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New research from ISCRR (how’s that again?)

February 4, 2015

I have written about the ISCRR before. I think it is a stupid name as it is almost impossible to remember, it stands for the Institute for Safety, Compensation and Recovery Research. Why, oh why, did they not twist this into RRISC or something similar?

Anyway it produces a monthly newsletter which has some interesting research finding. In the latest newsletter there are two items of research that I thought were interesting.

The first article is regarding Gender Differences with Mental Disorder Claims.

WorkSafe Victoria (Australia) workers’ compensation data (254,704 claims with affliction onset 2004–2011) were analysed. Claim rates were calculated by combining compensation data with state-wide employment data.

Results

Mental disorder claim rates were 1.9 times higher among women; physical injury claim rates were 1.4 times higher among men. Adjusting for occupational group reversed the gender difference in musculoskeletal and tendon injury claim rates, i.e., these were more common in women than men after adjusting for occupational exposure.

Conclusions

Men had higher rates of physical injury claims than women, but this was mostly attributable to occupational factors. Women had higher rates of mental disorder claims than men; this was not fully explained by industry or occupation. Am. J. Ind. Med. © 2015 Wiley Periodicals, Inc.

The second article was one of those articles that seem to be a total waste of time and provided a blinding glimpse of the obvious. I have summarised it for you.

Journal of Occupational Rehabilitation December 2014, Volume 24, Issue 4, pp 766-776

Mental Health Claims Management and Return to Work: Qualitative Insights from Melbourne, Australia

Mental health conditions (MHC) are an increasing reason for claiming injury compensation in Australia; however little is known about how these claims are managed by different gatekeepers to injury entitlements. This study, drawing on the views of four stakeholders—general practitioners (GPs), injured persons, employers and compensation agents, aims to describe current management of MHC claims and to identify the current barriers to return to work (RTW) for injured persons with a MHC claim and/or mental illness.

Methods Ninety-three in-depth interviews were undertaken with GPs, compensation agents, employers and injured persons. Data were collected in Melbourne, Australia.

Results MHC claims were complex to manage because of initial assessment and diagnostic difficulties related to the invisibility of the injury, conflicting medical opinions and the stigma associated with making a MHC claim. Mental illness also developed as a secondary issue in the recovery process. These factors made MHC difficult to manage and impeded timely RTW.

Conclusions It is necessary to undertake further research (e.g. guideline development) to improve current practice in order to enable those with MHC claims to make a timely RTW. Further education and training interventions (e.g. on diagnosis and management of MHC) are also needed to enable GPs, employers and compensation agents to better assess and manage MHC claims.

Don’t you hate it when researchers’ conclusion is that more research is needed!

Role of Impairment Assessment in Injury Compensation Schemes in Australia and New Zealand, a presentation at the 1st ISCRR Conference in 2011

December 3, 2014

I came across this paper recently and thought it might be of interest to you. It is a little out of date but the general information remains applicable.  The last 2 tables are especially interesting with an overview of thresholds and an overview of methods.

Role of Impairment Assessment in Australian & NZ Injury Compensation Schemes
Andrew Fronsko and David Swift
ISCRR 1st Australian Compensation Health Research Forum
October 2011

The Cost of Comorbidity to the Victorian TAC Scheme

October 24, 2014

The Cost of Comorbidity to the Victorian TAC Scheme (Latest Research from the Institute for Safety, Compensation and Recovery Research, an independent Institute jointly funded by the TAC and the Victorian WorkCover Authority under the auspices of Monash University)

The conclusions were that comorbidity did not have a large impact on the overall injury recovery cost but certain health conditions did have a significant impact on hospital, medical and paramedical expenses. These conditions are mental disorders, diabetes, cardiovascular disease, recent surgery and (suspected) back pain. Mental health history, particularly pre-injury psychiatric attendance and GP visits in relation to mental health significantly added to the total claim cost, administrative, income, hospital and paramedical expenses especially considered over the full post-injury year.

