ACC to reassess declined surgical mesh claims dating back 15 years

Victims of surgical mesh injuries can now have their declined claim to ACC reassessed, thanks to new guidance on cover criteria.

The offer by ACC to reassess claims dates back to any cover denied from July 2005, with data suggesting at least 380 people may be eligible.

The move is being cautiously welcomed by mesh injured advocates who are now calling for any mesh injury sufferers who either had a claim denied or never made a claim to come forward.

The new guidelines are based on the latest medical evidence and understanding of mesh injuries, said ACC chief customer officer Emma Powell.

“Last year, as part of a restorative justice process commissioned by the Ministry of Health, we had the opportunity to hear directly from people who have been harmed by surgical mesh,” Powell said.

“We also heard how our claims experience has contributed to the harm some people experienced.

“We recognise the severity and impact of the harm on people with surgical mesh injuries and the need for us to improve our systems and processes.”

Powell said ACC was committed to taking action to improve the claims experience and health outcomes for those treated with mesh.

This included looking back through declined surgical mesh claims to ensure that past cover decisions were consistent with the latest understanding of mesh injuries, and to look for opportunities to improve the experience of those who went to ACC for help.

“An initial look at a sample of declined claims showed that with changes in the medical evidence and understanding, some claims could get a different decision if lodged today, and some might benefit from further assessment.

“This doesn’t necessarily mean cover decisions will change, just that some of these claims may warrant extra investigation.”

The new cover guidance will be used to assess previously declined claims and any new surgical mesh claims.

Since July 1, 2005 there have been 1667 surgical mesh claims, with 77 per cent accepted leaving 383 without cover.

The recently published guidance is specifically for pelvic mesh injuries, and ACC is currently finalising its hernia mesh injury guidance.

Mesh Down Under, a support group for sufferers, said it was hopeful more claims would now be accepted for cover so injured patients could access the help they desperately needed.

Co-leader Patricia Sullivan said mesh-injured patients had suffered far too long.

“We will wait to see how many claim decisions are overturned or new claims accepted before we can say that this process has been a success.”

Living with surgical mesh injuries without ACC support

Teresa Mitchell has twice been denied cover by ACC for surgical mesh injuries.

The 50-year-old Pokeno woman had surgical mesh – a synthetic implant used to repair weakened structures – inserted for urinary incontinence caused by childbirth seven years ago.

Three days after the surgery she complained to her GP of leg spasms, pain and fatigue. For 18 months she was told it was all in her head.

At one point she had visibly eroded mesh in her vagina, which ACC asked for a photo of. She swore at the case manager and her cover was declined.

Now she is so debilitated, despite having the mesh removed two years ago, that she can barely lift a 3 litre bottle of milk.

Mitchell is permanently disabled, has developed Lupus, is losing her teeth and hair, weighs just 53kg despite a healthy appetite, and has ongoing nerve pain.

“I have no possibility from relief from this pain for the rest of my life.”

But because the former security guard is married and her husband works, she cannot qualify for home care assistance, rehab physiotherapy or any long-term financial support from Work and Income.

Because of ACC she cannot sue the doctor who implanted the mesh for medical misadventure and she no longer trusts any doctors.

“There’s a lot of people who have lost marriages, they’ve lost their homes, people have committed suicide.”

She says the mesh has likely dramatically shortened her lifespan and it ended her working years prematurely.

Because of her treatment by ACC in the past Mitchell was sceptical about the new cover guidelines.

“They have a moral obligation to resolve this because we cannot get any compensation against doctors because they’re protected.

“Unless they do so ACC is not fit-for-purpose as they currently stand when you are munted like we are by doctors.”

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