Noose Around My Neck
Author: Annette Mary Moody

Chapter 5
"Know Your Rights" - A Critique

Noose Around My Neck – ACC vs. OOS

 

5. “Know Your Rights” - A Critique

 

Learn your rights and then demand they are put into practice. Ensure all your questions receive answers. We all have Rights under various headings, eg. under ACC you have the Right of Review regarding any decision, followed by the Right of Appeal. To be honest, I have found these separate processes hurtful because although these entities tout themselves as independent they are nevertheless an integral part of the ACC body. I also found that whilst these ‘Rights’ appear sound and are there to protect our interests, they offer themselves open to interpretation to the contrary - in other words they seem to be for us, but they ensure the ‘providers or practitioners’ have a way out to suit their needs and often hidden agendas. Examples will follow.

Through the office of the Health and Disability Commission, I obtained much information and indeed contributed to, in a small way, ‘A Review of The Health and Disability Commissioner Act 1994’ and ‘Code of Rights for Consumers of Health and Disability Services’ published as A Report to [the] Minister of Health October 1999. I was losing faith and heart in the system due to the way I was being treated. I decided it was important to voice my opinion. I can’t speak of the results of my input unfortunately.

ACC comes under this Code because they are Health and Service Providers. Here is the short version from the brochure entitled ‘Your Rights when Receiving a Health or Disability Service’. I requested notification of my rights under the ACC Act and repeatedly received two booklets Is there a Problem? and You & ACC Working Together printed in July 1998 which I did not find to be especially helpful. No doubt these came out of the Report of the Inquiry into the Procedures of the Accident Compensation Corporation by [Judge] Peter J Trapski CBE, commissioned in 1990. Amongst other very real concerns this was an inquiry with subsequent findings on ‘whether there is a need for institutional safeguards within the Corporation’s system to protect the rights and interest of claimants’. The answer is clearly YES. I subsequently found when trying to tie the ‘Notice of Appeal’ form with the section, in the above mentioned booklet, ‘How to Appeal’ there were three parts to the former but six in the latter. When I queried this, in November 1999, with the District Court, I was told that this booklet had been superseded by another printed July 1999! I requested and received a copy through ACC.

The 10 Commandments of Health are:

1.            Respect. You should always be treated with respect. This includes respect for your culture, values and beliefs, as well as your right to personal privacy.

2.         Fair Treatment. No-one should discriminate against you, pressure you into something you do not want or take advantage of you in any way.

3.         Dignity and Independence. Services should support you to live a dignified independent life.

4.         Proper Standards. You have the right to be treated with care and skill, and to receive services that reflect your needs. All those involved in your care should work together for you.

5.            Communication. You have the right to be listened to, understood and receive information in whatever way you need. When it is necessary and practicable an interpreter should be available.

6.            Information. You have the right to have your condition explained and be told what your choices are. This includes how long you may have to wait, an estimate of any costs and likely benefits and side effects. You can ask any questions to help you to be fully informed.

7.         It’s Your Decision. It’s up to you to decide. You can say no or change your mind at any time.

8.            Support. You have the right to have someone with you to give you support in most circumstances.

9.            Teaching and Research. All these rights also apply when taking part in teaching and research.

10.            Complaints. It is OK to complain - your complaints help improve services. It must be easy for you to make a complaint, and it should not have an adverse effect on the way you are treated.

In conjunction there is The Code of Health and Disability Services Consumers’ Rights which are as follows:-

1.            Consumers have Rights and Providers have Duties:

            (1) Every consumer has the rights in this Code.

            (2) Every provider is subject to the duties in this Code.

            (3) Every provider must take action to -

                        a) Inform consumers of their rights; and

                        b) Enable consumers to exercise their rights.

2.         Rights of Consumers and Duties of providers: The rights of consumers and the duties of providers under this Code are as follows:

Rights 1, 3 and 5 are as stated above.

Right 2. Right to Freedom from Discrimination, Coercion, Harassment, and Exploitation. Every consumer has the right to be free from financial or other exploitation[1].

Right 4. Right to Services of an Appropriate Standard.

(1) Every consumer has the right to have services provided with reasonable care and skill.

(2) ... to have services provided that comply with legal, professional, ethical, and other relevant standards.

(3) ... to have services provided in a manner consistent with his or her needs.

(4) ... to have services provided in a manner that minimises the potential harm to, and optimises the quality of life of, that consumer.

(5) ... to co-operation among providers to ensure quality and continuity of services.

Right 6 ... to be Fully Informed

(1) Every consumer[2] has the right to the information that a reasonable consumer, in that consumer’s circumstances, would expect to receive, including -

An explanation of his/her condition[3]

The options available, including an assessment of the expected risks, side effects, benefits, and costs of each option;[4]

Advice of the estimated time within which the services will be provided

Notification of any proposed participation in teaching or research, including whether the research requires and has received ethical approval

Any other information required by legal, professional, ethical, and other relevant standards, and

The results of tests[5]

The results of procedures.[6]

This appears to tie in with the ACC Consent Form CM7, which reads ‘I understand that I have the right to access, and ask for the correction of, any information that ACC holds about me’. It is my distressing personal experience that this is not true but with pressure and a written request I did achieve this, to some degree. In fact it was not until 11/11/99 through my third Case Manager[7], that I was invited to fully participate!

(2)   Before making a choice or giving consent, every consumer has the right to the information that a reasonable consumer, in that consumer’s circumstances, needs to make an informed choice or give informed consent.

(3)   ... the right to honest and accurate answers to questions relating to services, including questions about -

a) the identity and qualifications of the provider

(b) the recommendation of the provider

(c) how to obtain an opinion from another provider

(d) the results of research.