Federalism gone mad-a multiplicity of motor accident schemes in Australia

May 30, 2014

In the process of doing some research for the training seminar on 31 May and 1 June 2014 I revisited some of the State motor accident schemes. The diversity of schemes is extraordinary.

In broad terms there are two different types of schemes, Compulsory Third Party Insurance Schemes that require fault to be determined and No Fault Schemes, however over the years hybrid schemes have developed.

The Compulsory Third-Party Schemes include:

ACT

New South Wales – (however small payment is made to those who are at fault and there is also a Lifetime Care and Support Authority for accident victims with specific injuries: spinal injury, moderate to severe brain injury, multiple amputations, major burns and blindness. This scheme is no fault.

Queensland

South Australia – however recent legislation has partially converted this into a no fault scheme so this is a real hybrid. There is also a Lifetime Support Scheme. The LSS, likely New South Wales Lifetime Care and Support Scheme will include people who suffer very serious spinal or brain injury, amputations, burns or blindness, regardless of who was at fault for the accident. The care will be provided from the time of the accident.

Western Australia

No Fault Schemes include:

Northern Territory

Tasmania   This scheme is No Fault but is also a hybrid with the opportunity to make personal injury claims if fault can be shown.

Victoria  – this is also a hybrid scheme that is mainly No Fault but also allows for personal injury claims when fault becomes an issue.

Fortunately, most of us only work in one jurisdiction but even then we are often unaware of the complexities. This post gives you an opportunity to look at the situation in your state and, if need be compare that with the situation elsewhere.

 

 

Translation Dilemmas

April 26, 2014

I have been touring Beijing, Shanghai, Nanjing, HangZhou, and HuangShen with my Chinese born wife on a 2 week tour Chinese born overseas Chinese people. We had Mandarin speaking guides, ate Chinese food for breakfast, lunch and dinner with weak Chinese beer. I have been to interesting places, seen ordinary street life with amazing contrasts of massive wealth and residual poverty. Mercedes 350sl and bicycle trucks.

I have been disconcerted by my sense of isolation,  I could understand any of the tourist guide’s information, the chitchat, the humour and the camaraderie amongst the group, who were kind and tried to involve me, but .

It set me to musing about problems with translation when seeing patients from different cultures.

The tourist guides spoke about the history of places referring to literature, myth, poems and especially well known stories. My wife and others struggled to explain what has been said because so much knowledge was taken as a given. When I first wrote this post, the day after Anzac Day, it set me to musing about what Anzac Day meant to me and other Australian as a story, a history, a myth and the traditions and literature that has grown from that, so that the word Anzac has a profound depth of meaning. But not to my wife who has no idea about World War 1, the growth of the nation etc, How do I explain all that in a few words, it seemed the problems she and others had translating the tourist information was similar. It struck me how much accidents and work injuries have a similar range of meanings according to our particular culture and how difficult it is to understand those meanings in another culture.  A Samoan church-going father of 3 had his right hand crushed in a machine at work.  He had a useless right hand and was unable to work.  I understood his sense of despair and concern for the future, what surprised me was that in his culture, a physical deformity was abhorred.  He was treated with contempt by his friends and Church members, his wife was ostracized and his children taunted. This was beyond my cultural experience.

When we see a claimant with an interpreter, does the claimant understand our role? Does the claimant understand our questions when translated and the implication of the questions? We have all had the experience of a lengthy dialogue between a claimant and the interpreter that concludes with the interpreter giving a one word answer. What has transpired in that conversation?

What is the experience of being in a English-speaking world without any English endeavouring to get treatment? How does one navigate the WorkCover system or the motor accident system?

This experience has led to me asking questions of the interpreter including questions such as “Doesthis accident have any specific meaning in your culture, does the type of injury have any specific meaning, are there any cultural issues with regard to treatment, are there any cultural issues with regard to seeing a psychiatrist?” I’m sure there are many other questions I could ask but these seem to be the most pertinent.

it is always a salutary experience being on the other side of the fence..

 

 

New Privacy Laws – all you wanted to know and more

March 13, 2014

New privacy laws: Is your practice ready and compliant?

