayle produced normal results.

Quayle was referred for specialist assessments in October 2018 after ACC received medical information that her symptoms and recovery were no longer consistent with what would normally be expected with a concussion.

"Our medical advisers recommended referral to a psychiatrist, psychologist and neurologist to help us further understand her symptoms and how they might relate to her concussion.

"Erica's specialist assessments found that her symptoms were not caused by concussion but were consistent with somatic symptom disorder, which the specialists believe was pre-existing.

"A medical adviser reviewed the reports and noted that there was no medical evidence to indicate that her visual symptoms were caused by her accident."

Quayle said she felt trapped in a catch-22 situation.

"It just feels like ACC have built a case against me that I can't fight without money.

"To get the money I need to pay for my own treatment I need to get back to work, but to get back to work I need the treatment to get better."