Hutchison Paul: Injury Prevention Rehabilitation and Compensation Amendment Bill (No 3) — First Reading 
Hutchison Paul: Injury Prevention Rehabilitation and Compensation Amendment Bill (No 3) — First Reading 
[Volume:619;Page:14696] 
Dr PAUL HUTCHISON (National—Port Waikato) 
: 
 National will support this bill but with considerable reservations both regarding the substance of the bill which is basically about medical misadventure and regarding some of the miscellaneous additions the Minister has mustered into this amendment. National does remain deeply and legitimately concerned that under this Labour Government the Accident Compensation Corporation is a State-run monopoly that provides little choice. By its very nature where there is no individual risk rating it tends to conceal real incentives and to conceal real problems. I have heard from many many upset constituents over the last few years that they do not have the right to sue in New Zealand apart of course from in the area of gross negligence where clearly it is right and proper for that right to be retained. 
National has supported a no-fault system in New Zealand since 1974 largely because it recognises the huge practical problems that occurred when claims relating to accidents went through the courts. Back in 1974 it was recognised that delays would often take years and then at the end of that time only a small proportion of claimants would in actual fact be compensated. Even in modern-day Boston it is said that only 5 percent of accident claimants at the end of a long trail are indeed compensated. The average time taken is usually 5 years and the compensation itself is hugely distorted by very high figures which cause the insurance premiums to be very high in the US. 
But I am concerned that the Government’s review which was carried out over 2 years although wide did not consult the private sector. It certainly did not consult the New Zealand Insurance Council or individual insurers such as QBE. There was as I say wide agreement about this review which identified the following. Firstly the medical mishap criteria are arbitrary often bearing little relation to the circumstances of the patient and resulting in claimants unfairly missing out on cover. Secondly the medical error criteria require it to be established that an individual practitioner or organisation is at fault which is clearly at odds with a no-fault system. There are some obvious anomalies with regard to that. For instance in my practice if I had snipped a ureter by mistake while carrying out a hysterectomy and if it was regarded as a rare and severe event with an incidence of less than 1 percent then the patient would be compensated. If however an individual had an unfortunate experience that occurred more than 1 percent of times then that person would not be compensated because it would not be deemed to be rare and severe. Clearly that is quite an anomaly and it should be sorted out. 
I note that the review of the medical misadventure provisions noted that the accident compensation cover decision and the requirement that the Accident Compensation Corporation must report individual practitioners involved in accepted medical error claims as well as patterns of medical mishap claims to the relevant registration authority results in health practitioners’ reluctance to participate in the claim process. That is of huge practical importance as well. The long delays with the process and the stress both on the claimant and on the practitioner is enormous and can sometimes be very negative. However it is hugely important if this process is to be put in place that individual practitioners do take responsibility for their shortcomings and that a process is in place to allow a free and frank discussion of adverse incidents—of how they can be prevented in the future and of how processes at all levels could be improved. It is absolutely necessary both on behalf of the public and on behalf of health practitioners to participate in continuous quality assurance programmes to aspire to best-practice guidelines and for provider organisations to develop accreditation programmes. Undoubtedly the reputation of professional providers depends on them fully participating in such programmes. Not to do so will earn public mistrust and disrespect. 
I also note that the reporting requirements similarly move the Accident Compensation Corporation from having a fault-finding role to one that captures information for the injury prevention purpose of the accident compensation scheme and therefore aligns the role of the corporation with its orientation and expertise. If there is a determination by the Accident Compensation Corporation that there is a risk of harm to the public the corporation will be required to report that risk and other relevant information to the person or authority with responsibility for safety in that area. That is a significant change. Again I say it is absolutely vital that health professionals move proactively to demonstrate that their organisations take the provision of the highest-quality services extremely seriously and that they act quickly to rectify faults when they are identified. I note that “treatment injury” itself will not cover injuries that are anticipated as part of or as a consequence of treatment such as a surgical incision. But there will be a big grey area there. Any practising surgeon will know that all sorts of things can happen to surgical incisions and there will be questions as to whether they were a treatment incident or whether they were a part of the normal process. There will be disputes and that is to be predicted. 
It is of concern that the Government has provided no impact statement in this bill. I learnt in the select committee that this legislation is likely to cost about $10 million to the public in terms of increased levies. I think it is quite appalling that the Labour Government has failed to bring in an estimation of that cost. I believe that the one it did provide to me is likely to be unreliable. It is hugely important that the Government faces up to the reality of what this significant bill will cost the Accident Compensation Corporation. Right now the medical misadventure account covers injuries from any unexpected outcomes of medical or surgical procedures that were properly carried out and it is funded from the earners and the non-earners accounts. The levy costs in total about $106 million and the claims liability is about $383 million. It is important that those figures are kept in mind. I note the way that the sponsor of this bill the Hon Ruth Dyson has absolutely omitted to include the financial aspects of this bill which are all-important. The accident compensation scheme is hugely costly to New Zealand—in the order of over $2 billion. Yet the Minister says that these changes will cost only $10 million. The cost of accident compensation is extremely important. It is also important to realise that 70 percent of treatments are carried out by public providers and therefore increased levies will fall on the providers in district health boards as well as on those in private practice. 
It is also to be remembered that it is the patient who has the accident and in a private individual situation patients would be individually risk rated. But at the same time the doctor could be sued through the malpractice system.