This article was published in the March 2014 edition of vicdoc
AMA Victoria Solicitor, Melanie Earles

On 12 March 2014 the new privacy law regime brought in under the Privacy Amendment (Enhancing Privacy Protection) Act 2012 will commence. The reforms are the most significant changes to Australia’s privacy laws since the implementation of the Privacy Act 1980 (Cth) (Privacy Act).

Some of the key points health professionals must keep in mind to ensure their practice complies with the new laws are set out below.

What are the changes?

The Act will replace the existing nine Information Privacy Principles (IPPs) that apply to the public sector; the nine National Privacy Principles (NPPs) that apply to the private sector; along with 13 Australian Privacy Principles (APPs) that will apply to the public and private sector alike.

Health practitioners fall within the definition of an ‘organisation’ that handles ‘personal information’ so the APPs apply to them.

Personal information means information or an opinion – whether true or not – about an individual whose identity is apparent or can be reasonably ascertained.

In Victoria, health practitioners are also subject to the Health Records Act 2001 (Vic), which requires organisations dealing with health information to comply with the 11 Health Privacy Principles (HPPs).

The new APPs will apply in addition to the Victorian HPPs. The APPs are more similar to the existing HPPs than the federal principles they are replacing. This is good news for Victorian doctors because it means minimal changes will be required regarding the way health practitioners handle their patients’ personal information.

The most relevant (but not all) of the 13 APPs have been set out below. Health practitioners should check their current practices meet with the federal APP obligations.

APP 1 – Open and transparent management of personal information

• Organisations must have a clearly expressed and up-to-date privacy policy, and take reasonable steps to ensure it is complied with.

The privacy policy must specify what type of information is collected, how an individual may complain about a breach of the APPs, and whether the organisation is likely to disclose information to third parties. The privacy policy must be available to patients on the practice website or in hard copy at the practitioner’s consulting rooms.

AMA members may obtain an AMA-approved standard form privacy policy free of charge. Members can also contact the legal advisor directly with any questions relating to privacy law compliance.

Reasonable steps to ensure compliance includes:

• training staff about the organisation’s policies and practices

• establishing procedures to receive and respond to complaints and enquiries

• establishing procedures to identify and manage privacy risks.

APP 3 – Collection of personal and sensitive information

• Organisations must only collect sensitive information (a subset of personal information, which includes health information) with an individual’s consent, and where the collection is also reasonably necessary for one or more of the organisations’ functions or activities. There are some exceptions that apply in certain circumstances (for example, where a patient is unable to consent due to a medical emergency, or permitting the collection of family, social and medical histories).
APP 3 is much the same as existing HPP requirements. Ensuring patients sign an appropriately drafted consent form prior to collection of sensitive information sufficient to discharge this obligation.

APP 4 – Dealing with unsolicited personal information

This is a new requirement that applies to situations where organisations receive personal information they haven’t asked for. If this occurs – first, the organisation must determine whether the information could have been collected under APP 3 (for example, if they have a signed consent from the individual). If so, they must deal with the information as they would other personal information – that is, in accordance with privacy law. If not, the organisation must either destroy or de-identify the information as soon as possible, assuming it is legal and practical to do so.

APP 5 – Notification of collection

Individuals must be made aware of the nature of the personal information an organisation collects. In a health setting, this should be covered in the patient consent. Additionally, the individual must be told where their information may go, for example – whether it will be disclosed to third parties or overseas recipients. There is an obligation under APP 5 to inform patients how they can access the organisation’s privacy policy and how they may make a complaint.

APP 6 – use and disclosure

This is much the same as the existing HPP obligation, and requires that personal information may only be used or disclosed for the primary purpose for which is was collected, or a secondary purpose directly related to the primary purpose.

Certain exceptions that apply to health information, permitting use and disclosure are:

• where there is a serious and imminent threat to the health and safety of an individual or the public

• for health and medical research if certain conditions are met

• of genetic information to lessen or prevent a serious threat to a genetic relative

• to carers for compassionate reasons.