(4)   ... the right to receive, on request, a written summary of information provided.

Right 7 ... to Make an Informed choice and Give Informed Consent.

(1) Services may be provided only if that consumer makes an informed choice and gives informed consent, except where any enactment, or the common law, or any other provision of the Code provides otherwise[8]

(2) Every consumer must be presumed competent to make an informed choice and give informed consent, unless there are reasonable grounds for believing that the consumer is not competent.

(3) Where a consumer has diminished competence, that consumer retains the right to make informed choices and give informed consent, to the extent appropriate to his or her level of competence.

(4) Where a consumer is not competent, and no person entitled to consent on behalf of the consumer is available the provider may provide services where -

a) It is in the best interests of the consumer

b) Reasonable steps have been taken to ascertain the views of the consumer

c) Either -

(i) If the consumer’s views have been ascertained, and having regard to those views, the provider believes, on reasonable grounds, that the provision of the services is consistent with the informed choice the consumer would make if he or she were competent, or

(ii) If the consumer’s views have not been ascertained, the provider has taken into account the views of other suitable persons who are interested in the welfare of the consumer and available to advise the provider.

(5) Every consumer may use an advance directive in accordance with the common law[9]

(6) Where informed consent to a health care procedure is required, it must be in writing if -

a) The consumer is to participate in any research

b) The procedure is experimental

c) The consumer will be under general anaesthetic

d) There is a significant risk of adverse effects to the consumer.

(7)   Every consumer has the right to refuse services and to withdraw consent to services.

(8)   ... the right to express a preference as to who will provide services and have that preference met where practicable.

(9)   ... the right to make a decision about the return or disposal of any body parts or bodily substances removed or obtained in the course of a health care procedure.

(10)   Any [of the above] removed or obtained in the course of health care procedure may be stored, preserved, or utilised only with the informed consent of the consumer.[10]

Right 8. Support. ... to have one or more support persons of his or her choice present, except where safety may be compromised or another consumer’s rights may be unreasonably infringed.

Right 9. Teaching or Research. The rights in this code extend to those occasions when a consumer is participating in, or it is proposed that a consumer participate in, teaching or research.[11]

Right 10. Complaints.

(1)   ... the right to complain about a provider in any form appropriate to the consumer.

(2)   ... May make a complaint to:

a) The individual or individuals who provided the services complained of,

b) Any person authorised to receive complaints about that provider

c) Any other appropriate person, including

(i) An independent advocate provided under the Health and Disability Commissioner Act 1994

(ii) The Health and Disability Commissioner

(3) Every provider must facilitate the fair, simple, speedy, and efficient resolution      of complaints.[12]

(4) Every provider must inform a consumer about progress on the consumer’s complaint at intervals of not more than 1 month[13]

(5) Every provider must comply with all the other relevant rights in this Code when dealing with complaints.

6) Every provider, unless an employee of a provider, must have a complaints procedure that ensures that -

a) The complaint is acknowledged in writing within 5 working days of receipt, unless it has been resolved to the satisfaction of the consumer within that period

b) The consumer is informed of any relevant internal and external complaints procedures, including the availability of

(i) Independent advocates provided under the Health and Disability Commissioner Act 1994

(ii) The Health and Disability Commissioner

c) The consumer’s complaint and the actions of the provider regarding that complaint are documented

d) The consumer receives all information held by the provider that may be relevant to the complaint[14]

(7) Within 10 working days of giving written acknowledgment of a complaint, the provider must

a) Decide whether the provider -

(i) Accepts that the complaint is justified

(ii) Does not accept the above

(b) If it decides that more time is need to investigate

(i) Determine how much additional time is needed and

(ii) If that time is more than 20 working days, inform the consumer of that determination and the reasons for it.

(8) As soon as practicable after a provider decides whether or not it accepts that a complaint is justified, the provider must inform the consumer of

a) The reason for the decision[15]

b) Any actions the provider proposes to take

c) Any appeal procedure the provider has in place[16]

3 Provider Compliance

1) A provider is not in breach of this Code if the provider has taken reasonable actions in the circumstances to give effect to the rights, and comply with the duties in this Code.

2) The onus is on the provider to prove that it took reasonable actions

3) For the purposes of this clause, “the circumstances” means all the relevant circumstances including the consumer’s clinical circumstances and the provider’s resource constraints.

4. Definitions

In this code, unless the context otherwise requires - ‘Advance directive’ means a written or oral directive

a)   by which a consumer makes a choice about a possible further health care procedure, and

b)   That is intended to be effective only when he or she is not competent:

“Choice” means a decision

a)   To receive services

b)   To refuse services

c)   To withdraw consent to services[17]

“Consumer” means a health consumer or a disability services consumer; and, for the purposes of rights 5,7, 7(1), 7(7) to 7(10), and 10, includes a person entitled to give consent on behalf of that consumer

“Discrimination” means discrimination that is unlawful by virtue of part II of the Human Rights Act 1993

“Duties” includes duties and obligations corresponding to the rights in this Code.” “Exploitation” includes any abuse of a position of trust, breach of a fiduciary [trustee] duty, or exercise of undue influence.

“Optimise the quality of life” means to take a holistic view of the needs of the consumer in order to achieve the best possible outcome in the circumstances.

“Privacy” means all matters of privacy in respect of a consumer, other than matters of privacy that may be the subject of a complaint under Part VII or Part VIII of the Privacy Act 1993 or matters to which Part X of that Act relates.[18]

“Provider” means a health care provider or disability services provider.

“Research” means health research or disability research.

