Complex Claims Panel

David Lawson made this Official Information request to Accident Compensation Corporation

Response to this request is long overdue. By law Accident Compensation Corporation should have responded by now (details and exceptions). You can complain to the Ombudsman.

From: David Lawson

Dear Accident Compensation Corporation,

I have recently become aware from a review of my ACC claim file of the ACC's use of a panel called the Complex Claims Panel, and have sourced some information from the internet at this site which may be somewhat related but I am not sure;- http://www.acc.co.nz/PRD_EXT_CSMP/groups...

The questions that I seek written statements from ACC are sought subject to Section 23 of the Official Information Act 1982.

Background:

A physiotherapist preformed deep acupuncture on my neck in 2014 with dry needling to the depth of 45 mm.

I sustained an acute reaction that included referral of symptoms to trigeminal nerves of the face following the acupuncture.

The physiotherapist acknowledged the reaction and accepted responsibility for the reaction and provided a written acknowledgement of this reaction.

I subsequently lodged a treatment injury claim for this reaction to the treatment providers acupuncture.

Whilst the injury from the acupuncture was caused to the internal structures of my neck the referral to the facial nerves suggest that their was involvement of injury or compression to the nerves of the upper cervical and or the cranial nerves. The most appropriate specialist to assess an internal injury that results in symptoms to the facial/cranial nerves is a neurosurgeon…confirmed to me by an orthopedic surgeon and information sourced from the internet.

ACC have declined cover for the injury which the treatment provider had acknowledged acceptance for.

ACC's case manger referred the Treatment Injury Claim to an internal ACC medical assessor, Mr William Taine who was an ex orthopedic surgeon, not trained in neurosurgery, and the orthopedic surgeon recommended declining the claim.

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Section 23 OIA request 1:

Please provide a written statement subject to Section 23 of the Official Information Act 1982 as to whether Dr William Taine is qualified to specialize in the field of neurosurgery.
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The case manager is J Plachecki

Section 23 OIA request 2:

Please provide a written statement subject to Section 23 of the Official Information Act 1982 as to whether J Plachecki is qualified to specialize in the field of neurosurgery.
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The case manager then took the claim to an internally staffed ACC Complex Claims Panel consisting of ( I have sourced the panel's occupational information from either Linked in In or the New Zealand Medical Council so any personal information provided is publicly accessible);

Dr P Jansen ACC Senior Medical Advisor

Linken in information;
Specialist Medical Practitioner with experience in health service governance, management, research and service delivery. My experiences have included:
- general practice in rural and deprived urban areas
- leadership of quality improvements across a network of 250+ GPs
- medical leadership in a mulch-national pharmaceutical company
- directorships of hospitals, health services and health quality agencies 
- researcher and consultant in health service improvements and cultural competency 
- leading clinical governance improvements tor a national insurance scheme

My strengths in analysis of issues and engagement of stakeholders have been successfully used in a range of public and private services. I have advanced qualifications in medical management (FRACMA) and primary care (FRNZCGP, Distinguished) as well as clinical teaching (Grad Cert Cln Tch).

My focus has been in supporting the delivery of high quality products and services to the entire population.

New Zealand Medical Council;

Scope of practice
General
Vocational
Medical Administration (10 February 2011)
General Practice (9 August 1988)

Dr Jansen is required to participate in an approved recertification programme relevant to the vocational scope of General Practice; Medical Administration.

Dr Jansen may work outside the stated vocational scope but must do so within a collegial relationship.

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Section 23 OIA request 3:

Please provide a written statement subject to Section 23 of the Official Information Act 1982 as to whether Dr P Jansen is qualified to specialize in the field of neurosurgery.
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Dr Moughan ACC Medical Advisor

New Zealand Medical Council;

Practising certificate
from 1 June 2015 to 31 May 2016

Conditions
Conditions on Scopes of Practice pursuant to Section 21 of the Health Practitioners Competence Assurance Act 2003 effective from 28 April 2008:

That Dr Moughan's vocational scope of practice is limited to non-clinical practice
General scope
29 November 1977
Provisional scope
3 March 1977

Scope of practice
General
Vocational
General Practice (28 April 2008)

Dr Moughan is required to participate in an approved recertification programme relevant to the vocational scope of General Practice.

Dr Moughan may work outside the stated vocational scope but must do so within a collegial relationship.