APP 7 – Direct Marketing

Organisations must not use personal information for direct marketing unless the individual has given specific consent for this. Alternatively, direct marketing is permitted if the individual has a reasonable expectation this would occur and they can easily opt out.

APP 10 – Quality

Organisations must take reasonable steps to ensure the personal information it collects, uses or discloses is accurate, up to date, complete and relevant.

APP 11 – Security

Organisations must take reasonable steps to protect the personal information it hold from misuse, interference and loss and from unauthorised access, modification or disclosure. In a health setting, this means having computer databases password protected, storing patient files in a lockable area, and training staff about the appropriate handling of personal information.

APP 12 – Access

Organisations are required to respond to requests for access of personal information from individuals within a reasonable time. If an organisation decides not to give access, written reasons must be provided. There are certain exceptions where access is not required; for example, where it may cause harm to the individual.

APP 13 – Corrections

An organisation must take reasonable steps to ensure the personal information it holds is up to date, accurate, complete, relevant and not misleading. There is a positive obligation to correct information where it is wrong. This differs from the old requirement that necessitated an individual to establish an error before any obligation to correct arose.

What happens in the event of a breach of an APP?

Where a breach of an APP occurs, the individual concerned may lodge a complaint with the Federal Privacy Commissioner (free of charge) and the Commissioner may apply to the Federal Court or the Federal Magistrates Court for an order that the entity pay a penalty of up to $1.1 million for corporations (and up to $220, 000 for individuals).

It is not necessary for the individual to prove loss or damage as a result of the breach of confidentiality – they may obtain compensation even if they have suffered no injury or loss.

AMA members are welcome to contact the legal advisor for further and specific information on issues related to privacy, including a standard form privacy policy and patient consent document.

Key points to remember

  • You must have a privacy policy available on your website (or in hard copy). AMA Victoria can provide this to AMA members, free of charge.
  • Your practice staff must be trained in your practice’s privacy policy and its application.
  • You must obtain consent (written, signed form is best) from your patients prior to collecting sensitive information. AMA Victoria can assist members to draft an appropriate consent form.

Further news on the TAC Amendment Act 2013

March 7, 2014

Victorian TransportAccidentAmendmentBill 2013 further information

 

Slater and Gordon had an information session on 25 February 2014 after discussion s with the TAC.  The relevant sections of the act for us are the following.

13    Amendment of section 46A (accident-related impairment)

After section 46A(1E) of the Principal Act insert—”(1F) When determining the degree of impairment under this section, section 47(7) or section 47(7A), the Commission must—

(a)   not include impairments resulting from injuries or causes that are unrelated to the transport accident; and

(b)   in the case of a person who has an injury that existed before the transport accident that is aggravated by an injury that was the result of a transport accident—

(i)   in the case of a spinal injury, use the apportionment methodology set out in Chapter 3.3f of the A.M.A Guides;

(ii)   in any other case, use the subtraction methodology set out in Chapter 2 of the A.M.A Guides.”.

21 Amendments relating to reimbursement of medical reports

The Commission is not liable to pay as compensation the reasonable costs of medical services that are the provision of a document obtained for medico-legal purposes, or related to medico-legal purposes for examinations made after 1 July 2014 unless the document—

(a)          is requested jointly by the Commission and the person who is injured;

and

(b)          is provided jointly to the Commission and the person who is injured;

(c)          is provided by a registered health practitioner within the meaning of the Health Practitioner Regulation National Law.

document includes but is not limited to a medical report.

The Minister Second Reading Speech Commentary on Amendment 21

Currently, the TAC funds the reasonable cost of medical reports obtained by or on behalf of a client, in relation to injuries sustained in a transport accident.

On average, clients attend 8 medical examinations over the course of their claim, of which, only 2 are commissioned by the TAC.  The remaining examinations are commissioned by the client’s legal representative in support of legal claims.

To address the need for a client to attend multiple examinations and to minimise the occurrence of a client attending duplicate examinations in relation to the same specialisation, this bill will enable the TAC to reimburse medico-legal report expenses if the medico-legal report is requested jointly by the TAC and the person who is injured.

