First do no harm: soaring claims for treatment injuries

Saturday, 24 May 2025

ACC claims for patients harmed by their healthcare have almost doubled in a decade, ruining lives and costing the health system hundreds of millions. Nikki Macdonald investigates what is going wrong.

Pat Copp thought she was getting the gold standard fix. Instead, she got pain so excruciating she sometimes can’t lift herself up in bed.

Having suffered bladder leakage after giving birth to her two children, she had a hysterectomy and bladder lift at 38. But as the years passed, it got worse.

A gynaecologist recommended a TVT sling. Better known as pelvic surgical mesh.

Like hundreds of other women since the early 2000s, the plastic tape eroded her tissue. Copp had hers inserted in 2020. Had the 2023 pause on the treatment been brought in earlier, the 68-year-old Nelson nurse would have been spared the knife-like pain that plagues her life.

“I’m absolutely horrified of what’s happened to women…They have been butchered. It’s deplorable…I never thought something like this would happen to me. I will never trust the medical profession again.

“To my mind, you knew all this, so you broke your oath, which is, first, do no harm.”

Copp’s ACC claim was accepted last month, making her one of a soaring number of Kiwis claiming harm from their health treatment.

The number of new claims for six injury types jumped from 4834 in 2015/16 to 9071 in 2023/24.

While surgical mesh claims have risen gradually, infection claims have more than doubled in that time, and the number of patients suffering pressure injuries have tripled. Both have spiked steeply in the past four years, at the same time as the health system has been crippled by Covid, GP shortages, overloaded EDs and funding woes.

While most patients emerge better off after health treatment, when injuries do happen they can be life-changing, or life-ending. They also cost the health system millions in hospital readmissions and follow-up care.

In 2023/24 ACC paid out $221m on active claims for infections, pressure injuries, surgery-related injuries, drug errors, surgical mesh and neonatal brain injuries. That’s more than triple the 2015/16 total of $71.7m.

So what is going wrong?

A bug in the system

Sally Roberts was spurred to investigate infections after seeing their terrible toll on patients and families. These are not wee skin flare-ups fixed with a daub of iodine or a quick course of antibiotics.

An infection in a hip replacement can mean the new joint has to be removed, necessitating one or two extra operations, each with added risk.

“You’re another six weeks off work, and you’ve got no sick leave, and you’ve got to have a family member driving you around to various appointments - it really is a major impact.”

An infectious diseases expert, Roberts’ biggest worry is the 1-2 Kiwi patients a day who get bloodstream infections from dangerous bacterium Staphylococcus aureus. About 15% of patients struck by the bug die from it, or with it, within 30 days.

“It’’s all ages…To lose a young family member from a preventable healthcare-associated infection is an absolute tragedy.”

Roberts has been leading the Health Quality and Safety Commission’s infection prevention programme.

She thinks the spike in ACC infection claims could be due to more reporting, as more doctors realise infections count as treatment injuries. But that doesn’t make them any less important.

A 2024 study estimated healthcare-associated infections in public hospitals cost the health system $955 million in 2021, and caused more disability than car crashes.

“Preventing infections is crucial,” Roberts says. “There’s been a sense that some of these infections can’t be prevented, and they’re just a consequence of receiving healthcare. But while we may not be able to prevent every single one, we should be doing our absolute best to minimize the risk.”

Stopping infection can be as simple as proper hand-washing between patients, so busy staff don’t transfer bacteria from one patient’s wound to another’s intravenous line.

But Roberts’ team also identified other risk factors, including diabetes control, delaying surgery if a patient has skin infections, and clipping instead of shaving hair at a surgery site.

Anything that damages the skin, from surgical cuts to shaving to IV lines, increases infection risk, Roberts says.

“The most important natural defence we have as humans is our skin.

“Every day someone leaves the hospital with an IV line in their arm, and they have to go back to have it removed. And you just think - how did that happen?”

Understanding how such mistakes happen means documenting how long IV lines are in for, how often they’re checked, and ensuring they’re removed as early as possible.

“You can’t just put a fancy poster up on the wall saying: ‘Do this’, because people just glaze past it.”

But that requires time. An ACC pilot planned to help four district health boards investigate health harm, went nowhere.

“Due to their COVID-19 response, staff changes, and shortages, most providers were not ready to participate,” ACC says.

Roberts says a surgical site programme reduced hip and knee replacement infections by 50%. But more work is needed to cut Staph infections, about 70% of which are caused by IV lines.

She was hoping to work with hospitals nationwide to improve IV line practices, but her HQSC job has just been disestablished, as Health NZ is taking over.

