What Your GP or Physio Should Tell you if you Have an Accident in New Zealand.

As you may have seen from earlier posts, I had a back accident 15 months ago and after 4 visits to hospital, the most recent being of 7 days duration, I am still no nearer to getting the surgery my orthopedic spine specialist / surgeon recommended for me and requested ACC to fund.

What went wrong?

I’m going to tell you about 2 critical things. The first is about how I injured myself, by which I mean the primary cause and the second is about who I got referred to.

1. The Primary Cause

My latest accident didn’t seem like much. I was at my 6th Relay For Life in March last year and ready to walk a marathon distance (my goal, which I achieved) over 18 hours.

Setting up prior to the event and prior to heading for the survivors’ tent (I am in remission from prostate cancer), we had a 4 room tent to set up, and the poles and pegs were in a big bag in the trailer that was provided by the organisers to get our gear from the car park to our team site.

It was super heavy. No one seemed to want to get it out, including the guy driving the tractor. So I tried. Unfortunately, my back couldn’t take it and I ended up with a back strain injury that still has me off work today, 15 months later.

I managed to do the distance through the use of medications like Panadeine and I had booked a couple of days annual leave after the event to recover, based on previous years experience. I also had a float and massage the following day, so I didn’t feel too bad after that. A bit sore, but otherwise OK.

A few weeks later, on ANZAC Day, in fact; I remember because it occured on the weekend before the public holiday (a Wednesday) and my wife and I had taken the Thursday and Friday off to go away in the Corvette for a few days holiday.

It had been raining, and on the Sunday before our planned holiday, I mowed the lawn and using the catcher to collect the heavy wet grass. I had to twist on an awkward angle to detach the catcher from the mower, twisted my back again, and the rest as they say was history.

You can read previous blogs but the key point was that whilst an MRI showed damage, ACC weren’t satisfied with the injury having been caused by the incident, they said it was age based degenerative disc disease. They said they would try to see if a previous injury could be relevant that they could tie it to which would convince them to cover the cost of the surgery and herein lies the problem.

A Skydiving Accident

Many years ago I had a skydiving accident. It was a tandem jump and if you have ever experienced one, you know that the customer is at the bottom and the Jumpmaster is on top. When she tried to flare at about 30 feet we got into an air pocket and instead of opening up, the parachute closed down. Instead of gliding to a running stop, we dropped and I took her weight on top of my own, on my tailbone.

It hurt like mad, but I was also flying high on adrenaline from the jump, so I didn’t really feel the pain that much. That night it was very sore, but we went to a big neighbourhood party and I found that bourbon acted as a great pain killer, so I managed pretty well and enjoyed the festivities as long as I didn’t make any sudden moves.

That night there was a bit of a storm and one of our trees was blown over.

The following morning, I was trying to clear branches in our yard, bent down and found I couldn’t straighten up again.

I went to physio who asked what happened and I told my story, the ACC record said “bent down and hurt back while picking up branches in garden”. I had 26 physio visits, was referred to Pilates and was assigned a personal trainer.

I did talk to them all about the sky diving, but it never made it to the ACC records. It therefore registered as a strain.

Another Accident

I was racing my land yacht in a 180 km enduro on 90 mile beach. I crashed at the northern end of the beach, picked myself up and raced back again and had to endure racing through snapper holes around Ahipara Beach, which is like racing on sheets of corrugated iron. Lots of pain, but again lots of adrenaline. For much of the race, I was going at speeds of up to 100 kph on a thin cushion as you can see on the video above, and with my feet sitting on a steering rod so all of my weight was on the lumbar area of my back.

At the end of the weekend it was a 5 hour drive back home to Auckland and a couple of days later, guess what? I was in the garden again, bending over and suffered intense back pain.

Guess what went on my ACC record?

Lots of physio for an injury sustained doing gardening.

So, when the specialist looking for reasons to not approve surgery (me having had every other treatment they could think of, for over seven months), they looked at what I had been referred for (back strain), looked at old injuries sustained in the garden, so probably not significant, all because I didn’t understand the importance of mentioning the crash or the sky diving on the initial ACC form. After all I was getting treatment. That was all I was concerned with at the time.

So What?

I might have got a very different response to my request for surgery if the primary causes of injuries had been clearly recorded, instead of lost to obscurity. Now I am chasing a Review of ACC’s decision not to fund the surgery which is going to be time consuming and expensive.

So if you are injured and covered by ACC, make sure that, irrespective of which straw broke the patient’s back, that the primary cause of injury is documented, even if you are happy that the treatment will fix the problem.