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Section 23 OIA request 4:

Please provide a written statement subject to Section 23 of the Official Information Act 1982 as to whether Dr Moughan is qualified to specialize in the field of neurosurgery.
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P Carr ACC Team Manager and chaired the panel.

From Linked in: I am a registered General and Obstetric nurse who trained in Wellington Hospital, qualifying in 1979. I worked continuously in medical, surgical, paediatric and orthopaedic areas within Wellington and Kenepuru Hospitals before transferring to district nursing where I spent 13 years working in the community. A large part of the community work involved oncology nursing which I found very satisfying.
I completed a Bachelor of Nursing in 2000 at Whitireia Polytech.
From 1999-2002 I worked for the Office of Veterans' Affairs as the National Review Officer. This was an autonomous role being the first step in the review process of assessing decisions made by a panel on War Disablement pensions. This required working within a legislative framework and applying clinical knowledge to ensure the correct decision had been made for veterans.
In October 2002 I joined the Accident Compensation Corporation working initially as a clinical advisor and then as a team manager within what was the Medical Misadventure Unit to what is now the Treatment Injury Centre. This is an incredibly interesting and challenging area to work in as part of a professional and caring team.

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Section 23 OIA request 5:

Please provide a written statement subject to Section 23 of the Official Information Act 1982 as to whether P Carr is qualified to specialize in the field of neurosurgery.
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R Aston ACC Team Manager

Prior to working for ACC:

After Hours Manager
Capital & Coast DHB
July 1992 – February 2003 (10 years 8 months)Wellington & Kenepuru Hospital sites
After Hours Management in charge of a team of Duty Managers and Clinical Coordinators for management of acute in patient services- clinical and non clinical emergencies, management of resources for patient allocation/ bed management etc.
Education

Marlborough Girls College, Nelson Public Hospital, Wellington District Health Board,
Nursing - Registered Enrolled Nurse, Registered General and Obstetric Nurse, Batchelor of Nursing
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Section 23 OIA request 6:

Please provide a written statement subject to Section 23 of the Official Information Act 1982 as to whether R Aston is qualified to specialize in the field of neurosurgery.

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L Shaw ACC Team Manager

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Section 23 OIA request 7:

Please provide a written statement subject to Section 23 of the Official Information Act 1982 as to whether L Shaw is qualified to specialize in the field of neurosurgery.
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and the panel was observed by;

M Ahern Senior Solicitor
J Funnell ACC's Corporate Issues Manager

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Section 23 OIA request 8:

Please provide a written statement subject to Section 23 of the Official Information Act 1982 as to whether M Ahern, and J Funnell are qualified to specialize in the field of neurosurgery.
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The ACC Response form: Complex Claims Panel completed on 10/12/2015, had no associated ACC categorization number such as ACC 45, ACC 712 etc denoting the specific purpose and use of the form.

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Section 23 OIA request 9:

Please provide a written statement subject to Section 23 of the Official Information Act 1982 as to why this form has not allocated ACC categorization number detailed on the form.
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The available sources of information that can be used by the Complex Claims Panel are listed as on the form;

1). ACC 2152 (Treatment Injury Claim)
2). ACC 2184 Please confirm as to what an ACC2184 in a written statement subject to
Section 23 of the OIA 1982.
3). Medical Reports
4). Clinical records
5). Internal Medical Advice
6). External Medical Advice
7). CCP referral
8). Other if any

In my case an internal ACC Medical Advisor/Ex Orthopaedic Surgeon, without any external specifically protocoled imaging suited to determine neurological damage of the upper cervical and cranial nerves and or surrounding structures that could be causing compression causing the facial nerve symptoms, recommended the non acceptance of an injury the treatment provider had acknowledged and accepted responsibility for.

I will suspect that the written statements that Government Services return to me will confirm that not one of the person's noted above, and for whom are all internally employed by or contracted to ACC are or ever have been qualified to specialize in the field of neurosurgery, and thus not one of the ACC staff are qualified to have had determined my eligibility to have had the treatment injury claim accepted or declined.

My requests to J Plachecki to be able to have my symptoms assessed by an independent and practicing neurosurgeon, since this is the field that a neurosurgeon specializes in, not a field that an orthopedic surgeon is specialized in), were ignored.

