Small gains, big problems trouble politicians
BACK in 1967, Owen Woodhouse released his landmark report which recommended that New Zealand set up a nofault compensation scheme for unintended injury.
Because little happens quickly in the world of politics, it took until 1974 for what is now the accident compensation system to be set up.
And, because little happens in the world of politics without a contest of ideas, our MPs have been fighting almost ever since about the function, scope and ownership of the scheme.
However, most likely next week and most likely unanimously (more on that later), ACC coverage will be altered, and not before time.
Parliament is about to consider and pass the Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill, after a gruelling select committee process.
Gruelling because, as all too many mothers know, some kind of maternal birth injury is part and parcel of bringing a child in to the world — when it started deliberating on the Bill the education and workforce committee began with the premise that 85% of birthing mums would have experienced one of the many forms of trauma covered by the law change.
Some of those injuries are incredibly unpleasant: Invercargill National MP Penny Simmonds said she feared the committee’s very young male report writer might be scarred for life by some of the technical discussions about birth injuries he had heard.
But that is nothing compared with the actual scars suffered by the many mothers who appeared before the committee to tell their stories of sphincter and urethral tears, prolapses or inversions.
Women like Disa Walker, whose arduous birthing story and the inadequate response to her concerns have featured in the Otago Daily Times before.
Her refusal to be bullied and determination to stand her ground resulted in her receiving a muchdeserved apology from the southern health service, changes being made to maternity complaints and training procedures, and her case being taught to University of Otago Medical School students.
Mrs Walker’s submission, one of many from Otago and Southland to the select committee, called for all people suspected of having suffered a birth injury to receive a talk therapy session to triage for mental as well as physical trauma, retrospective cover, and for a system of maternity injury review to be developed.
The Bill was back before the House late last month, and Dunedin National list MP Michael Woodhouse led off for his party.
The only man to speak in the secondreading debate, Mr Woodhouse is well informed about the issue: a sister and a daughter are both registered midwives and he is a former ACC minister and employee.
‘‘Mental injury, and this has been a challenge for successive governments — the degree to which mental injury should be covered,’’ he said.
‘‘We’ve settled on a place that is mental injury as a consequence of physical injury, and, of course, postnatal depression and other psychological stress that may not be related to a birthing injury is not going to be covered. I can understand why.’’
Dunedin Labour list MP Rachel Brooking took the discussion back to first principals and the ACC Act, which exists to enhance the public good by providing for a fair and sustainable scheme for managing personal injury.
‘‘It applies to (2)(a) ‘personal injury caused by an accident’, that word ‘accident’ is a key definition,’’ she said with lawyerly precision.
‘‘What this Bill does is it adds a new subclause . . . ‘an application of a force or resistance internal to the human body at any time from the onset of labour to the completion of delivery that results in an injury described in schedule 3A to a person who gives birth’.’’
Ms Simmonds chose to highlight the disparities in cover offered at present.
‘‘One young woman told us of the situation where her partner went to rugby practice, and at rugby practice he pulled his hamstring,’’ she said.
‘‘He then went to the doctor or went to his physio, was able to straight away go through to physio through ACC, yet this poor woman, as a mother who had suffered significant pelvic floor injuries, wasn’t covered, had been trying to get cover to be able to go to physio, couldn’t afford to pay to go to physio, and it was obviously impacting on her quality of life, her ability to care for her children, and was likely going to have ongoing impacts for her.’’
The ‘‘nonsensicalness’’ of the situation showed immediately that the need for change was obvious, she said.
So far so good, but while this Bill is certainly better than the status quo, that does not mean there are not some issues with it.
The biggest sticking point, noted by many submitters, is the inclusion of a prescriptive list of what constitutes a ‘‘maternal birth injury’’.
It is this point in particular which prompted the Green Party to issue a minority view on the select committee report.
While there had been comprehensive evidence on the types of injury one could suffer while giving birth, which had prompted several more to be added to the list, the Greens — and several ACC law professionals for that matter — fear that having a list will simply lead to deserving cases being excluded from cover because they fail to meet the criteria.
The minister responsible, Carmel Sepuloni, responded by drafting a supplementary order paper which will add a review period to the law change, but that will come as scant compensation for anyone who fails the coverage test in the meantime.
And speaking of missing out, the fact the law change is not retrospective may well dismay people who suffer to this day from a birth injury, as might the fact mental injury — as noted by Mr Woodhouse — and injury to the baby are not within scope.
There has been a pattern of such law changes in recent weeks — the Accessibility for New Zealanders Bill, the Support Workers (Pay Equity) Settlements Amendment Act, and now maternal births — where much has been promised but stakeholders have been left largely underwhelmed by what has been delivered.
Labour cannot blame the Opposition here — the need for reform in all these areas is recognised, but sweeping change has been tempered by timidity.