I’m now in a situation after many back injuries, that ACC are claiming age based disc degeneration disease and I am going to have to prove that I did in fact sustain some major injuries and that it was the cumulative impact of those injuries that has me now needing expensive surgery.

If I had made sure they had all the information correctly recorded, it would probably have been plain sailing for me now, instead of 15 months off work, the possibility of losing my job, and a long, expensive and stressful battle to get my back repaired so I can get back to work.

2. If Referred to a Specialist, Make Sure it is one who Operates in Your Local Public Hospital.

I was referred to a very good surgeon by my GP, largely because he is one of the category of trying everything else before getting the scalpel out and doing major surgery, which in my case will involve 2 surgeons for 4-5 hours and a 5-day stay in hospital.

Because of all the drama with ACC (New Zealand’s Accident Compensation Commission), in April I asked my GP (at the recommendation of my surgeon) to refer me to the public hospital. Whilst I have other medical insurance, it only pays (up to) 80% of the costs, which means I would personally be up for around $18,000 that I have to find myself. It could even be more because they won’t know exactly what they have to do until they cut me open.

So I was referred as ‘URGENT’ to North Shore Hospital on the 4th of April this year. I told them I was not working and that I could come at short notice and asked if they would put me on the cancellation list and they said “Yes, we have a cancellation list, is there anything else?”

I rang a few times, mostly talked to voicemail and the first time I spoke to someone they said “It’s only been a month!” To which I responded, “yes but I was referred as urgent.”

This month I had a flare up and spent 7 days in the Orthopedic Ward at North Shore Hospital. They did an MRI, hooked me up with a pain team and eventually once the pain was under control with drugs, they let me go home.

They told me that the stay would not be seen as my First Specialist Assessment (FSA) for which there is an expectation that you will be seen within 4 months of referral. They said that the Orthopedics Team knew about me and I would probably now be seen within 2 weeks. So they scripted 2 weeks of pain medication for me. They said I would get a confirmation letter from the hospital.

So I got out of hospital on the Sunday, waited until Wednesday and rang to find out when my appointment would be. I had to leave a message on their voicemail. I rang again on Friday and again left voicemail.

On Monday this week I got a phone call telling me that they did in fact have a date for me in late August. Today is the 17th of July.

So much for my 2 weeks of pain medication. I should have got the message when the doctor who checked me out of hospital laughed when I said I was expecting to be seen in 2 weeks.

So what?

If my GP had originally referred me to a specialist who also worked on the public health at North Shore Hospital, there is every likelihood that I would have been referred for surgery at the hospital in November last year, and could well have been back at work by the beginning of this year.

Now instead, I am still waiting for a First Assessment, and they will want to decide for themselves what treatment I should have. So while the logic behind my original referral was sound, the end result is that it set me back anything up to a year.

Hindsight is a wonderful thing, but the point I am making is that you, dear reader, may have a back injury like me, or perhaps a knee or shoulder injury from playing sport.

By learning from my experience, you might be able to have a better experience, receiving treatment within the same year of your injury and not jeopardising your employment and having double the stress. 

SUMMARY

Being in severe chronic pain for over a year is horrific. The potential consequences can be many including

• losing your job,
• becoming addicted to pain medications,
• sleep deprivation with all that comes with that,
• becoming stressed to the point of depression,
• having no social life or family life,
• which also results in relationship stress.

Here are two ways you can reduce the risk of experiencing what I’m going through.

1. If you injure yourself doing something major and then aggravate it with a lesser injury. Insist that the cause on the ACC form is the major impact and the secondary injury is clearly shown as secondary. It might not matter now, but in 10 or 20 years it could save you from the horrible 15 months I’ve endured so far.
2. If you need to be referred to a surgeon, even if you have medical insurance, get referred to one who operates from your local public hospital. You may not end up needing to go public, but at least you have viable options and it could save you many months in getting treated.

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Thinking About the Consequences of our Education System, Bullying, our Health System, Coach Azul, Cameron Harold and FREE Publicity

I listen to a lot of podcasts. I was listening to them while commuting to and from work. Then last year I suffered a back injury and I have been waiting at home, consuming pain medications and exercising for what seems like forever, for ACC to approve spinal fusion and a discectomy so that I can get back to work.

Around a week ago they notified me that they are not going to pay for the surgery on the basis that I have degeneration in my discs that was not caused by the injury. It ‘rendered them symptomatic’ and I am now waiting for an appointment with the Waitemata District Health Board, whilst working on a review claim with ACC, New Zealand’s Government Accident and Injury insurer, who I feel could have had me back at work 6 months ago. They are still covering me for the back strain, but my specialist has said that they have tried everything bar surgery. “We’ve painted ourselves into a corner” he said.

