Question to Minister

Question 4: Kevin Hague to the Minister for ACC: Does she agree with Peter Trapski's recommendation in his 1994 Report of that "the Corporation must ensure that the opinions it obtains from medical practitioners are independent, not only of the claimant, but also of the Corporation, and that they are seen to be so"?



Hon JUDITH COLLINS (Minister for ACC): Yes.
Kevin Hague: Is she concerned that just four of ACC’s favourite specialist medical advisers— Dr Martin C Robb, Dr Vic du Plessis, Dr Bill Turner, and Dr David Beaumont—are collectively paid up to $2 million a year from ACC for services rendered?
Hon JUDITH COLLINS: I believe that the member is referring to a TV3 report on Sunday evening—oh, no, he is not. When it comes to saying that people are paid up to an amount, it is not particularly helpful, because it is anything under that amount. But I have been advised by ACC that for medical case reviews, it has 338 doctors who can carry out those assessments, for initial medical assessments the number is 97, for vocational initial medical assessments it is 62, and for impairment assessments it has got 59, and that, on average, the four particular doctors who were discussed on the 60 Minutes programme, whom I thought he was referring to, actually conduct between 8.7 and 4.7 percent of those particular reviews. So I hope that is helpful to the member.
Kevin Hague: Does she believe that an ordinary person would consider it possible that medical advisers like Dr du Plessis, Dr Turner, Dr Beaumont, and Dr Robb could remain independent of ACC, when it pays them between $300,000 and $500,000 each per year?
Hon JUDITH COLLINS: I think that that is an issue that needs to be considered, and I have spoken to ACC about it. The member will be aware that there is a new board now put in place. I will be meeting with the board and discussing—obviously not the individual cases or the matters— how we can end up with a system that, obviously, achieves good, robust, and independent medical reports and assessments, and that can be seen as independent by both the claimants or clients of ACC and ACC. I also note that even back in the year 2000—12 years ago—the same lawyers for ACC clients were claiming exactly the same issues around what they said were non-independent medical assessments. So I do not think much has changed, but I am happy to work with the member to try to get things to change.
Kevin Hague: Does she agree that an ordinary person would find it unbelievable that ACC would continue to fly these doctors around the country and pay them an average of almost $1,700 for each client they see if they were not acting as “hit men”, to use the phrase that Laurie Gluckman was described as according to Judge Trapski, in targeting the exit of long-term claimants, which ACC has referred to as low-hanging fruit?
Hon JUDITH COLLINS: I think it is absolutely right that people who are not highly trained skilled medical professionals, just like people who are not highly trained, very skilled legal professionals, find the fees that are charged outrageous, but that is actually something that I think most people in New Zealand would say around this area. I do not know for certain and I cannot tell the House that the medical professionals he is referring to are paid any differently from any other medical professionals—
Hon Ruth Dyson: So that makes it all right.
Hon JUDITH COLLINS: —with that degree of expertise, and I am surprised that the former Minister for ACC, who left the job so abruptly, should want to call out about this issue.
Kevin Hague: Does she accept that there is a risk that the assessments performed by a doctor who earns up to half a million dollars a year working part-time for ACC could be affected by that doctor’s desire to continue receiving such lucrative contracts from the corporation?
Hon JUDITH COLLINS: Well, I think that there is always that perception. Whether the perception is reality is a different matter, because as I understand it, these very highly trained, experienced medical professionals are in great demand all over the world. What we do know is that in a country the size of New Zealand, which, of course, has a fabulous health system, thanks in good part to this Government, it is thanks also to the level of qualifications and experience and the work attitude of many of the medical professionals he is referring to.
Kevin Hague: Does she agree that contracting for specialist medical assessments with district health boards or professional colleges would help ensure that they are independent and are seen to be so, as Judge Trapski says they must be?
Hon JUDITH COLLINS: I think the member has raised a very good point, and he has privately raised that matter with me. It is certainly one that I have raised with ACC, and now that the new board is in place I wish to take that matter further and see whether or not that is a realistic situation that we should consider.
Kevin Hague: What are the instructions she has given the reconstituted ACC board about specialist medical assessments?
Hon JUDITH COLLINS: I have not yet met with the board. It has only been in place a few days, but I will be attending the first board meeting to discuss some of these issues with the board members and ask them whether they can start considering these matters. I have, however, met with the chief executive, raised those issues, and asked for some suggestions. I think it is a very important issue that the member has raised.
Barbara Stewart: Will ACC cap the annual amount it spends on any individual medical assessor to avoid the risk of incentivising advisers to provide reports that ACC wants rather than independent advice?
Hon JUDITH COLLINS: I am not sure that that would be a good idea, particularly if, for instance, there may be only two or three specialists with the level of expertise in the country. So I think that might be a bit of a blunt instrument, but I can undertake to look at all those considerations.

http://inthehouse.co.nz/node/15035

ACC assessments also key for sensitive claimants

A press release from the New Zealand Association of Psychotherapists by Kyle MacDonald

