Surgical mesh has made headlines and court rooms around the world for the harm it has caused in injured patients.
The medical device is used in hernia repair, pelvic prolapse and urinary incontinence surgery. In New Zealand, hundreds of women and men have suffered serious complications.
The severity and scale of problems saw patient advocates first come together in 2012 to flag problems with health authorities over the lack of oversight in its use. Over the years, incremental progress has been made. This includes reviews of specific imported mesh products known to be problematic in overseas jurisdictions, public acknowledgement of the pain of mesh-injured patients from policy makers, and some inclusion of those with lived-experience at the decision-making table.
Last week, marked another step on the road to improvement. ACC announced it would reassess surgical mesh claims it had previously denied.
The corporation said new evidence regarding surgical mesh use showed denied injury claims may now meet the threshold for coverage. Since July 2005, 1667 surgical mesh claims have been made to ACC. Seventy-seven percent were accepted, leaving about 380 claims without cover.
The refreshed approach from ACC is a good thing. It represents a second chance for those desperately seeking help. However, it comes after years of mesh-injured patients attempting to highlight the real, systemic barriers in accessing help.
Nearly a year ago, a restorative justice report on the experiences of mesh-injured people was submitted to the Ministry of Health. More than 600 people participated in the research, undertaken by Victoria University, Wellington. About 30 health practitioners were also involved.
The report illustrated how ACC - alongside other significant cogs in the health system - often made things worse. One advocate's feedback summarised the experience of many mesh-injured survivors when they described ACC's "default response as deny, defer, defend", the report said. Others described a "dehumanising" and "humiliating" claims process which stretched over a number of years.
Stories of nepotism in ACC's expert review process also detailed how doctors were influenced by their connections to medical professionals whose treatment practices they were reviewing.
Overall, it made for grim and demoralising reading. ACC's chief customer officer Emma Powell highlighted its importance and the accompanying restorative justice process in her media appearances last week.
"We took part in that restorative justice process last year….and heard from people affected by surgical mesh, men and women, and heard a number of stories not only of the pain and challenge of those physical injuries, but actually too, the system response." Powell told RNZ.
She explained how the process, combined with developments in surgical mesh research, underpinned ACC's refreshed approach to injury claims. Powell also touched on the wider impact of mesh-injured survivors on ACC.
"We're also undertaking a much broader review, utilising human-centred design practices to take an empathetic approach to interviewing our clients and understanding those experiences," she said.
"We then take that and create what we call an imperative around our service, and those are those critical things we must have right for our customers. We're looking to put those in place."
Yes, it's jargon-heavy and a tad difficult to decipher, but Powell's message is significant.
First, she has admitted the treatment of mesh-injured patients, and other claimants, by ACC has been flawed. Second, she has pointed out to fix that, a culture change in how claimants are treated and spoken to must occur.
Seems pretty basic right?
Unfortunately, systemic and culture change is never basic. The plight of mesh-injured survivors is ongoing. Spearheaded by patient advocate group Mesh Down Under, it has been nearly a decade of fighting for access to fair injury compensation, the right to be treated with dignity, safe treatment practises and proper informed consent processes.
ACC's recent claims review announcement is testament to their tenacity, however there is still a lot yet to be set right. That includes implementing a robust and transparent qualification process for surgeons performing surgical mesh procedures.
As ACC's sets out to be more understanding in its treatment of mesh-injured claimants, it would be good for other cogs in the system to do the same.