Showing posts with label acc. Show all posts
Showing posts with label acc. Show all posts

Wednesday, December 12, 2012

ACC. Sigh. AGAIN!

I remember 3 years ago writing a post about my frustrations with ACC over them declining my cover when my Cochlear Implant needed replacing after the electrodes migrated out after surgery. Back then, the surgeons were sure ACC would cover as it arose from surgical complications. ACC grabbed on to the face that it was something else and simply refused to cover it. Very frustrating, as because they took so long, I was totally deaf for nearly a year.

Now it's my ankle.

In 2010, I rolled my ankle while walking down the main street of Kaitaia. At the time I remember going ouch, but carried on walking. About 24 hours later, the ankle/foot really started hurting, and two days later I couldn't weight bear at all. The ankle started swelling then. I was taken to Kaitaia Hospital, where they told me I had sprained it, put a bandage on it, given crutches, and sent home. I was on crutches for 3 weeks before I was able to weight bear. In the meantime I went to my GP who sent me for an xray (which showed nothing), and to physio who was convinced that I had really damaged my ankle, much more than a sprain, and urged me to see a sports physician as soon as possible. As I was leaving to go to Blenheim one week later, I had to wait until then.

As soon as I got to Blenheim, I went to see a GP, told her I had been advised to see a sports physician, but she told me there was no such thing in Blenheim and promptly referred me back to Physio. The Physio here said exactly the same thing as the physio in Auckland and finally referred me to an Orthopaedic Surgeon. He said I had a coalition injury which he picked up on the xray, and that it would settle down. He then referred me back to Physio. It had now been nearly 3 months since the accident and all that had happened was to-ing and fro-ing with no real commitment from anyone to find out what was wrong. Several more weeks of physio appointments and the ankle was no better, so I insisted on being seen by the orthopaedic surgeon again. This time I was referred for an MRI. They found that the tendon had been severed, so it was decided to operate. ACC and my private health insurance Southern Cross went halves each for the operation. 

Operation was done in July 2010 and I was in plaster for 10 weeks. When I came out of plaster the foot was still very sore. This *NEVER* got better. In November 2010, I finally convinced the Orthopaedic Surgeon to do another MRI to find out what was wrong. The Co-alition injury was then picked up again, and it was at this stage that I was referred to a Surgeon in Auckland. One that specialised in feet and was internationally reknowned. I couldn't get an appointment until February 2011. I was then told that yes, I had to have the operation to remove the coalition. This is basically two bones that were fused together from birth, which I happened to have injured when I rolled my ankle. At this stage I still said to Matthew Tomlinson that I thought there was more than just the Coalition injury as I seemed to be in pain in more than one place. 

Anyway, ACC was applied for, and accepted and I went ahead with the Surgery 2011. That took care of that part of the pain on the side of my foot, and that particular operation was successful. However I was still in pain inside my ankle, as I had always been since I rolled it. Despite the pain, and by taking regular pain killers, I went to Europe to see my daughter (she shouted me for my 50th birthday), but really it was no better. I decided NOT to wait until March to revisit the foot, and rang ACC to get help to see the surgeon again. At this stage I told ACC that I thought it the originally injury was still unresolved. I managed to get an appointment in December two days before Christmas. An ultrasound was done and they found another coalition over my ankle. Removal of this would not take away the pain, so it was decided that a fusion of the Subtalor joint would do the trick.

Once again funding from ACC was applied for. This time they turned it down. My private health insurance kicked in, and they covered the operation instead, on the proviso that I fight ACC all the way to Mediation, otherwise they would ask for my money back. So I was between a rock and hard place. It would have been nice to just forget ACC then, but I couldn't.

Operation was done in July 2012. Plaster for 8 weeks, non weight bearing. Plaster came off and I was pain free for about a week. Then the pain came back - right in the middle of my ankle. I got home from surgery to a letter from ACC stating they had revoked the previous operation as well, done in 2011 but 'in a matter of good faith they won't ask for the money back'. WTF??? The ACC Mediation was today. I was asked questions to try and trip me up, to find out if I had been lying about my injury. I hadn't. They didn't trip me up because I have never lied. Their oral submission insinuated that they thought I had provided false information, lied, that I had lied to the surgeons, and they were also in cahoots with me and acting unprofessionally. These are surgeons of high international standards who would be quite frankly appalled to hear what ACC said. At this stage ACC has only said this orally. They also said I have already have had my fair share of operations from ACC. To be honest, I didn't realise there was a limit! Do car accident victims who need multiple surgeries to be corrected get told that 'that's enough'?