It is intended that this provision come into operation on 1 July 2014 to inform and assist medical practitioners of this new policy change.

ISSUES: Potential for TAC to veto some IMEs.  We have been assured that current arrangements will continue but the future is uncertain.  Solicitors requiring other reports will have to pay for the reports themselves and will only be re-imbursed if the case is successful.

Clause 26 Amendments -Common law damages claims for mental injury due to injury or death

A person who is injured as a result of a transport accident may not recover damages from a person indemnified by the Commission if—

(a)          the injury is nervous shock or other mental injury; and

(b)          the person was not directly involved in the accident and did not witness the transport accident; and

(c)          the mental injury or nervous shock was suffered as a result of the injury or death of another person who was directly involved in the transport accident; and

(d)          the transport accident was caused—

(i)            in the course of the other person referred to in paragraph

(c) committing, or intending to commit suicide; or

(ii)          solely or predominantly by the negligence of the other person referred to in paragraph (c).”

 

The Minister Second Reading Speech Commentary on Amendment 26

The bill will clarify that the injury or death of a person through suicide, an intention to commit suicide or predominately through their own negligence does not give rise to an action by another person for damages in respect of mental injury (including nervous shock) where the other person was not directly involved in or witnessed the transport accident.

ISSUES: The TAC has assured us this does not exclude first responders and will be implemented flexibly.  The usual benefits will be paid, this only refers to common law claims.

 

27 Amendments relating to serious injury applications

the definition of serious injury, a person has a severe long-term mental or severe long-term behavioural disturbance or disorder if that person, for a continuous period of at least 3 years—

(a)           has a recognised mental illness or disorder (other than abnormal illness behaviour) as a result of a transport accident; and

(b)           displays symptoms and consequent disability that have not responded, or have substantially failed to respond, to known effective clinical treatments provided by a registered mental health professional who is registered under the Health Practitioner Regulation National Law to practice (other than as a student); and

(c)           has severely impaired function with symptoms causing clinically significant distress and severe impairment in relationships and social and vocational functioning.”

 

The Minister Second Reading Speech Commentary on Amendment 27

 

As a community we know much more about mental illness than we did when the TAC scheme was established in 1986 . The government understands that  recovering from a transport accident can be a very emotional and challenging time.

This bill introduces clauses that set out clinical criteria of what constitutes a severe long-term mental or severe long-term behavioural disturbance or disorder for the purposes of serious injury.  This provision has been  developed in consultation with the Department of Health, including the chief psychiatrist.   The clinical criteria will encourage people who were directly exposed to a transport accident and who have suffered a recognised mental illness or disorder to seek treatment by a registered mental health professional, to improve their chances of getting their life back on track as soon as possible.

ISSUES: We have been assured that the retired, those out of the workforce and others will not be disadvantaged.  It has been recognized the no-one is a ‘qualified mental health practitioner’ but the explanatory notes from the TAC state that all but GPs and social workers will be included as treaters.  This begs the question of the status of GPs with mental health specialist qualifications.  We have also been advised that it is recognized that symptoms will fluctuate and this will not disadvantage claimants.  We will see!

.

A compilation of discrimination against people with psychiatric injuries in the various schemes in Australia and new Zealand

February 6, 2014

Discrimination against people with psychiatric injuries in various schemes used in Australia and New Zealand.

 This is going to be in the nature of a running blog as there are frequent changes leading to further discrimination.

In South Australia there is no lump sum payment for any permanent psychiatric injury in their WorkCover scheme.

In Queensland following a review significant changes were made effective from 29 October 2013.

Employment is to be ‘the major significant contributing factor’ for psychological or psychiatric claims. For physical injuries the definition remains unchanged stating ‘Employment to be ‘a major significant contributing factor’ for psychological or psychiatric claims’. Note the term ‘ the major significant contributing factor’, this is a much more stringemt test than a major significant contributing factor.