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Section 23 OIA request 10:

Please provide a written statement subject to Section 23 of the Official Information Act 1982 as to why ACC has not sought to have the treatment injury claim assessed by an independent neurosurgeon.
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I had requested to be consulted in respect of any additional information sought by ACC to help the decision of cover to be made, with my consent requested prior to the information being sought.

Section 23 OIA request 11:

Please provide a written statement subject to Section 23 of the Official Information Act 1982 as to why ACC sought internal advice from an ACC medical advisor, and ex orthopedic surgeon without consulting me first. I would have pointed out that an orthopedic surgeon is not appropriately qualified to make the decision for a claim that falls within the field of neurosurgery.

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Section 23 OIA request 12:

Please provide a written statements from William Taine as to why ACC did not request from me permission to approach a neurosurgeon for advice on this claim.
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Section 23 OIA Request 13:

I have received advice that in order for ACC to legally make a decision on claim acceptance that ACC must have first received advice and or assessment from a specialist that is appropriately trained within the field of assessment and treatment that is appropriate to the injury symptoms, so in my case that would be advice and assessment of the injuries by an independent neurosurgeon.

Please provide me a written statement as to why ACC have not sought advice from a neurosurgeon prior to making any decision on claim acceptance on this claim.

Section 23 OIA Request 14:

Please provide me all Official Information that specifies what medically trained and qualified specialists/surgeons are accepted by ACC to determine issues of cover that involve symptoms to the facial/cranial/upper cervical nerves and or blood vessels and surrounding structures.

Section 23 OIA Request 15:

Please provide me under the OIA a copy of ACC's required guidelines for allocating the assessment of cover decisions to the appropriately trained medical specialists that includes cranial nerve and upper cervical nerve and loud vessel injuries and or symptoms.

Section 23 OIA Request 16;

ACC's MA ex orthopedic surgeon, William Taine has suggested that there is no evidence of a physical injury. Given that no protocoled imaging or diagnostic testing has been undertaken to determine whether an injury has occurred from the 10 dry needles were embedded 45 mm into my neck prior to the adverse reaction, any such injury that is causing the facial/cranial/upper cervical symptoms cannot be established in the absence of specific and targeted physical assessment by a neurosurgeon and then their review following targeted imaging and diagnostic testing, how can an orthopedic surgeon not trained in such matters make such a decision on cover. Of course the naked eye can not determine the extent of injury a needle that is placed 45 mm into the neck may have caused.

Section 23 OIA Request 16;

Under Section 23 of the OIA please have Mr Taine provide me with a written statement as to how an injury to an internal structure of the neck, leading to referral of symptoms to the facial neves, caused from the introduction of a foreign body, in this case an acupuncture needle, can be assessed for acceptance of cover, other than through the proper diagnostic testing, imaging and throughout neurosurgical assessment.

Section 23 OIA Request 17

The treatment provider made the following declaration/admission;

I XXXXXX XXXXXX can confirm on XX/XX/XX David was having acupuncture treatment and suffered an adverse reaction (increase in severity of symptoms and referral into head/face and shoulder which was not recorded at the time.

The treatment provider in this session only used 45 mm needles instead of the usual 30 mm. The Treatment Provider was treating a C5/6 Prolapse, with the pain localised at and around c5/6. The acupuncture adverse reaction increased the pain around the c5/6 area slightly.

The adverse reaction directly following the acupuncture caused the referral into the head/face and shoulder. The referral to the facial nerves was a totally new symptom and there were two sites during the acupuncture that caused strong pain.

The increase in the severity of symptoms and the referral to the facial nerves were two distinct new reactions, the facial nerve symptoms never before experienced, so they were not an increase in symptoms, but new symptoms and indicative of a new physical injury having had occurred.

ACC's William Taine wrote (comments in brackets are mine) :

There is no evidence of physical injury (only targeted imaging and diagnostic testing will be able to determine injury or not, which has not been carried out). The acupuncture reaction that this claim was lodged for was defined as an increase in symptoms (this is substantively inaccurate, because the treatment providers statement notes that there was referred symptoms to the head and face, which were totally new symptoms and not an increase in severity of previously experienced head/face symptoms…but simply new symptoms.). There is no evidence of a nerve injury (other than the symptoms of a nerve injury, which in themselves are indicative of a nerve injury…but again only diagnostic testing and imaging would be able to establish the injury). This claim does not meet the criteria for a treatment injury under the Accident Compensation Act 2001 and accordingly this claim is declined for cover ( as pointed out William Taine was only an orthopedic surgeon, and has never been registered, trained and or specialized in the field of neurosurgery and thus not qualified to have had made a decision on cover entitlement for this treatment injury.)

