ACC Treatment Injury Cover Assessment

Surgical mesh-related treatment injury claim data updated to end October 2017
Prepared for Carmel Berry and Charlotte Korte
November 2017
TICAC Reference: IR20172452

Introduction

Following the release of the ACC treatment injury claim data report https://www.acc.co.nz/about-us/news-
media/latest-news/surgical-mesh-claim-data/, a request has come in for some updated and additional information
on surgical mesh-related claims to end October 2017.
Data provided

Treatment related injury data is provided from 1 July 2005 to 31 October 2017 and extracted on 14 November
2017. The data includes:
Number of surgical mesh-related claims by gender and treatment event (surgery type groups) and
surgery types
Number of surgical mesh-related claims by gender and primary injury/symptom
Number of decided surgical mesh-related claims including the percentage of accepted and declined
claims

Request

Request for more recent numbers of decided (surgical mesh-related) claims until the end of October 2017 by
gender and condition.

Response

From 1 July 2005 to 31 October 2017 ACC made cover decisions on 872 surgical mesh-related claims.

The table below shows the 872 surgical mesh-related claims by gender group, treatment event (surgery type
groups) and surgery type.

Surgical mesh-related claim counts by gender by surgery type groups and surgery type
from 1 July 2005 to 31 October 2017

Surgery type Gender

Surgery types Total
group Female % Male %
POP repair 203 100% 0 0% 203

POP and/or SUI SUI repair 125 100% 0 0% 125

repair POP & SUI repair 169 100% 0 0% 169
Subtotal 497 100% 0 0% 497
Groin hernia repair 19 17% 93 83% 112
Ventral hernia repair 93 50% 93 50% 186
Hernia repair
Other hernia repair 10 48% 12 52% 22
Subtotal 122 38% 198 62% 320
Includes mesh removal surgery, sling surgery for
Other mesh
male urinary incontinence, breast reconstruction 39 71% 16 29% 55
surgery
and other reconstructive surgeries using mesh.
Total 658 75% 214 25% 872

Accident Compensation Corporation

The table below shows the 872 surgical mesh-related claims by clients gender group by primary injury/symptom.

Surgical mesh-related claim counts by gender by primary injury/symptom

from 1 July 2005 to 31 October 2017

Gender
Primary injury/symptom Total
Female % Male %
Mesh erosion 326 98% 8 2% 334
Infection 99 53% 89 47% 188
Pain 39 74% 14 26% 53
Hernia 22 42% 31 58% 53
Nerve injury 26 67% 13 33% 39
Haematoma - bruising 18 60% 12 40% 30
Perineal injury 16 100% 0 0% 16
Mesh migration 7 44% 9 56% 16
Seroma 7 50% 7 50% 14
Urinary tract injury 13 100% 0 0% 13
Bowel injury 5 42% 7 58% 12
Fistula - other 7 58% 5 42% 12
Gastrointestinal injury 6 60% 4 40% 10
Sexual dysfunction 10 100% 0 0% 10
Scarring 10 100% 0 0% 10
Urinary Incontinence 6 100% 0 0% 6
Inflammation 5 100% 0 0% 5
Hydrocele 0 0% 5 100% 5
Wound dehiscence 5 100% 0 0% 5
Urethral injury 4 100% 0 0% 4
Other 20 injuries/symptoms 27 73% 10 27% 37
Total 658 75% 214 25% 872

Request

Please give more detailed information pertaining to the claims that have been declined. Break this down further to
show how many claims were declined specifically for POP, SUI and hernia repairs and the reason for the claims
being denied.

Response

From 1 July 2005 to 31 October 2017 ACC made cover decisions for 872 surgical mesh-related treatment injury
claims. Of those treatment injury claims, 678 (78%) were accepted and 194 (22%) were declined.

The table below shows the 194 declined surgical mesh-related claims by treatment event (surgery type groups)
and surgery type.
 Declined surgical mesh-related claim counts by treatment event
from 1 July 2005 to 31 October 2017
Decision
Surgery type
Surgery type % % Total
group Accept Decline
Accept Decline
POP repair 152 75% 51 25% 203
POP and/or SUI repair 105 84% 20 16% 125
SUI repair POP & SUI repair 141 83% 28 17% 169
Subtotal 398 80% 99 20% 497
Groin hernia repair 72 64% 40 36% 112
Ventral hernia repair 146 78% 40 21% 186
Hernia repair
Other hernia repair 19 86% <4 - -
Subtotal 237 74% 83 26% 320
Includes mesh removal surgery, sling
Other mesh surgery for male urinary incontinence,
43 78% 12 22% 55
surgery breast reconstruction and other
reconstructive surgeries using mesh.
Total 678 78% 194 22% 872
Note: Claim counts fewer than four (n=1, 2 or 3) are presented as <4; percentages are not provided for <4
value.