I’m told that the North Shore Hospital spine surgeon is fantastic, but they also told me they have to legally see me within 4 months. In other words, just because it says “urgent’ on your case file, doesn’t mean you will even get to speak to someone anytime soon.

So I’ve had a lot more time to listen to podcasts while exercising, strengthening my core, whilst awaiting the needed surgery I still need, so I can return to work. I suspect there are thousands of people like me, numbers that get recycled in meetings focused on saving money. Ironically, when I work I am saving citizens much more money, but I digress.

One of the podcasts I enjoy is from Azul Terronez called Born to Write. If you follow me, you know I am passionate about writing and storytelling as a means of sharing a message on my various blogs and books.

The latest podcast from Coach Azul really resonated with me. The guest was Cameron Harold, a writer, entrepreneur, business mentor and founder of the COO Alliance.

He talked about some struggles he had growing up when he was told that he was  not academically in the top 40% of students and how he battled in his mind with that through school and university.

His story to becoming an entrepreneur resonated with me but from a different perspective, particularly the education part. It fascinates me how education systems seem to fail at both ends of the spectrum, contrasting with today’s apparent dumbing down of some generations whist the skill levels that create our greatest achievements are held back, limited to those who often achieve despite the system, rather than by its design.

I was one of those kids who didn’t fit in school, particularly once I got to high school. This was not because I wasn’t in the top 40%, but because I was in the top 2%. I’m starting to write about it, but not at this stage for publication.

I used my smarts to survive in a school (being a good guitarist helped) where the height of success was failing exams and getting into the school rugby 1st 15. In my school an A+ meant getting bullied for showing up the other kids. We had streaming, but being in the ‘Ac 1’ class also put a target on the back of your head.

Even teachers who tried to encourage kids to do well were on occasion beaten up and thrown down stairwells because the kids they tried to help were embarrassed in front of their peers. I liked sport (I played in previous schools, hockey and club soccer when living in Holland) but the thought of having to stay at school a minute longer than I had to (for training) was anathema.

The podcast I listened to this morning was about getting FREE publicity. I learned similar lessons to Cameron Harold early in my career, when I was racing landyachts as a hobby sport, and I was looking for sponsorship to send a team from New Zealand to the USA.

Me on my Class 5 Winger on 90 Mile Beach

I needed publicity to attract sponsors for a sport where one minute you see the yachts racing over the sand on a long beach or on the tarmac of an air base; and for the next half an hour or so, you sit there waiting to see them briefly again as they would fly around a mark, crashing into each other on 2 wheels. It was a great spectator sport for about 4 minutes of each race that could take up to an hour and a half.

I did two things. I got a well worn small book from the library. I don’t recall what it was called but it may as well have been called “Get the coverage you want by giving the media what they want”.

One of the things it said to do was to ask them what they wanted. That seemed to simple but I did it. I rang radio sports journalists, I rang TV, I rang magazine editors and I rang newspaper sports writers. I introduced myself and gave a quick pitch of why I was ringing, explaining the challenges of a fast exhilarating sport, with yachts on wheels doing over 100 kph on the beach that no one had heard of.

Next thing I found myself in the newsroom of the New Zealand national daily, speaking with the Sports Editor. End result, they got some great stories, we got global TV coverage, we got international magazines and radio stories, we got sponsors and our team (unfortunately I had to pull out at the last minute) went to the Nevada Desert and won the America’s Cup of Land Yachting! And I learned how to get more than my fair share of media coverage for my employers and my modest entrepreneurial ventures.

Ironically listening to Cameron’s story, and despite being very gifted intellectually, I didn’t do any university study until much later in life, because I spent many of those teenage years rebelling against a system that had no place for bright people. I’ve had a pretty exciting life so far and I feel I have made a strong contribution in my endeavours, but I also wonder if I didn’t live in the land of Tall Poppy Syndrome, how much more I could have achieved if the education system had acted on what they discovered about me and nurtured it.

Which sort of brings me back full circle to my ailing back. I have now sat down too long writing this and need to do some stretches and exercise as I wait for my number to be called by the Waitemata District Health Board for my first specialist meeting, so I can have my surgery and get back to my job. When you’re a number in the system, a few pages in a manilla folder, you are equally invisible if you want to work and be productive as someone who will quite happily live on a benefit.

Does any of this resonate with you?

 

Your indicator is not an extension of your steering wheel!

I had two near misses on the way home from work last night. The first one was on the freeway. A guy two lanes across from me turned into the lane I was turning into after I started my man-oeuvre  into an empty space. He didn’t indicate until he was halfway into my lane. He jumped back when he saw me coming as did I. The difference was I was well ahead of him and indicated a couple of seconds before I started turning my wheel.