Health NZ says it formed a committee in April to prioritise work to reduce healthcare associated infections, but failed to say what that would involve.

ACC head of injury prevention Renee Graham acknowledges the increase, but says claim numbers aren’t an accurate gauge of medical mishap rates, because not all treatment injuries are reported, and claims take time to be approved.

Possible reasons for the increase include more public awareness, better understanding of injury claims support by health providers, and patients seeking help earlier, Graham says.

The safety card is in the seat pocket

When an x-ray showed Ian Tollemache had cancer in the lower lobe of his left lung, he was obviously gutted. His mother died from the disease.

But the doctors assured him he’d caught it early. And if the surgeon had removed the correct bit of his lung, he should have been good. But he didn’t, and he wasn’t.

Despite having done the same operation almost 300 times before, the surgeon failed to notice the lung had flipped during the procedure, so he lopped off the cancer-free upper lobe instead of the lower one.

When they discovered the botch-up, Tollemache was stunned, the surgeon was distraught, and the expert who assessed the case for the Health and Disability Commissioner, surgeon Richard Bunton, struggled to explain the “major error in judgement”.

“It is hard to imagine how this could occur in the hands of an experienced surgeon,” Bunton said.

The mistake and repeat surgery (to actually remove the cancer) have ruined Tollemache’s life, and may prove a death sentence for the 66-year-old. He now has cancer in his right lung, which is inoperable because it’s his only lung.

“I have permanent, unbearable, neuropathic pain. Honestly, if I wasn’t taking drugs for it, I would have killed myself.”

The drugs make him too groggy to work, costing him his job as a software developer. He got ACC payments, but they stopped when he turned 65, despite his pre-op plan to work well past retirement age.

“I might have lost 10 years of income. The state f…ed up my life. To be blunt, I think I deserve a little better than that.”

He thinks he should get a lung transplant. And a better explanation.

“Mistakes do happen, and me hating the surgeon for it isn’t going to help…My main concern is, they could do exactly the same thing again, unless they put some procedure in place to stop it.”

Humans make mistakes, but systems should stop those mistakes ending in catastrophe. That’s the basis for what’s called a human factors approach, pioneered in aviation. It’s about looking at how humans and systems interact, anticipating errors, and designing for them.

That could be anything from plane design errors, to a mechanic messing up a repair, to a pilot doing the wrong thing because they’re fatigued or distracted.

The same is true for healthcare, says former air force pilot turned safety consultant Scott McKenzie. A good example was a Sydney baby who died because a gasfitter mixed up the oxygen and nitrous oxide lines, so the newborn got the wrong gas.

In a plane, the flap lever and gear levers have different shapes on them, to avoid mix-ups, and the fuel off switch has a guard, so you can’t inadvertently trip it in flight.

“Some really experienced healthcare providers feel that they’re quite sick of being related to aviation. But for human factors considerations, like education, training, rules and policies, and then standardisation and automation, all can be applied really well to healthcare.”

Aviation is also full of checklists. Did McKenzie ever miss a critical step while flying, that was picked up by a checklist, or a colleague?

“It happens all the time.”

(Checklists are used in operating theatres, including to count instruments, to ensure nothing is left in the wound.)

McKenzie’s company, Pappus, did an ACC-sponsored human factors investigation into IV line infections at Hutt Valley DHB. While they came up with good suggestions, including encouraging patients to question whether their IV line could come out, implementation is challenging, McKenzie says. Especially in a “maxed-out” health system.

Victoria University School of Health senior lecturer, Brian Robinson, has been investigating patient safety systems since setting up the southern hemisphere’s first patient simulation facility at Wellington Hospital in 1997.

While he says the increase in ACC treatment injury claims is “staggering”, more detail would be needed to unpick the cause.

Mistakes usually result from a failure to recognise, Robinson says. Whether that’s a wrong diagnosis, confusing drugs with similar packaging, or, in the case of surgical mesh, underestimating risk and overestimating benefit.

Design and distraction also figure - research has found noisier theatres are linked to more surgical site infections.

Robinson thinks health can learn from aviation’s ingrained safety focus, right down to the safety briefing before every flight.

“I think it’s more about culture…If we look at what ultra-safe industries do, they’re always checking and they’re always asking. You see some of that culture within the hospital setting as well. It’s perhaps when it’s times of busyness or lapses occur that these things get lost.”

Under pressure

Of the six key types of treatment injury, claims for pressure injuries have rocketed up the most, more than tripling since 2015/16.