“Rights” includes rights corresponding to the duties in this Code.

“Services” means health services or disability services or both, and includes health care procedures.

“Teaching” includes training of providers.

5 Other enactments. Nothing in this code requires a provider to act in breach of any duty or obligation imposed by any enactment or prevents a provider carrying out an act authorised by an enactment.[19]

6 Other Rights Not Affected. An existing right is not overridden or restricted simply because the right is not included in this code or is included only in part[20]

Clearly, one’s energy should be focused on a full recovery - that is surely the best result. Yet how can this be achieved when stress is put upon you by the very agents who are in business to promote well being. This operation needs to be a team effort, but it breaks down when the units are at opposing polarities, clearly stated under Right 4. It is my belief that stress is not always a dirty word - it is often healthy and helpful, because it is also a definition of motivation. But this becomes counterproductive when stress turns into pressure which leads to dis-satisfaction, followed by resentment, the final result being dis-ease.

I actually came across these ‘Rights’ quite by accident. They were not handed to me. They were not alluded to in any way by any member of the ACC team, despite my requests for a simple brochure. I do find the word ‘Consumer’ confusing because it is non-specific, it also to my mind suggests a ‘healthy person’, the word ‘patient’ surely is aptly applicable.

Now I will attempt to illustrate contentious points and show examples of infringement. As my claim comes under the 1992 Act, it is my belief that I can only argue from that premise. However, I am sure this will be of assistance to anyone seeking restitution.

So, I begin with 1. Respect. You should always be treated with respect. For the word value read worth or esteem. For belief read an emotional conviction for [anything]. At ACC, on the first day of April 1998 (which should have held a clue for me) I signed a Claimant’s Declaration - a consent to ‘the collection and release of information’. Further, this Declaration states that under the Privacy Act 1993 and the Health and Privacy Code 1994, [I] ‘agree to the collection and release of information’. Under these two Acts [I] ‘have the right to access, and ask for, the correction of any information’ that ACC has about me. This has yet to happen. In fact it would not be until November 1999 that I would be invited to add, delete, or correct information contained in my new Rehabilitation Plan, which I received upon request 25 november 1999. I had signed it on 15 November but I note it is without my CM3’s signature. Therefore is it valid?

Respect for my belief in the Alexander Technique (and Cranial Osteopathy) was not acknowledged for 20 months. CM2 noted an improvement in my vision - how she came to that conclusion is beyond my comprehension. Since the first 10 sessions, I wear prescription glasses only for night driving and at the movies, previously more frequently. A fact CM2 was not aware of. She ignored the obvious changes in my upright posture - noticeably visible. She ignored the greater flexibility in my neck and shoulder movements - all benefits of this technique. As my GP commented, if you believe in your treatment provider and your treatment a huge percentage of the battle is won. I was therefore understandably appreciative when I achieved recognition of, and the right to proceed with further such treatments, approved under ‘discretionary funds’ by CM3 in November 1999, as recommended in a report dated July 1998.

 

2. Fair Treatment and 3 Dignity and Independence. I was repeatedly discriminated against, by both the Occupational Therapist and Human Resources at my place of employment, who picked up on O/T’s antagonism towards me for twice postponing a session with another of O/T’s associates, The  Sports & Rehab Centre. Further dismay was expressed by all at me for declining the intended programme and for not following O/T’s every instruction. ACC were charged ‘$45.00’ (and paid it!) for my ‘no-show’, yet I produced the ‘Terms’ from that centre which clearly stated that $10.00 ‘could be charged’ for failure to notify [us] ‘of a cancellation within 3.5 hours’. I am a professional person and indeed I did just that. Yes, I felt pressured into attending yet another assessment, however I did and whilst I was treated with care and humanity by the physiotherapist, I truly felt participation in this proposed service would have been detrimental. My two doctors agreed with me, and on that basis I purchased an air jogger renowned for low joint impact and elevated cardiovascular exercise, the basis of the intended programme.

Let’s face it, there are many ways to achieve the same goal - why not opt for one which is also enjoyable. Surely it’s preferable, economical and practical to have a piece of equipment at home rather than getting into a car, driving for 20 minutes both ways, dressing and undressing etc, etc, etc. That’s fine if you are in optimum health, but hardly suitable if you are not.

My belief in O/T’s treatment had diminished considerably after her Functional Capacity Evaluation. That was horrific. Lifting weights above my head and extending both weights and my arms out at shoulder height, pushing or pulling a trolley loaded with heavy items was barbaric. In that subsequent report to ACC she attempted to pathologise my condition, and wrote ‘Annette became visually emotional and distressed as time wore on, which ... greatly contributed to her feelings of pain’ - I agree that I was emotionally distressed but it was due to the painful and inappropriate tasks ordered of me. It was weeks before I got over that, both physically and emotionally. You can imagine my dismay at having her oversee my Graduated Return to Work Programme with my employers, later that year. Two of the five ergonomic items she ‘authorised’ arrived in poor condition 9.5 weeks into the 10.5 week programme. However, this oversight was also ignored and whilst an offer was made to replace the equipment, this never occurred.

O/T attempted to instruct me in what is known as ‘micro-pauses’ - these in her view, included shoulder rolls, neck rolls, lifting and dropping the shoulders - I felt physically sick, the pain levels increased - her reaction and written comments were derogatory. It clearly states in a most helpful booklet by Microsoft under the section ‘Ergonomics Guide’ ‘Note Don’t do any exercise that feels uncomfortable or causes straining’. Surely this is a basic rule that any occupational therapist should know and employ.