In addition, no one on of the Complex Claim Panel have been trained in neurosurgery and therefore the Complex Claims Panel were not in a position to be able to decline the treatment injury claim without first seeking advice from a neurosurgeon.

Section 23 OIA Request 17
Please provide me a written statement from Mr William Taine as to why William Taine, (who should not even be making any comments on a matter of claim that falls within the field of neurosurgery), has not taken the treatment providers statement that referral to the head and face as having been new symptoms as indicated by the treatment provider.

Section 23 OIA Request 18

the increase in severity of symptoms and referral into the head/face and shoulder are separated by the word and which denotes that the symptoms referred are new, otherwise the treatment provider only need to state that there had been an increase in the severity of symptoms.

Mr Taine on behalf of ACC has written;

As stated by XX XXXXXX

"….suffered an adverse reaction (increase in severity of symptoms) and referral into head/face and shoulder." (Mr Taine then acknowledges that he has on his own accord altered the treatment providers written declaration of acknowledgement and acceptance by on behalf of ACC by typing the following words in the physio's statement in bold for emphasis "increase in severity of symptoms"), and thus totally altering the intent of the physio's statement by then omitting to register that the referral to the face/head were new symptoms.

Section 23 OIA Request 18:

Please provide to me Mr Taine's written statement under Section 23 of the Oficial Information Act as to why he is in a position to have altered the meaning of a physio's declaration, and has not accepted that the symptoms to the face and head were not new symptoms, since they were new and acute symptoms not previously experienced ever.

Section 23 OIA Request 19:

As the most senior member at the CCP, on 10/12/15 I request Dr Peter Jansen's written statement as to why external advice was not sought from an external and independent neurosurgeon for a claim which symptoms to the facial nerves fall with in the field of neurosurgery and not orthopedic surgery, medical administration, general, practice, nursing, and acc team management. In addition please ask Dr Jansen to confirm in a written statement which panel members have been trained in neurosurgery, and whether at the time Dr Jansen took part in this panel whether he was in full knowledge that William Taine was in fact a retired orthopedic surgeon, now medical advisor for the ACC, and has no specialized training and registered qualifications in the field of neurosurgery.

Section 23 OIA request 20

Please provide me a written statement from William Taine as to why no advice was sought from a neurosurgeon who's field of practice my treatment injury falls into due to the referral of symptoms to the facial/cranial and or upper cervical nerves which were new and additional symptoms that followed the deep acupuncture (45 mm deep) to my neck.

OIA Request:

Request 21)

Please supply me all OIA with regard to the development and operation of the CCP, inclusive of policy, decision guidelines, and the requirement for the panel members to have been suitably medically trained and qualified/registered in the field of specialty that the claim decision falls within…..i.e nurosurgery for nerve issues, adudiology of heaing damage accidents, optometrists for eye injury etc.

Request 22)

Please provide me a written statement as to why an ACC claimant is not advised that a decision has been put to the CCP, and has no right of reply to the information that the ACC staff members/case managers put in front of the panel, and therefore no ability to be heard, and have any inaccuracies, omissions attended to prior to the panel being presented with the claimants evidence.

Under s16(2) of the Official Information Act, my preferred way of receiving a response is by email to the address from which ACC received the original request, not by post.

I thank you for your time and assistance.

Yours faithfully,

David Lawson
116a Lynwood Road
New Lynn
Auckland

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From: Government Services
Accident Compensation Corporation


Attachment 0047807 EXTENSION.pdf
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Please refer to attached letter.

 

 

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attachments or disclose the contents to any other person."

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From: Government Services
Accident Compensation Corporation


Attachment Response LawsonD 070616.pdf
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Dear Mr Lawson

 

Please refer to response attached to your requests made by email dated 2
April 2016 under the Official Information Act 1982 (OIA).

 

 

Yours sincerely,

Government Services

Disclaimer:

"This message and any attachments may contain confidential and privileged
information. If you believe you have received this email in error, please
advise us immediately by return email or telephone and then delete this
email together with all attachments. If you are not the intended
recipient, you are not authorised to use or copy this message or any
attachments or disclose the contents to any other person."

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