That’s no surprise to nurse Christine Warrander, who increasingly sees the nasty sores on her medical ward at Gisborne Hospital.

The Nurses Organisation delegate says they can happen on any pressure point, from heels, to the backs of heads, to anywhere medical equipment is attached. And they range from treatable wounds to dead tissue right down to the bone, which has to be cut out.

“It can take months to years, sometimes, for those very serious pressure injuries to heal, if they heal at all. It’s quite serious, and can be very expensive and time-consuming to look after.”

Of those she sees, many would not qualify as treatment injuries, as patients have suffered them in the community rather than in hospital. While family carers do their best, they can struggle to get GP appointments and buy healthy food, and sometimes have to leave their loved one home alone all day to go to work.

Some injuries also come from rest homes too short-staffed to turn patients two-hourly.

“It’s a multi-factor issue.”

But even in hospital, equipment and staffing shortages can mean patients don’t always get the treatment they should, Warrander says.

“Some days, no problem. Other days, you can have really sick, acute patients and you just don’t have the time or manpower.”

Nurses Organisation college of gerontology nursing chair, Bridget Richards, says pressure injury claims might have jumped because rest home providers are making more claims, to access support.

But older people are also suffering from what she considers the under-funding and under-staffing of rest homes.

“We’re just not funded appropriately, and there’s big, big gaps in services, and unfortunately, older adults are the ones that are the most vulnerable and often don’t get prioritised.

“It’s not fair to our residents. It’s not fair to the family…It’s sad. It’s terrible.”

Health NZ chief clinical officer, Richard Sullivan, acknowledges that pressure injuries at the less serious end of the scale (stages 1-2), are increasing in hospital patients.

Patients having hip replacements and other orthopaedic procedures, and those having breathing tubes put in, have the highest rates. Work is underway to manage risk, including giving nutrition supplements to all hip fracture patients, Sullivan says.

Health NZ is also supporting an HQSC programme to reduce hospital-caused pressure injuries in Māori and Pacific people aged over 75, in Counties Manukau and Waitematā.

However, like Warrander, they have seen a bigger increase in pressure injuries happening outside hospitals. Those are at the more serious end (stages 3-4), which go right down to the fat, muscle or bone.

Work to reduce pressure injuries will be discussed at a National Quality Forum in Wellington on May 28.

Lessons from surgical mesh

It was two years of agony before anyone figured the surgical mesh implanted inside Carmel Berry could be the source of her life-screwing pain.

That was about 2006 - before the surgical mesh scandal blew up - and everyone told her she was the only one in New Zealand. She wasn’t, not by a long shot.

ACC now has 794 active claims for surgical mesh injuries, costing $12.6m, and Berry’s Mesh Down Under Facebook page includes 1200 victims and their supporters.

Berry was just 40, with two young kids, when she had a “device” inserted during a hysterectomy to prevent further prolapse.

“She said I’d have light period pain, but I just felt like I’d been run over by a train.”

Twenty-one years on, she’s talking from her bed. Despite having had the mesh removed, she still can’t sit for long. She lost her successful marketing business because she couldn’t meet deadlines. Her marriage broke up because she could no longer do fun stuff. And still the pain rages.

“If you were to ask me, 20 years ago, would I have ever imagined what I've been through from what was deemed a simple, routine operation, I wouldn't have believed you.

“Probably the hardest thing was my family going to Disneyland, and I had to wave them off at the airport, because I couldn’t sit on a plane for 10 hours.”

Having petitioned parliament for an inquiry, and now serving on the Health Ministry’s mesh roundtable, Berry is angry authorities didn’t act sooner on reports of harm, which were noted by Medsafe as early as 2008. They should have demanded evidence of safety and effectiveness earlier, and hit pause before 2023.

And she’s sceptical whether anything has really changed.

“Often people talk about the Thalidomide story and the Unfortunate Experiment, and this should never happen again. But it still did.”

Copp is also angry more wasn’t done sooner. While she continues to work, managing the pain with drugs, deep tissue massage and horseriding therapy, she can still be left rolling on the floor trying to do exercises, unable to get back up.

“Who has the right to harm somebody that much? It should be banned completely.”

Asked how claims analysis has changed to ensure a pattern such as the surgical mesh injuries would be picked up and acted on, ACC says it’s always analysing its data and uses “various technologies” to understand claims trends. It’s also increasing data sharing with others in the health sector.

Berry says there should be one over-riding lesson from the mesh disaster:

“Listen to the patients, believe them. If doctors and health officials had listened and acted sooner - so many people could have been saved from harm.”