Later I was discriminated against for advising O/T that Human Resources had allocated their own O/T and that in fact she was made redundant. Her report to ACC in December 1998 states that ‘I query whether there is much point in continuing a return to work programme with Annette ... I am finding it difficult to work with [her] because she has set ideas in regards to her own rehabilitation and wants to self direct this ... I will discharge her from my case load’. Well, excuse me for having a brain! I was in my view, fulfilling the requirements of the ACC Act.

The only two benefits I received from her unfortunate involvement were confirmation that I was physically able to work nine hours per week, as concurred with by another of her associates, during my participation in a ‘work experience’. This concurrence was in direct opposition to Specialist2 who insisted from the outset that I could continue to work a 40 hour week. This single statement caused great controversy with my employer for a full thirteen months. Further, Dr Specialist2 had told me (in front of a witness), that my condition ‘could take up to two years to resolve’ but omitted this from his reports. The second benefit was confirmation of my recommendations for proper ergonomic equipment! So, from, these three agencies, I received very little real worth but a great deal of aggravation and no improvement in my condition and certainly I didn’t receive ‘services to support a dignified, independent life’. The only person of this trio of associates sporting any credentials on their business cards was Margaret, MNZSP Dip MT. So what are these people’s qualifications? Please note the clear indication of qualifications from my chosen treatment providers - they are, my GP, MBBS (London) MRNZCGP and she holds a Diploma in Occupational Health, my Osteopaths1 DO, MRO, MZNRO, and Osteo2 BOstSci., MNZRO BAppSci Registered, my Counsellor, BSc, MPhil (Hons), NZAC, and Alexander Technique Master, NZSAT, AUSTAT, one of three in New Zealand qualified to practise.

I was not provided with business cards by Specialist2, or Specialist3, nor the Psychology Consultants. Although I am entitled under Right 6 to know the ‘identity and qualifications of the provider’ this simple courtesy was not offered to me. It was not until some time later when I requested and subsequently received a damaging report by Specialist3 that I learnt his credentials as written in that report, to be Dr, FAFOM, Consultant Occupational Physician.

More importantly, how do these ‘contractors’ get themselves into a lucrative position with a profitable organisation. What is their accountability? Apparently a free thinking individual such as myself has no impact.

Because earlier that year my employer had told CM2 there was no work for me I was very surprised that this matter was dropped for a time. A friend of mine had been through a similar experience with her health. Her employers were told in no uncertain terms that they had to find employment for her or suffer consequences. They did. So what happened to me? This was despite the fact that CM2 had a copy of a letter from my employers stating that they ‘would give [me] every support and assistance to get [me] into another suitable position’ within their environment. I have to say I was bewildered. However, I agreed to see their employment agent. Initially as a possible employment opportunity (because I offer six years of personnel consulting experience) and the thought of helping people like myself was attractive. The interview was pleasant; we agreed on a two week trial period. Although this was without my employer’s consent or knowledge, I agreed to this course of action because I was anxious to see what I could do after being off work for nearly four months. It was immediately clear to ACC’s employment agency that greatly reduced hours would be necessary, so I began three hours with a break, three times a week. Somehow this spiralled, because it was obvious I needed supportive equipment, a ‘work site assessment’ took place. That report, by a younger member of O/T’s staff, is full of inaccuracies, and under normal circumstances would have rung alarm bells in my head.

Because I had already been introduced to these two agents, with CM2’s permission, I cancelled the appointment scheduled with the Penrose Occupational Health Clinic - I didn’t see the point of going to two of the same kind of people. I freely admit that I made a mistake in this, as was clear after a subsequent phone call with one of their consultants, following the above functional capacity evaluation. He also felt that the tasks that O/T forced me to complete were inappropriate and not suited to the type of work I do which is as a Personal Assistant/Secretary. However, it was too late.

The premises at this employment agency were not conducive to someone with OOS - negotiating a fifteen minute drive, a first floor suite of rooms at the top of a steep stair case, unfriendly door handles and unclean facilities were difficult and definitely a ‘turn-off’. However, on the whole, a great team of people. Company was welcome. This wasn’t successful as the employment agent and I apparently had different agendas - she to poach me for her company, me to see what I could realistically cope with. I lost respect for this woman when I read her ‘Special Report’ to ACC. Comments such as ‘Annette did not take the (unpaid) work trial seriously, and that [her] effort and time had not been returned ... but that [I] achieved the tasks [she] set me well’. She talks about ‘an incident’ ... ‘that cut off oxygen to the brain’. In fact after typing for approximately 30 minutes, I had stood up and almost fainted due to the poor set-up of the work station I was using. The typing and set-up had caused my neck and shoulders to freeze, thus cutting down the flow of oxygen to my brain. A completely different view.

As a side note, it took me a considerable amount of time to have my self-written ‘consultant’s manual’ returned by her to me, and indeed not until I had sent a self-addressed handy-bag with postage, did I receive it. Enclosed was a ‘thank you’ note for ‘providing the vehicle’ for it’s return! Really!

In September of 1998 I received an invitation from ACC to be part of a survey. The letter was headed Understanding Your Needs and signed by the Business Manager. I was happy to participate and spent 31 minutes answering their questions. This same letter, again signed by the Business Manager was sent again in January 1999. I had been requested in December to sign off on a rehabilitation plan - something I was not aware that I was doing, and neither were my two support people, Ursula , my Union Rep, and John from my local MP’s office. A page was handed to me and under ‘Claimants Comments’ I wrote ‘Comments will be forthcoming in writing’ and that was what I was putting my signature to. So, from the 13-22 of January with Ursula’s excellent assistance, I wrote a response and using the premise of the letter from the Business Manager, I outlined in detail the process and my concerns. In fact at our meeting of 2 March 1999, he told Ursula and me that this was a stylised letter, it was written without this knowledge, and the signature was in fact computer generated! How extraordinary!