I have asked for it in writing due to my deafness, and the fact they didn't supply any interpreter or face to face mediation. Instead, a speaker phone conference was supplied which I couldn't hear properly. This means, I may have got the wrong end of the stick, but if I have, they knew I was deaf, but they weren't able to interpret the oral submission for me.

On Friday, I was walking a short distance when my right foot must have landed on a stone. My right foot rolled. As I have no balance, and my left foot is already badly injured, I just went down on the ground very rapidly. I have no way of righting myself without balance, and without a good foot. As long as I have pain in my foot, I am at increased risk of falls because of my lack of balance. I'm about to register a new ACC claim for Friday's injury.

I have discussed amputation with a few friends of mine. The pain isn't mild, its very severe. I spend most of my days on my chair with my foot up. I can't bear that for long as I like to be active, especially when out taking photos. Camera club trips need to be planned, normally I have to just keep near the car. I can't walk long distances or on uneven ground very well. I can't walk to the end of my street without pain. I can't mow my own lawns. Frustrated is an understatement. Amputation would mean six months of healing, a prosthesis and hopefully a new lease of life without pain. It's very very tempting. Another 3 years of pain would drive me insane. Half an hour upright and the foot swells terribly. The swelling and pain go hand in hand.. Some days I can't get my shoe on.

I cannot understand ACC's stance. Both surgeons have made it clear that the evidence is from the original injury. The specialist in Auckland is New Zealand's top foot surgeon. He based his evidence on what he saw during the operation. Unless ACC have a specialist opinion from someone on an equal footing to my specialist, then they can't refute it.

Prior to the injury, I had no problems with my ankle. I walked (trained for the Oxfam back in 2008), I was training for the half marathon in 2010, in fact, I had booked and paid for it but had to pull out due to my ankle injury. I used to go to the Gym in Auckland 6 days a week doing aerobic and weight training. I used to walk for miles for fitness in Auckland, and belonged to an informal running group with the oxfam walkers.  All my friends can vouch for this and can bear witness to this. They, like me, are horrified it has come to this and I'm sure they'll comment on this blog post.

These days? I can do...  Nothing.

I had planned to join tramping clubs here in Blenheim when I moved down. I planned to do the Queen Charlotte Track, the Abel Tasman walk, the Walks up at the Nelson Lakes. No go so far.

I live in hope. I just need two good legs...

Saturday, February 28, 2009

Finally - The Legal Opinion

ACC sought a legal opinion from Bruce Corkill QC based on Phil Birds report. QC stands for Queen's Counsel - so as far as legal matters are concerned in New Zealand - that's pretty high up. Again I've had to upload them as images. If you need to make your screen bigger so you can read it, you can hold down ctrl and press the + key several times, or you can just double click on a portion of the text which will open them up so you can read it on a bigger but separate screen.








Based on this information - although I think there are a few thigs that aren't correct in these documents, I don't think I have a leg to stand on fighting it, as it boils down to scar tissue pulling the electrodes out.

The Outside Independent Surgeon's Report to ACC...

This is what the Cochlear implant specialist said in his report to ACC. Unfortuantely I wasn't able to cut and paste text but had to upload them as images as it was a scanned document.







ACC Declined Funding for my Cochlear Reimplantation

Ugh.

It happened. ACC denied me funding to fix my defunct, not working Cochlear Implant. It didn't come as a surprise - I had had a really bad feeling about ACC right from the beginning. Probably not helped by the case worker who had been trying to PHONE me despite me putting on my forms that I was unable to hear on the phone!!!

Anyway - their letter verbatim......

We’re sorry, we can’t approve your claim
We’ve been told you were injured on 12/11/2008 while being treated by a health professional. After careful consideration, we’re sorry to say your claim has not been approved.
Why we can’t approve your claim
We’re unable to approve your claim because it does not meet the criteria for a treatment injury.