Last night’s shocking expose on TV3’s 60 minutes showed how even “insiders” from ACC admit that a deliberate process of using medical assessors favourable to ACC has lead to a clear and dramatic increase in the “exit” of long term claimants from the ACC’s books.
This approach also continues to detrimentally affect survivors of sexual abuse and violence, or “sensitive claimants” says psychotherapist Kyle MacDonald.
“What was not widely reported with the release of the recent monitoring report of the Independent Clinical Review of the Sensitive Claims treatment pathway was how the ACC’s independent assessors are also preventing New Zealander’s accessing counselling.”
To access ongoing counselling, beyond sixteen support sessions, the client must have a cover determination report, or an external psychological assessment. This is usually conducted by an ACC appointed and contracted assessor.
“What is shocking is to me is that the report details that less than 4% of claims have been accepted based on these assessors reports, in 2011 and 2012. This is down from roughly 60% in 2008.” says MacDonald. “I believe this is further evidence of the cynical management detailed by 60 minutes. The idea that only 4 out of every hundred clients require more than four months of counselling to recover from sexual abuse and trauma makes no clinical sense.”
“It’s also clear that from the clinicians and clients I talk to that all the problems outlined with 'hatchet' assessors, outlined in last nights report also apply to long term Sensitive Claimants and the ACC’s psychological and psychiatric assessments.”
The “Monitoring Report on the Recommendations from the Independent Panel’s Review of the ACC’s Sensitive Claims Treatment Pathway: 18 months follow up” was released on the 17th of July, 2012. The quoted statistics can be found on p. 29.

http://www.scoop.co.nz/stories/GE1209/S00048/acc-assessments-also-key-for-sensitive-claimants.htm

Independent medical assessments must be a top priority

A press release from the Green Party by Kevin Hague

The newly constituted ACC Board needs to demonstrate its commitment to culture change in the organisation by immediately changing the way it commissions the services of specialist medical assessors, Green Party ACC spokesperson Kevin Hague said today.
Melanie Read's 60 Minutes story, which screened earlier this evening, has revealed to the public what ACC advocates, long term claimants, and the Green Party have known for some time: that ACC is selectively contracting favoured medical assessors who deliver the assessments that ACC needs to end the entitlements of long-term claimants.
"There is no doubt that ACC has a standard practice of using specialist medical assessors who are likely to make an assessment favourable to ACC,” said Mr Hague.
“The many claimants' stories I have on file show, in particular, it is common for ACC medical assessors to have views which are unusual in their specialty, and who are willing to offer opinions outside of their recognized scope of practice.
“Dr Du Plessis, who was interviewed in Melanie Reid's story is far from unique.
“This is not a new problem. The review of ACC claims management undertaken by Judge Trapski in the wake of the scandal in which Dr. Laurie Gluckman was used by ACC to give opinions in ACC's favour, recommended in 1994 that specialist medical assessments should be genuinely independent of both the claimants and ACC itself.
"It is scandalous that ACC is still engaging in these unethical practices. It is yet another illustration of the sick culture of disentitlement that has taken hold of the organisation,” said Mr Hague.
“It will be an important test of the Minister and the new Board whether urgent action is now taken to introduce truly independent assessments.
"The Green Party has suggested several ways of doing this to the Minister. One is to engage with the specialists' professional colleges to have them appoint medical assessors. Another is simply to extend the contracts ACC already has with District Health Boards so that DHB specialists make the assessments,” said Mr Hague.
Mr Hague has also raised with the Minister ACC's intention to now exercise greater control of the clinical "gateway" into the scheme.
"ACC is now extending the methods they have used to 'exit' long term claimants to the processes by which accident victims are referred into the scheme by general practitioners. The Minister has indicated that our grave concern about these practices will be considered by the new Board. This can't come soon enough,” said Mr Hague.

http://www.scoop.co.nz/stories/PA1209/S00112/independent-medical-assessments-must-be-a-top-priority.htm

ACC pays millions to send its 'hatchets'

