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Home / New Zealand

Medical payouts soar

By Michelle Coursey
Herald on Sunday·
23 Aug, 2008 05:00 PM4 mins to read

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KEY POINTS:

ACC payouts for medical mistakes, treatment injuries and adverse reactions to medicine have jumped by 1100 per cent in three years.

Total accepted claims until 2005 cost $5 million, but have since risen to just over $60m. And the rise shows no sign of slowing, with more than
$6m paid out in July, the first month of this financial year.

The real cost is even higher, as the ACC figures cover only entitlement claims - those that require ongoing care and support - not one-off fees for visits to the doctor or hospital.

Medical experts told the Herald on Sunday the increase in costs and number of claims indicated a positive shift from a "blame and shame" culture in the health sector.

A 2005 law change saw the medical misadventure category scrapped.

Previously, a patient had to prove a health professional had made an error resulting in a rare and severe mishap.

The new "treatment injury" definition allows anyone who has suffered a physical injury as a result of treatment by any registered medical professional to claim compensation, without proving any fault.

ACC spokesman Laurie Edwards admitted costs had "gone through the roof" after the change, which was in line with the "no fault" policy.

"The bar has been lowered quite a long way for actually getting cover from ACC, so a lot of stuff people wouldn't have bothered with before, they are now putting in for claims.

"And actually that's good, because we can get people help and get them back to their normal lives quicker."

The average payout was around $10,000, although Edwards said payouts could range from $50 to $1m-plus. He expected the increasing costs and claims to level off soon.

ACC data showed the highest numbers of accepted claims were for adverse reactions to medication, although claims for hip or knee surgery or replacement, dental treatment, removal of skin lesions, and injections were also common.

Wound infections, allergic reactions, bruising, nerve damage and chipped teeth were the most common injuries to result in a payout.

College of GPs president Jonathan Fox said the increase in costs was not down to more incidents occurring.

"There is no evidence to suggest that suddenly the health service has become a more dangerous place.

"This is just finally recognising the unintended consequences of correct treatment."

Fox said the high figures proved that the scheme was working "as intended".

He added that the greater level of reporting was helping to educate health workers about things that could go wrong and how to avoid mistakes.

"Now, not just doctors, but nurses, midwives, any registered health professionals, are all happily helping patients lodge these claims."

While many claims were reported by GPs, Fox said that was because they saw more patients than other health practitioners.

"It's not a worse environment, it's just because we have so many consultations."

Medical Association chairman Peter Foley was not surprised the most common claim category was adverse reactions to medication.

"When the number of medications handed out to patients must be umpteen-fold more than procedures done, it makes sense."

Of the claims, 970 were classed as sentinel, where a death or major loss of function had occurred, or serious, where there was potential for those outcomes.

ACC referred those cases to the Director General of Health, and details of about 100 were passed to registration bodies such as the Medical Council and the Midwifery Council.

Foley said the policy was helping to encourage an open approach to errors in the health sector and moving New Zealand away from a "blame, shame and fault" mindset.

National Party ACC spokeswoman Pansy Wong was concerned about the cost, but said finger pointing needed to stop so injuries could be addressed.

MEDICAL CLAIMS

Ten most frequently accepted claims
* Wound infection
* Allergic reaction
* Haematoma/bruising
* Nerve damage
* Chipped/damaged tooth
* Cellulitis (a bacterial skin infection)
* Adverse drug reaction
* Skin damage/tear/injury
* Anaphylactic reactions (the most severe allergic reaction)
* Incisional hernia (a hernia resulting from surgery)

Most common medical misadventures
* Bowel perforation
* Cerebrovascular accident
* Blindness/visual disturbance
* Disease progression
* Adverse drug reaction
* Bile duct damage/injury
* Haemorrhage
* Infection

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