It goes on to say...

For ACC to approve cover for a treatment injury claim, the following must apply:

*There must have been a personal injury, which occurred when you were seeking or receiving treatment from, or at the direction of, one or more registered health professionals
*The personal injury occurred as part of treatment
*The treatment can be shown to have directly caused the personal injury; and
*The personal injury is not excluded from cover (for example, the injury must not have been mainly due to an existing underlying condition)

The following condition was not identified as being related to treatment in this case:
*Failure of the right Cochlear implant
This is because:
*The treatment you received did not directly cause the condition in question.

A report from the surgeon Mr R Gunn states “At the re-implantation procedure, Robyn was found to have some fibrous scar tissue in the cochlea, and it was only possible to insert 17 of the 22 electrodes. A post-operative x-ray showed that the electrode was well in position”.

In recent months you have had a progressive deterioration in your hearing and non-auditory symptoms which is said to be due to the stimulation of the more proximal electrodes. More and more electrodes have needed to be switched off to eliminate the non-auditory symptoms, so your hearing has deteriorated accordingly.

An x-ray of the implant in late October 2008 confirmed that the implant array has been progressively migrating out of the cochlea. Mr Gunn states “we assume that this is occurring because of scar tissue contraction within the mastoid bone, through which the electrode passes in between the internal receiver/stimulator unit and the intra-cochlear electrode array. This is an unusual complication which has been reported by some cochlear implant clinics elsewhere”.

The claim has been lodged to replace the implant.

Mr Gunn further comments that the migration of the electrode out of the ear “is certainly not simply a function of a disappointing result from the implant replacement operation”.

The underlying hearing loss was present prior to the cochlear implant but you were “hearing very well with her new cochlear implant until the electrode migrated out”.

This is considered to be a rare but already reported complication in some overseas cochlear implant clinics.

External Clinical Advice was obtained by ACC from the ENT surgeon Mr Philip Bird, who specialises in cochlear implant surgery. Mr Bird states that in terms of a physical injury “…the implant itself is not damaged but the electrode has been displaced, possibly by contraction of scar tissue. The extrusion of the electrode meant that the implant is no longer effective. In this respect I think is almost certainly a physical injury given that the device has not been damaged per se. Scar tissue causing migration of the implant necessitating further surgery is not a necessary consequence of surgery. It has certainly been described and is incredibly rare both in the New Zealand experience and the overseas literature”. In fact he notes the incidence is a fraction of 1%.

Legal ECA from Mr Bruce Corkill, QC Barrister. Mr Corkill states:
With regards to a physical injury he states “In the circumstances of this case, the medical evidence is that a physical injury has occurred, namely the scar tissue which is having a critical impact on the implant. However, there is no evidence as to how the scarring was caused – which it would be essential to have if the scarring were to be regarded as a personal injury.”

He goes on to state that with regards to the physical injury being caused by treatment – “The final and critical question is whether that “treatment” is causing the “personal injury”. “Here, it appears that the reverse has occurred. It is the scar tissue which is causing the failure of the implant. On those grounds, then, it is not possible to conclude that there is a treatment injury here, unless it can be shown that the failure of the implant is in some way causing the scarring.”

Claims about scars as personal injuries caused by treatment provided by or the direction of one or more registered health professionals have been the subject of many previous claims over the years. Scars have long been determined to not be personal injuries caused by treatment.

A scar that results from the healed surgical incision is part of the healing process of the body. A scar can grow in claw-like manner into normal skin or other internal body parts such as the ear.

A scar is not a personal injury caused by treatment under the treatment injury provisions. It is the host body’s ordinary mechanism to heal wounds that are the cause of a scar. The incisional wound is a necessary part of the treatment.

The Complex Claims Panel concurred to decline the claim for cover.

*Based on the medical information available, ACC considers that failure of the right Cochlear Implant is not an injury caused by treatment. The desired results have not been achieved in this case. Additionally an injury caused by treatment cannot be found. Accordingly the claim for cover is declined.


So that's it in a nutshell - No reimplantation for me as yet. Funding will have to be found elsewhere to go ahead.