Hutchison Paul: Injury Prevention Rehabilitation and Compensation Amendment Bill (No 3) — Second Reading 
Hutchison Paul: Injury Prevention Rehabilitation and Compensation Amendment Bill (No 3) — Second Reading 
[Volume:625;Page:20174] 
Dr PAUL HUTCHISON (National—Port Waikato) 
: 
 Thank you for the opportunity to speak on this Injury Prevention Rehabilitation and Compensation Amendment Bill (No 3). I must compliment Parekura Horomia on his very short speech. It was excellent because of its shortness I believe. 
The National Party will support this bill because of the clear difficulties with the current regime of medical mishap and medical error which is unfortunately very confusing and unfair on patients. However we do have reservations about this bill and those that are particularly important are the financial ones. I see Dr Cullen over there representing this lackadaisical Labour Government which does not care about quality health spending and which we know has great worries about lack of productivity in the health sphere. Here we have another bill on accident compensation—the third one as was said by Parekura Horomia—brought in by the Labour Government and it did not even have ready a financial impact statement. Since then during the select committee process we had a rough stab at how much it will cost. The stab is about $10 million. I predict that the cost will be considerably more than that. Once again we have a Labour Government that is just not worried about quality spending of scarce health dollars. Nevertheless I must say that the select committee worked well under the chairperson Steve Chadwick. Essentially its members were in agreement as to the need to pass this bill. 
It is important to talk about the other reservations that we as a National Party do have about the State monopoly of accident compensation which provides little choice. There is no doubt that when the legislation came in in 1998 that allowed choice of provision premiums came down rehabilitation efforts were increased enormously and efforts at prevention in a whole range of fields were markedly improved and fortunately that caused the Accident Compensation Corporation to take notice and improve. But undoubtedly as with all State monopolies there is every chance that with time it will become once again inefficient. There is no doubt that by its nature there is no individual risk rating. The monopoly tends to conceal real incentives and it also tends to conceal real problems. 
However I think most New Zealanders have accepted the loss of the right to sue although as a constituent MP I find that among the most poignant—and not infrequent—submissions I get are those from people who have had a terrible time with the Accident Compensation Corporation. They have had horrendous injuries and unfortunately the provisions that are available do not cover them fairly. It does happen time and time again. However I think there is consensus in New Zealand that the system prior to 1974 was a lottery. As I understand it something like 5 percent of those who were injured and went through the courts finally came up with an award and it was years and years later before they did. In modern-day Boston for instance I understand that people who are subject to this sort of accident go through a legal lottery. The figure is about 5 percent but the difference is that the payouts are ridiculously out of perspective—often in the tens of millions of dollars. There is no doubt that worldwide accident insurance has gone berserk. I understand that Rugby School was seriously thinking of stopping the boys from playing rugby because of the fear of being sued by parents for accidents that their boys might suffer. 
There is no doubt that in New Zealand we have agreed that a no-fault scheme does on the whole with the checks and balances produce a workable system that is reasonable. But there are occasions when because of the fact there is no right to sue gross injustices do occur. I think it would be very useful in the future for parties to think about how we can address those rare and exceptional circumstances where an unfairness happens. 
I note that the Government’s review on this bill did not include the private sector. The Insurance Council was not asked for a submission; nor were other individual insurers from the private sector. However there were a large number of submitters and there was wide agreement that these provisions should be addressed. 
A couple of points are worthwhile mentioning. Firstly medical mishap criteria are arbitrary and often bear little relationship to the circumstances of the patient resulting in claimants unfairly missing out on cover; and secondly the medical error criteria require it to be established that an individual practitioner or organisation is at fault and that is clearly at odds with the no-fault system. I know that in my own practice there were quite crazy anomalies in this respect. If for instance during the course of a hysterectomy ureters were damaged or injured which is not unusual and if the practitioner had a rate of injury of less than 1 percent it would be regarded as a rare event and the patient could seek compensation through the accident compensation system. If on the other hand the practitioner had a high rate of injury then the patient could not seek compensation. Clearly two patients side by side can be treated differently by the system and that has to be sorted out. 
I note however that the review of the medical misadventure provisions noted that the Accident Compensation Corporation cover decision and the requirement that the corporation must report individual practitioners involved in accepted medical error cover claims as well as patterns of medical mishap claims to the relevant registration authority resulted in health practitioners’ reluctance to participate in the claims process. With the new Health Practitioners Competence Assurance Bill this will not happen so often. What is hugely important however if the medical error option is taken away is that the professions take on the responsibility to ensure that they are very vigilant with their quality assurance regimes with their continuous quality improvement and that they participate in them extraordinarily vigilantly. Just recently the New Zealand Orthopaedic Association produced an excellent report of all the morbidity that had occurred with hip operations over the last 5 years. This was an excellent example of a profession being prepared to take on quality assurance on a continued basis and going into the future. If this bill is to work well it is very important that pressure is maintained on the professions to continue with high standards. 
I must say that the acupuncturists are in a bit of a shambles. I agree entirely with Judy Turner that it is up to them to organise themselves into a unified body that takes on a professional attitude towards quality assurance towards education and towards being a collegial organisation that can be addressed by the competence assurance legislation. 
Yes National members do support this bill but with some reservations. It does address some important areas of medial mishap and error that have been unfortunate for patients right around New Zealand.