Like a lot of people, when I visit an ‘expert’ I trust that this person knows more than I. Respect is automatically conferred upon them. I do as I am told. Problems therefore arise when I find my voice and disagree. That is usually because my whole being is screaming ‘stop’! Communication through out this ordeal has been a one sided commodity - you will do as I tell you - accompanied by an implied threat that if you don’t you’ll lose any entitlements! This is exactly what happened in March of 1999, though exactly what these entitlements were remained a mystery. Some light was shed on this matter during a case meeting on November 4. Surely it’s policy to set up a supportive environment giving a reasonable time-frame in order to implement lastings changes before any retribution is considered. My original rehabilitation plan prepared on July 10 had a goal of being back full time at work by 31 October - that is approximately 3.5 months to undo at least three years of damage. Clearly, ACC was not aware of the severity of my problems.

No, I did not receive Fair Treatment, and the Services [did not] support [me] to live a dignified, independent life, or even the beginning of one.

I think you can clearly see how this runs onto Right 4 Services of an Appropriate Standard which also states that [I] should expect services provided with reasonable care and skill. Neither the employment agency nor the O/T did that. ACC’s medical officer, in an early interview as at the local Branch conducted a medical examination by visual means without my knowledge. Again he was unreasonable and uncaring and this shows in his written report. For example ‘typists do not have a significant risk of De Quervains’[21] ... ‘the widespread nature of her pain is not consistent with a specific work activity’, ‘clinically there is no evidence of de Quervain’s, ‘no swelling’ [my] ‘eyes didn’t flinch [I] sat for twenty minutes without discomfort’. I was not aware that this man was a qualified doctor, and after I had obtained my copy of my ACC file, I was appalled at what had been written about me, by these ‘professional’ bodies.

With medical personnel bickering between themselves it was no wonder that it took from 31 March until 26 June to get my claim accepted.

This Right further states [I] have the right to have services that reflect [my] needs. All those involved in [my] care should work together for [me]. How I wish this had been true! CM2 called a second case conference with my employers, we arrived a little early - a professional move - we were acknowledged by the person we were to see, and after half an hour of waiting I saw her and her boss disappear down the back stairs - leaving us there. I would love an explanation of this. Obviously a third appointment had to be made. Such was the nature of the triangle between ACC, my employers, and myself. I did all I could to get the wheels turning, providing information, searching for remedies, asking for understanding - and basically I was viewed as a nuisance. The Branch Manager, reputedly ‘got into quite a liver’ over me - I can’t say I’m sorry to hear that earlier this year, he and his self-confessed irritable bowel syndrome were relocated to sunny Northland! I also find it interesting that both CM2 and ACC’s medical officer are working in the commercial field now, the same company no less.

No, the service I had received from ACC did not reflect my needs. I did not appreciate CM2 telling me that I should ‘get in a flatmate, sell something or get a bank mortgage holiday’ when I told her the osteopathic costs were getting me into economic strife. In fact this process had all but broken me emotionally and financially - a direct violation of the Act. How are people less bright coping with the involvement, or do they become robots and dance on the puppeteer’s strings?

5. Communication - how many people can really do this well? When someone uses the phrase ‘I hear you’ you may be absolutely certain - they do not. This was one of CM2’s popular sayings. Her computerised personal file notes show she has not ‘heard’ me at all. I have the right to be listened to - yet I find all I do is repeat myself. I have the right to understand and to receive information in whatever way I need. So, where are the answers to my letters and the questions contained in them? Where are the answer in a simple straightforward manner, no legalese - such as the six letters received in one week in March after what my union rep and I felt was a condusive meeting - without rancour, pleasant. Such as the Review Decisions - hello I am not a lawyer! Clearly I cannot afford to hire one. I don’t study ACTS. I don’t know the first thing about THE HUMAN RIGHTS or THE PRIVACY ACTS.

It was communicated to me that I had to undergo a Work Capacity Assessment. This, according to the FACT SHEET I received (never referred to again by either of these service providers) was a two part process. A psychologist would work through my Resume and talk about my education, qualifications and employment history. The Psychology Consultant came up from Hamilton - remarkable when Drake Personnel are within half a kilometre of this office, and I was repeatedly told to get the ‘nearest treatment provider’, and ridiculous when I myself had been a consultant for six years.

In fact we believe this person was so embarrassed, he turned his attention mostly to Ursula, my union rep! He drew up a huge report which potentially offered me roles of employment or training for which I was suitable ‘without regard to my injury’ - fair statement you might think. Wrong. I have no experience (and nor would I consider such as a career move thank you) in being a cloakroom attendant, medical receptionist, bar steward, or computer operator, survey interviewer, statistical clerk (to name a few) - all titles and job descriptions abandoned in the late 80s, let me assure you. He talked of working from home and re-training, both potentially excellent possibilities, yet neither were not included in his report. However, I found it interesting - I went along because you never know, you might learn something. But in my opinion, it was a total waste of Ursula’s and my time and ACC’s money.