Don’t people think about their turns any more, or that there might be other people on the road. Sometimes you might have a car or a motorcycle in your blind spot, but not when they are in front of you.

Or beside you which was the case in the second incident last night. It was a 2 lane 60km per hour road and the car in the lane exactly next to me, not in front or behind, just shifts straight into my lane, indicating as his hand reached the arc that allowed it to connect with the indicator in mid term.

I slammed on the brakes, and fortunately the car directly behind me must have seen it coming because he also managed to avoid crashing into my rear end.

So I got home safe and sound, but continue to wonder at the number of people who either don’t indicate at all, or are half way through their turn or lane change when they finally get around to it. It’s a wonder there aren’t a hell of a lot more accidents.

We focus a lot on learner drivers, but I think we should also retest experienced drivers, perhaps once every 10 years. Would you pass a randomly required driving test tomorrow?

Judder bars slow down traffic

The road I live on is fairly narrow and is often used as a shortcut from one suburb to the next. Boy racers like to race up the road to the intersection where my house is situated on a corner site, testing out their turbo’s. A few years ago I joined fellow residents in the street and called for a council meeting to do something about it. We asked for a couple of chicanes with side barriers, basically barriers that run at an angle to the road and force people to slow down to navigate around them. But no, North Shore City council decided to put in fairly long judder bars, that is they go up and the road rises for a bit over a car width and then they go down again.

Now 2 things happen, the first is that people coming from the intersection go reasonably slowly over the judder and then plant it going down the hill. The main casualties are pets, although there are accidents from time to time as they get to the first corner and meet someone coming the other way.

The other thing is people come racing up the road and either don’t notice the judder bar or forget it is there until they have hit it at speed, which is pretty silly because it is right before a T junction. Every night we hear the scrapes of car underbellies as their cars get gravel rash and houses on both sides of the road are showing cracks from the impact, although council denies that this is possible.

Last night at 4:30 AM I heard one of these crashes followed by some clattering. It was pretty loud and I jumped out of bed and raced to the windows to see if there had in fact been an accident. I didn’t see anything and went back to bed. This morning, I got a call to say come and have a look on the corner and you can see on the photo what I found. A rubbish truck had managed to fkip itself and land between 2 trees after knocking down a couple of signs. I hope the driver was ok.

It’s pretty obvious what happened. He must have been coming up the road way too fast, didn’t see the judder bar which would have been like a ramp for motor stunts. He would have been airborn on an angle as he realised there was a corner coming, started to turn just before he hit the air, landed on 2 or 3 wheels , overcorrected and flipped.

If we had the chicane we asked for, there may have been some damage to the truck, although only a fraction of what there was as you can see from the photo and the main damage would have been to the driver’s pride. But then I’m not a traffic engineer, I’m just using a little common sense.

The hospital is the best place to be when you are sick, or is it?

Lately there have been a spate of stories about medical misadventure in the news, focussed on hospitals in New Zealand. Tales of drugs being given to the wrong patient, the wrong limb being operated on, things left behind inside the body after the wound has been stitched and lots more. Stories like Mistakes Kill 40 and Death Tally have been around for years.

In my own personal experience I was once prescribed an antibiotic and an antihystamine where the medical documentation stated that they should not be used in combination. The consequence was a major long term allergic reaction. My father in law who has a lanryngectomy has suffered from pneumonia several times as a consequence, not a reason, of being admitted to hospital for other problems.

For years we have had stories of people waiting in corridors in hospital Accident & Emergency areas because there were insufficient beds in the wards for them, even though they had been admitted. Each time one of these stories come out, the hospital spokespeople make out that it is an isolated incident due to a suddent spate of health problems caused by weather or other factors outside their control. Funny then that each time I have visited A&E with various family members over the last couple of years, I’ve had the same experience, summer and winter. For example last year my daughter suffered what eventually was diagnosed as a relapse of glandular fever. She was instantly admitted to the hospital by agreement between an A & E clinic and the hospital. I got her to the hospital around 5 p.m. on a Saturday afternoon and she got to see a doctor at 1:30 the following morning. I assure you I can quote many more cases with the same results from personal, not anecdotal experience.

My younger daughter was a blue baby and had regular visits to hospital for that and as she got older for various injuries from her sport of gymnastics. As a child a common occurence was that they could not find her file, even for appointments scheduled a week or more in advance.

So what’s my problem with that, other than as a taxpayer and concerned citizen? It’s that they have had solutions available for many years that cost dramatically less than the consequences of not having them. I know because I presented many of those tools and solutions to them.