In Victoria in the WorkCover system the threshold for a permanent injury is 10% but 30% for any psychiatric injury. Similarly for a civil injury claim (Wrongs Act) claim to proceed it must exceed the threshold of 5% for a physical injury but more than 10% for a psychiatric injury and the psychiatric injury cannot be secondary to a physical injury.

In New Zealand  by contrast with the system in all the Australian states a person only has cover for a mental injury (defined as a clinically significant behavioural, cognitive, or psychological dysfunction):

because of physical injuries such as death of a person, physical injuries suffered by a person including  those arising from an accident, treatment, treatment for another physical injury and under certain circumstances gradual process, disease or infection or from cardiovascular or cerebral vascular event.

Crimes involving sexual assault that lead to a mental injury are compensable.  Suicide is excluded  suicide unless  the suicide was the result of a mental injury arising from a physical injury.

I will keep adding to this as I further examples of discrimination

 

 

Post-traumatic amnesia: Mechanisms, assessment and efficacy of early treatment following traumatic brain injury- an ISCRR report on new research

December 12, 2013

Post-traumatic amnesia: Mechanisms, assessment and efficacy of early treatment following traumatic brain injury

Project summary

Individuals with traumatic brain injury experience an initial period of disorientation and inability to lay down new memories. This is known as post-traumatic amnesia (PTA). Patients are generally given very little therapy while in PTA to minimise the risk of agitation. No studies have evaluated the effectiveness of therapy to enhance independence in activities of daily living during PTA.

Funding: $410,000. Funded under the ‘Bench to Bedside’ priority of the Neurotrauma Research Program

Chief Investigator: Professor Jennie Ponsford, Monash University

Commencement date: January 2014.
Anticipated conclusion date:  June 2017

Project Aim

To better understand the processes of assessing patients in Post Traumatic Amnesia (PTA) and to evaluate the effectiveness of therapy to enhance independence in activities of daily living provided during PTA.

Benefits of project

Current practice is to minimise therapy during PTA to avoid agitation. This project will explore whether additional therapy in this phase reduces PTA duration and the time to attain functional independence or whether current guidelines to avoid to non-essential therapy are appropriate.

Introducing daily living activities during PTA has the potential to reduce the length of stay in hospital and improve patient outcomes within three to five years.

Duration of PTA is the strongest injury-related measure of long-term functional outcome in survivors of TBI and long-term care costs. Given the importance of PTA as a prognostic indicator following TBI and current lack of understanding of PTA, in terms of both its processes and potential for benefit from therapy, the research will provide world-first invaluable evidence.

Pain and Pathos Dr Byron Rigby – Consultant Physician in Psychiatry

September 17, 2013

Byron Rigby has written an interesting paper on the relationship between depression/pathos and pain. The studies of pain have exploded in recent years but, frankly, I am more confused than ever.  Especially with regard to chronic pain and CPRS. I have included some excerpts from Byron’s paper.

Medical practitioners and healing professionals of all persuasions are endlessly called upon to treat pain, anxiety, depression, unhappiness, distress and suffering in all their combinations and kinds. Yet the subtle relationships between these experiences are seldom considered, and have only recently been subject to serious research.

In almost all languages, the words for physical pain and mental suffering are similar, or even the same. Our expressions of distress about them, including crying, tone of voice, withdrawal and mutual sympathy are also often nearly identical. The behavioural, social and pharmaceutical measures we adopt to ameliorate these experiences are also sometimes similar.

Language reflects connections between many experiential, cognitive and affective states that are increasingly being found to be neurologically grounded. We talk about someone or some event as a “headache”. A person or event that distresses us may be referred to as a “pain in the …. (neck, gut, etc)”. We routinely refer to “wounded pride”, “a broken heart,” “hurt feelings”, “painful memories”, etc. The wistful memory of past things is called “nostalgia” (“our pain”).

Words like “pathos” and “passion” have migrated across languages with meanings varying between emotional and physical pain. Languages are replete with synaesthetic references, the commonest of which deserve to be regarded as potential leads to neurological connections.