The second phase of this procedure was yet another visit to another ‘specialist’. I had done my homework and took along the questionnaire that I had filled out, as I was instructed. This was never looked at. He did not have the detailed report, nor the Fact Sheet. I asked their receptionist, Natalie, to photocopy all, which she did. On his desk was my file and Specialist2’s notes - these were not referred to in my presence either. The purpose of this interview was to determine which positions the Psychologist had suggested I could do with regard to my injury - simple eh! This did not happen. Specialist3 writes in his report ‘Ms Moody’s reluctance to undergo a physical examination was despite my having carefully discussed the nature of the assessment procedure and the proposed structure of the consultation ... at the outset of the interview’ is a down right lie and total misrepresentation of an actual event. Fortunately I learnt very early in the piece to always have a support person present, and in this case, there were two, so my perception of the ‘interview’ - not ‘assessment’, please note - is verifiable. When I first met Specialist2 he assured me that ‘if I did not like the look of him, I could ask for someone else’ - the first suggestion that, indeed, I do have Rights.

Specialist3 grilled me for one hour and 20 minutes about the history of my symptoms, my medical history, my parent’s medical background, did I suffer from rashes, patches of dry skin, irritable bowel syndrome, and numerous other possible conditions - all of which I failed to see were relevant. He then concentrated on possible psychosomatic or psychological causes such as was were my parents alive? Had there been any significant deaths in the family recently? Was I afraid of my boss? Hardly I replied, we had shared for two years prior to him taking his current role, I knew him extremely well.

Specialist3 never once referred once to any of the information provided, or previously collected. Then to my horror, he demanded that I remove all my clothes and lie on the examining table. “Oh!” he said. “You may leave your underclothes on”, and held up a piece of light cotton, with which I could ‘cover myself’! I don’t think so.

There was absolutely no mention whatsoever in the Fact Sheet about a physical examination. If there had been, I would have: One - requested a female physician, and Two: - dressed in entirely different clothing. Three: - as Specialist2 had not required me to take inner items of clothing off, nor had my GP whose initial examination was just as thorough as either of Specialist2’s two examinations, I did not see any need to determine the state of my neck, shoulders, elbows and wrists. I was in short, appalled.

In hindsight, if as part of the initial process with ACC, I had been required to have x-rays taken of my spine and lower back, my injury could have moved from invisible to visible but then radiation poisoning could have also resulted. My boyfriend and a masseuse had clearly noticed bone protruding along the spinal column and at the base, or so they thought. Although I took with me x-rays of my neck, (taken in February 1994 after a whip-lash accident) to both Dr Specialist2 and Associate Professor Des Gorman, Director Occupational Health, UoA, no indications of trauma was evident. With OOS/RSI six areas need to be remedied. They are the skeleton, surrounding soft tissue, associated nerves and muscles, energy, and fluid pathways. Chris Wall’s offer of a steroid injection may have temporarily alleviated the pain in the muscle of the left forearm but not the swelling at the base of my neck, nor the tightness in the shoulders or the weakness in the elbows and wrists. My right arm was altogether ignored. How can ‘fixing’ one small area, eg the wrist, be regarded as a ‘cure’. The fingers are connected to the palm, which is connected to the fore-arm, then to the elbow, up to the shoulder and the neck, finally the brain - these are not separate parts acting independently of each other, they are intertwined to become a whole, and need to be treated as such. Indeed, with Cranial Osteopathy, they are.

Two days after this debacle with CTC Kenny, I was sent by my employers to see A/P Gorman, BSc, MBChB, FACOM, FAFOM, Dip DHM, again with my support person in tow. On the steps of this building was Des talking with Chris Specialist2! With me was my ACC file, and as requested I had tagged all the ‘work site assessments’, including one conducted by my employers dated October 1997. I left this file with him for some days. Again we talked for well over an hour. The Health and Safety Officer, by my request, was also present. I learnt several things. One, that he and Enviromedix worked for/with each other, and all are contracted to ACC, and I have no doubt that research plays a part in this network. Two, that since the early Egyptians era medical personnel have been trying to figure out why one in x number of ‘scribes’ would fall victim to RSI - with no satisfactory conclusion. Three, it is possibly a defective gene, and the blame could be placed on one’s grandmother’s shoulders! Four, Des was responsible for the Fact Sheet - the outline of procedure - which Ursula and I hastened to inform him made absolutely no mention of a physical examination. My GP - who is also acquainted with the man - had assured me that he ‘shouldn’t touch me’ - and indeed I would have declined.

However he was aware (I wonder how) that I felt I had been poked and prodded enough and so he abstained from the apparent intention - in direct contrast to CTC Kenny’s written comment that [he] ‘had no doubt that [Des] will also need to complete a physical examination’. Further he writes that he ‘sent a copy of this letter to [my] general practitioner’. Why? I also did not appreciate seeing my unlisted telephone number plastered on his report. I requested ACC to have this file sent to my home, thus removed , I’m still waiting. Five, he confirmed that the palm holds the initial nerve pain gate way and any stimuli then travels along the arm, across the shoulder, up the neck and into the brain, therefore it is important to ensure the palm is open when performing a task, and, more importantly, when resting. Six, he acknowledged that my partner was doing the right thing by use of massage ‘because, guess what, that is how often you need it’. Seven, that I should request ACC to send me to a woman, suggesting one of his associates, to conduct a physical examination. I declined. It is still my clear understanding that this process is to determine the kind of work I could actively participate in with regard to my injury.

I now firmly believe that this is a tool to remove malingerers from ACC. Fine. However, it was inappropriately and improperly used in my instance. CM3, my current and supportive Case Manager acknowledges just that. I believe CM2 had a brief to complete prior to July 1999, and that was to get as many people off the books as possible. A political move, and I was a pawn - but one that wouldn’t lie down and play dead! And why should I?