First there is a simple concept of bar coding or using RFID tags to identify and locate files and other plant. This is everything from patient files (even though a lot of information is digitised, it generally isn’t available to registrars and other staff on demand in the wards or at the bedside) to critical equipment. I’ve heard of operations being cancelled or postponed because equipment had been borrowed from operating theatres and not returned.

So what was my solution? Very simple. Every patient folder has a bar code on it, which identifies the patient, their national health code etc. Each staff member has a bar code on their ID card. A bar code reader can be placed at the entrance to all key areas and as critical documents or plant leaves an area, it is scanned and the person removing it scans their identity and when it arrives at the next location, it is again scanned. Now a central data register knows where each file is, where each heart monitor or other item of plant is. Imagine the amount of time and pain that could be saved and avoided!

Then there is the very common problem of people being given drugs they are allergic to. I introduced 2D and 3D barcode readers into New Zealand many years ago, through an agency I managed with a well respected medical technology brand, Welch Allyn. The conept of these bar codes which are now (12 years later) starting to appear on patients bracelets, is that the bar codes can contain large volumes of digital data including crucial information such as allergies, their condition, their blood type and much more, without having to resort to a central database. Anyone that uses a computer, especially attached to a network, knows that its integrity and availability can’t be relied on.

So, at the bedside, I recommended a protocol each time drugs were administered, that the bar code be read with a small handheld scanner with a display, or built into a small handheld computer, and critical information could be confirmed before blood or drugs were administered. It would also ensure that it was clear that it was the right leg or appendage that was causing problems. By using a drug database, which can reside in a Palm sized computer, an alert would be delivered instantly if drugs that are dangerous when taken at the same time might be administered.

This is not a small problem and it is not a local problem, but it seems that only a few hospitals spend the money on using this technology which is readily available. It is usually hospitals that are attached to universities or med schools that invest in the technology. But it isn’t expensive and the cost of not using it is much greater. In Australia for example according to the Sydney Morning Herald, between 85,000 and 115,000 people over the age of 65 are admitted to hospital EACH YEAR due to adverse effects of their medication. And that’s the tip of the iceburg. What about those under 65, but of coursewith the older ones these problems are often fatal. Google in your country and you will find countless stories. This can so easily be avoided.

I’ve often wondered what has to happen before the government steps in. How many New Zealanders and people around the world have to die because of ‘accidents’ that could have been avoided. What is the cost of each one, or even the prolonged treatment of people who’s recovery from illness is hindered due to these problems. The solution is far cheaper than not doing something about it. I thought that perhaps if the family of an MP got caught i situations like this, that then maybe the Minister or others would do something about it, but I suspect that these people would not find themselves in public hospitals where cost restraints are more important than patient’s health and care.

I’m lucky that I can make a choice and I do have a couple of minor procedures I need to undergo soon. I can assure you, I will be using my medical insurance and going private.

But tell me please, what does it take. What are you going to do nect time you take one of your friends or family to hospital and they say take a number and we will see you as soon as possible. When you ask how soon, they tell you “Maybe 2 or 3 hours, because one of our registrars is off sick” and in ‘2 or 3 hours’ they tell you “another 2 or 3 hours because there has been a major car accident that was unexpected”. Are accidents ever expected? How come tow trucks and ambulance organisations know that there are certain spots at certain times of day or night where they should be waiting because an accident is going to happen, but hospitals don’t expect it. Goodness me, it’s 11 p.m. on Friday night and it’s raining. I guess there is no reason for the hospital to expect one out of a million people to cause an accident due to drunk driving is there?

I’m pissed off. This is the 21st century. I don’t live in the 3rd world, we have a modestly affluent society, but we can’t cater to a growing population? I shudder to consider what it’s going to be like in the next 30 years as the baby boomers get older and need more medical assistance because those that don’t succumb to medical misadventure or die in the waiting rooms. The hospitals might still be saying that they were caught by surprise with the extra people who succumbed to the flu this winter.

People are so forgiving. They say the staff did their best under the conditions they have to work in. I don’t disagree, I have utmost respect for the doctors, nurses, orderlies, domestics and everyone else who make the hospitals run, despite their masters. But why should they have to, shouldn’t health be one of our highest priorities?

Now throughout all this I have been talking about public hospitals funded by the state, by our taxes. I have a couple of minor surgeries coming up and guess what, I won’t be sitting in a waiting list for 2 years and then find myself being bumped after having starved myself overnight because they needed their resources for an unexpected accident. I’ll be going private. No I’m not wealthy, but I pay my medical insurance as I have since I was 18 or so and I’m going to take advantage of it.

Anyway, is hospital the best place to go when you are sick? I don’t think so.