An article from the Dominion Post by Phil Kitchin

ACC is spending millions of dollars flying doctors around New Zealand to assess long-term clients who have already been assessed by other doctors.
The policy has been slammed by John Miller - one of the country's top lawyers specialising in ACC legislation - who said the so-called “independence” of some assessors was a sham.
ACC lawyers, advocates and claimant groups know those doctors as “hatchet men and women”, Mr Miller said.
“They are not independent, as a substantial part of their income comes from ACC,” he said.
ACC figures reveal the corporation pays millions of dollars a year to a group of “independent assessors”, often flying them to towns or cities where other doctors with suitable qualifications already practise. In some cases the ACC assessors are flown from the South Island to North Island cities.
At least $3 million was spent last year on airfares and assessment fees for a group of less than 12 doctors.
Mr Miller said medical professionals had expressed serious concerns to him about the issue. Because some assessors earned virtually all their income from ACC it was “inevitable” they would tend to “provide reports ACC wants".
“The old saying of ‘he who pays the piper calls the tune' definitely applies with ACC assessors. The use of such assessors actually damages and diminishes ACC's reputation,” Mr Miller said. “ACC knows the assessors who have particular fixed medical views, for example on degeneration . . . and they keep sending injured claimants to be assessed by those assessors as they know they will receive reports they want.”
Mr Miller said ACC advocates know when clients are sent for assessments by “the same usual suspects ... there will be an adverse outcome for the injured claimant”.
ACC has seen a drop in the number of cases it is winning as claimants fight assessments. The corporation won 77 per cent of cases challenged by clients in 2009 but in the year to date that figure has dropped to 56 per cent.
Mr Miller said his firm had experienced cases where independent assessors such as occupational therapists for seriously injured clients refused to provide reports “for us in ACC disputes".
“They fear that it will affect their livelihood from ACC contracts,” he said.
“It confirms in people's minds it is an organisation more concerned with removing claimants from ACC assistance this way rather than being concerned with properly rehabilitating injured claimants off the scheme.”
Mr Miller said the solution would be for ACC to start using a group of trusted assessors who could “be used by both sides."
ACC's claims management acting general manager Phil Riley said ACC chose appropriate providers, but if clients did not want to see them because of genuine concerns, a choice of two alternative providers was offered. If clients chose not to see a local assessor, ACC could arrange for a specialist from another area to travel to their location.
"For practicality purposes, we try to send specialists to other areas when there are a number of clients to see in that area. This is why ACC flies specialist medical professionals to other regions, to hold ‘day clinics' for ACC clients."
ACC paid specialists at market rates, Mr Riley said.
ACC Minister Judith Collins said changes she made to ACC's board include new priorities for the corporation to ensure entitlements were delivered transparently. She said ACC must follow a fair process for assessments and provide best practice and lawful services to preserve public trust.
However ACC would not be a soft touch for people trying to take advantage of it, Ms Collins said.

© 2012 Fairfax NZ News

http://www.stuff.co.nz/national/politics/7637014/ACC-pays-millions-to-send-its-hatchets

ACC culture must be more fair and open

An editorial from the New Zealand Herald

The need for a culture change at the Accident Compensation Corporation has prompted the departure of the chairman, two board members, the chief executive and several officials. With the decks cleared, much of the responsibility for turning the ship around will lie with the board appointees announced by the ACC Minister, Judith Collins, this week. Unsurprisingly, the interim chairwoman, Paula Rebstock, will reprise her fix-it role at the table's head for the next three years. Other new appointments see Trevor Janes in the deputy chairman's chair and Professor Des Gorman and Kirsty McDonald, QC, on the board.
Ms Collins says these choices "underline the Government's commitment to genuine culture change, and will lead to a more balanced and comprehensive approach to the governance and operation of ACC". It is on that basis that the appointments will be scrutinised. Labour's ACC spokesman, Andrew Little, was quick to talk of "a sharp lurch to the right" and to zero in on Professor Gorman. The professor, head of the Auckland School of Medicine, had, he said, been a senior medical adviser to the ACC for many years, and "given some of the most retrograde advice on claimants' files I've known".
He said the professor had been the subject of many complaints over his advice about occupational overuse syndrome in the 1990s.
That raises questions about the precise nature of the culture that will be implanted at the ACC. The first priority, in the wake of the privacy breach which saw details of 6700 ACC claimants emailed to Bronwyn Pullar, is no longer said to be cost containment. Rather, it is trust and confidence. But the criticism of Professor Gorman over OOS advice has had a recent echo in the stricter enforcement of the ACC's policy of declining to pay for surgery for "pre-existing conditions". To save money, the ACC seized on age-related degeneration of claimants' bodies to unjustifiably reject their claims for surgery after an injury.
On appeal, too many rejections of such claims were reversed. Understandably, this led to accusations that the ACC was too hard-nosed. The corporation, after an internal review, conceded as much, yet comments this year by the previous chairman, John Judge, suggested nothing much had changed. The ACC was still not getting the balance right in its decision-making.
An early task for Ms Rebstock must, therefore, be to respond to the criticism of Professor Gorman's appointment and to spell out exactly what it signifies. When the stricter policy for pre-existing conditions was introduced, there was no public notification of why it was necessary or how it would be applied. That lack of transparency is not sustainable. More broadly, the new culture must include a clear explanation of exactly where the ACC is headed under the new board.
The corporation should be involving claimants' surgeons more in its decision-making and applying extra expertise where necessary. It should also be explaining the reasons for its decisions more clearly to people. The "almost cavalier" attitude identified by official inquiries into the Pullar case cannot continue. But the changes to the way the ACC approaches its job, notably in keeping costs under control, should be kept in proportion. There can, for example, be no question of unworthy claims for surgery being approved with few questions asked.
The lessons of the Pullar case are that the ACC must be more sensitive, fair and open in its dealings with people. That culture change will not have to be as drastic as that needed at the top level to achieve it.

© 2012 APN Holdings NZ Ltd

http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10832252