I find it interesting that a sporting personality such as Michael Campbell, winner of a 1999 prestigious Golf Award, who suffered from Tenosynovitis (a form of OOS), publicly talked of the pain levels and resulting depression. He hasn’t, to my knowledge, been disparaged against. I understand perfectly how he felt - as I write these words I find myself 20 months into treatment in that place between illness and wellness - a limbo of frustration because emotionally and mentally I am becoming stronger, yet still hampered heavily by physical limitations. My sense of humour is slowly returning. My spiritual appreciation is also strengthening. I remember to enjoy the little things like rainbows through a crystal, dew drops glistening in the morning sunlight and the brightness of a child’s smile, a little feline face at my door waiting for a drink and a pat. Indeed, these treasures have most likely kept me sane.

I recall, during my first visit with Dr Specialist2 in April 1998, that he asked me if I experienced difficulty making my bed. When I didn’t respond immediately, he wrote down ‘no’. How many people can vividly and instantly recall a task that one does automatically and without thought? I ‘saw’ myself tucking in the sheet and re-arranging a queen size duvet which seemed uncomplicated enough but in fact I still have great trouble removing and replacing the six pillow slips. Obviously a tugging and pulling action. I was more bemused by the question and at the time, failed to see the relevance to the medical examination.

The right to have an ‘environment that enables both consumer and provider to communicate openly, honestly and effectively’ is not encouraged. In nearly all cases, and this included meetings with my employer, I found that my comments and questions were basically ignored. I gained the distinct impression that I was ignorant and a nuisance. Ignorant because I wasn’t playing the role of a sheep, that was apparently expected of me. No, this one is a Ram! A nuisance because I was asking too many questions and having too much input into my rehabilitation. CM2 described me as ‘Proactive’. However the way she said it, it seemed like a dirty word.

Right 6, To be fully informed. Not one of ACC’s experts has satisfactorily explained my condition to me, therefore my theory is just as good as the next one, with the obvious exception that I am living it. I was not given ‘ ... (b) an explanation of the options available, including an assessment of the expected risks, side effects, benefits, and costs of each option’. Dr Specialist2, operating ‘without [his] notes and from memory’ wrote that he had given me a steroid injection. He did no such thing. He made a vague reference to this, which I declined. I know that some people are highly allergic to this and that the body can have a powerful reaction to it. As a matter of fact, a German specialist in Sydney, 1979 had put two injections into the muscles of my back. When I asked him what was contained in the syringes, he replied ‘don’t you know, oh, it’s a special blend of Irish whisky’ very funny. ‘Get some Codeine 41 tablets, go home and put ice packs on your back’. What a sick man. Around nine months later the pain in my lower back was so intense it was worse than before. Hardly a ‘benefit’, and no mention of any ‘side effects’. No, I wasn’t having cortizone, thank you. Again, I caution anyone about ‘quick fixes’.

‘... (d) Notification of any proposed participation in teaching or research ... and whether the research ... has received ethical approval’. I digress slightly here, but offer the following as an example of, in my view, misrepresentation. I received a letter of welcome in the mail, to the National Register regarding Cervical Smears Tests. I was extremely upset, and rang the writer to request my name be immediately removed, thank you. This person recommended that I talk with my GP (a local female doctor). I spoke at length with her nurse who was sure that I had been involved in discussion regarding the Register - I assured her that this had not happened, and had I been asked, I would have refused. No this subject was not broached in the doctor’s surgery. No, I had not seen any literature on this, and no I had not put my signature to anything. Something as deeply personal and private as this is my business and not the country’s.

Shortly before my 40th birthday, Geoff noticed my right breast was completely solid. We ended up at the South East Auckland Radiology clinic, and after the obligatory mammogram, I was sent for an ultra-sound. Dr P Jain, an Indian woman, had me lie on the table, then literally slapped some green jelly on the offending lump. When I cried out and nearly jumped off the table with fright, she said, echoing Dr Specialist2 ‘ if you are not comfortable with me, you can get someone else’. I told her that she should talk to me first before taking such an unexpected action. I was then sent to the St Mark’s Breast Clinic. Very nice ladies, however at one point I had four of them in the room with me. Although they were working on the right breast, the left side was also unnecessarily exposed. My left hand was gripping one of the attendants. Dr Sue McKeage realised that I was ‘a model patient’ and whilst she described the procedure she would use, an air-gun (my words) would be shot into the breast to remove tissue, ie a core biopsy. It would take a fraction of a second, I was to lie perfectly still, and she would need to do it ‘twice’. Try four times. She proudly held up the container of ‘worms’ as she called them.

I asked if the condition was perhaps caused by my boyfriend favouring that side with too much attention - shall we say? The answer from the radiologist was, we haven’t had that question before. Back in Dr Keage’s office she told me I had Fibrocystic Tissue and gave me a sheet on it. She then suggested I return in three months - my response was a flat NO.

To my dismay, as I was paying a portion of the bill, my body started to shake uncontrollably and did so for upwards of an hour - not the best circumstances under which to drive a car under. A side-effect that was not mentioned, and no-one took into account. I still have the small scar. Interestingly enough, it is not recommended that such sufferers should ‘breast feed’, and certainly not recommended we have HRT. Happily I report that shortly afterwards the lump disappeared and hasn’t recurred - in my view because of a simple instruction to the boyfriend! If I had known this would cost me $453.00 I would have waited, the lump would have dissipated on it’s own, and all the associated stress would have never happened.

I met a woman recently who was diagnosed with this same condition. She clearly was in awe of the doctors and allowed them to remove the offending tissue. This was done under the premise that “they thought” it was cancerous. It proved to be benign, as statistically 94% of these cases prove. She now has a chest littered with scars from their stitches. Yes, ACC paid for the surgery, but at what personal cost to the woman? Almost 20 years ago my young Aunt had a breast removed - seven years later her doctors says “Sorry I made a mistake”!