The table below provides a breakdown of decline reasons by surgery type groups.

Declined surgical mesh-related claim counts by surgery type group and decline reason
from 1 July 2005 to 31 October 2017

Surgery type group Decline reason n %

No Injury 54 55%
Ordinary consequence of a treatment 26 26%
No causal link 15 15%
POP and/or SUI repair Necessary part of treatment <4 -%
Lack of information <4 -%
Withdrawn <4 -%
Subtotal 99 100%
No Injury 32 39%
No causal link 25 30%
Ordinary consequence of a treatment 19 23%
Desired results not achieved <4 -%
Hernia repair
Underlying health conditions <4 -%
Necessary part of treatment <4 -%
Withdrawn <4 -%

Subtotal 83 100%
 No Injury 4 33%
Ordinary consequence of a treatment 4 33%
No causal link <4 -%
Other mesh surgery
Underlying health conditions <4 -%
Previously declined medical misadventure claim <4 -%
Subtotal 12 100%
Total 194 -%
Note: Claim counts fewer than four (n=1, 2 or 3) are presented as <4; percentages are not provided for <4
value.

Examples against decline reasons

Decline reason Example

No Injury The decision to decline a claim on the basis of no personal injury relates to where the
evidence fails to demonstrate physical damage is present e.g. pain may be present
however case law states that pain of itself is insufficient to establish personal injury.
Ordinary The decision to decline a claim on the basis that the injury is an ordinary consequence of
consequence of a treatment relates to where there are client specific factors that have increased the
treatment likelihood of the injury occurring.

e.g. A client who undergoes surgical treatment where mesh is successfully inserted and
resolves the clients underlying problems for several years. The client develops evidence
of mesh erosion several years later when she is menopausal, and has thinning of vaginal
tissues and vaginal atrophy that is likely hormone related. If the client is not on hormone
replacement therapy, these factors increase the likelihood of a subsequent complication
developing where mesh is present and is likely to represent an ordinary consequence of
treatment.

No causal link The decision to decline a claim on the basis of no causal link is where the clinical evidence
is clear in determining that there is no link between the claimed complications and the
treatment. The client may have thought mesh was inserted however the
contemporaneous evidence doesnt demonstrate it was used in the provision of
treatment and whatever the client is claiming is not demonstrated in the evidence as
being caused by treatment.

Necessary part of The decision to decline a claim on the basis that complications of surgical mesh insertion
treatment are considered to be a necessary part of treatment is more likely to relate to problems
with the surgical incision where there is no additional injury i.e. poor healing of a
necessary incision. The incision is necessary for the procedure however the healing is the
clients own healing process.

Lack of The decision to decline a claim on the basis of a lack of information is where the provider
information lodges a claim and then doesnt provide ACC with any clinical information that would
allow ACC to make a cover decision on the specific facts of the case. In this situation if the
clinical information is subsequently received ACC would then go on to investigate the
substantive claim if the client consents for ACC to do so.

Withdrawn The decision to decline a claim on the basis that the claim was withdrawn by the client
means that ACC no longer has client consent to continue investigating the claim.

Desired results The decision to decline a claim on the basis that desired results were not achieved may
not achieved relate to e.g. the look of a surgical incision where their client is unhappy with the way
 the incision looks but there was no additional injury over and above the surgical incision.

Underlying The decision to decline a claim on the basis that the claimed injury is an underlying health
health condition condition is where the evidence shows the clients problem was pre-existing. The client
may have suffered nerve symptoms prior to surgery and post surgery the symptoms
remain and treatment fails to resolve the clients symptoms.

Previously A claim that has been previously considered under the medical misadventure provisions
declined under is unable to be considered under the treatment injury provisions unless there was no
medical personal injury identified at the time of the first investigation, and an injury is then
identified. If a personal injury subsequently becomes evident and a new claim is lodged,
misadventure
this can be considered as a treatment injury.
claim
If the claim was declined on criteria other than personal injury, then any further
consideration must be under the same legislation as the original decision.