Clearly, we are still in the dark ages - have victim, have scalpel, will research! Isn’t that what this amounts to? Last year my twin, along with several other women was informed by St Marks Breast Clinic that her results showed cancerous cells - this turned out to be white spots on the actual film used for the individual mammograms. Unbelievable. Ladies should always get a second and even third opinion.

This month, I think I’m still in November 1999 as I write this - my mother contracted a chest virus from the mammogram machine itself - that’s disgusting and hardly quality of service.

In 1997 I was sent to an endocrinologist at Auckland Healthcare. This was advantageous only from the point of view that I came across a brochure entitled “Your Rights”. This again proved to be a most unpleasant experience. Although I had the brochure in my hand, the man who came to usher me into a room no bigger than a cubicle introduced himself, simply as Ian. Not Dr Reid, not Associate Professor Reid, just Ian, and yet under ‘Informed Consent’, it states that ‘All patients are entitled to: ... know the name, position and role of any staff treating them’ - I find this lack of simple courtesy distasteful.

Like my mother, I commenced menopause in my late 30s, and as I said the information obtained from the St Mark’s Centre clearly stated that if one is prone to the above disorder, one should not have HRT. However, this man was adamant that I should consider it. He then told me to take my clothes off - if I had once again known that this would be a requirement, I would have worn different clothing and requested a woman physican. Even after my obvious distress was communicated this option was not offered. I left. And I didn’t pay the $30.00 either. The bill was waived, but not until a monotonous series of written complaints was exchanged.

I have waved these Rights in front of ACC on numerous occasions, and I have requested a similar brochure be produced and given to all claimants. I expect this to eventuate.

I truly hope the Trapski Report commissioned in 1990 will be finally and fully actioned. At our meeting with ACC on March 2 and again at the Review in September, I read the following from Judge Trapski’s report, page 59.

‘... Claimants should be informed, preferably in personal discussion, with information confirmed in a subsequent letter

(a)   that a report, assessment or opinion from a particular type of specialist is sought;

(b)   the reason why such a report is being sought;

(c)   who the Corporation suggests[22] as an appropriate specialist

(d)   that the claimant may nominate an alternative specialist if the one suggested by the Corporation is in any way unaccceptable; and

(e)   that the claimant will be required to consent to the specialist reporting to the Corporation and to the Corporation’s supplying that specialist with such medical information as it already holds.

If this happened, not only would one be involved in one’s rehabilitation, one would be informed during every step of the process. I guarantee results would be swift.

You have the Right [to know] costs of each option. The main reason I have got myself into financial strife is the way in which ACC has operated with the Still Sutherland Centre of Osteopathy. By this, I mean, that I would attend a session each week, pay the full fee, collect the receipts and bi-monthly send the bundle to my case manager, who in turn sent them to Wellington. In due course payment of around 39% would be credited to my account. So not only was I out of pocket by $480.00 or so dollars each period, the return was only $187.20. Then the ‘rebate’ ceased.

I acknowledge here the generosity of Drs Doyle and Jagoe, who lowered my payment from $60.00 a treatment, to $50.00 and then Dr Doyle suggested a ‘donation’. I chose to pay $30.00 a time, and so it currently is. Several times, for the same fee, both these woman would treat me together - one at my head, and the other at the base of my spine. A great priviledge. Their belief in me, and my progress, has been the single most satisfying encouragement for my recovery.

Obviously it is preferable to have surcharges abolished. Some treatment providers expect one, and some don’t. There is much to be said about uniformity, especially when treatment is necessary over many, many months. As a direct result of my November meeting with my third case manager, the cost of a further 12 treatments was reimbursed, using this rate. What was remarkable was that she authorised this herself, and within two days, I was able to utilise the refund. Apparently CM2 could have done the same, but chose not to.

All Treatment Providers should bill ACC direct. A contract has twice been entered into with the Alexander Technique Master. All I need to do is show up on time and find petrol money. What a stress free situation. I am aware that I could claim for travel expenses, but have not been encouraged to do so. All expenses show in the following table.

ACC Costs

Item

My Costs

Item

 

 

 

 

270.00

Initial Visit with Dr Specialist2

80.00

General Practitioner

270.00

Second visit with Dr Specialist2

619.34

Golden Glow Health

425.00

10 sessions Alex Technique

130.00

Healers

337.50

Employment Agency

32.00

Essential Health

163.13

O/T Site Assessment

94.00

Osteopath

213.75

O/T Functional Capacity

155.00

Naturopath

337.50

Agent’s ‘Special Report’

3019.00

Cranial Osteopathy

90.00

O/T Case Conference

180.00

Counselling

281.25

Counselling

15.80

Wrist Supports

45.00

O/T - Cancelled Physio

186.90

Air Jogger

101.25

O/T Case Conference

129.95

M/S Elite Keyboard

180.00

O/T Physio Report

40.00

House Cleaning

[922.50] 1

Proposed Physio Treatment

 

 

135.00

O/T Worksite Assessment

40.00

 

Notify me when...

"This extract remains the exclusive property of the author who retains all copyright and other intellectual property rights in the work. It may not be stored, displayed, published, reproduced or used by any person or entity for any purpose without the author's express permission and authority."

Please rate and comment on this work
The writer appreciates your feedback.

Book overall rating (No. of ratings: 
6
):
Would you consider buying this book?
Yes | No
Your rating:
Post a comment Share with a friend
Your first name:
Your email:
Recipient's first name:
Recipient's email:
Message:
 

Worthy of Publishing is against spam. All information submitted here will remain secure, and will not be sold to spammers.

No advertising or promotional content permitted.