KEY POINTS:
Lisa Clarke doesn't have much good to say about ACC. Actually, that's not quite true. She doesn't have anything good to say.
She's not alone.
Clarke was hit by a logging truck in 2002 in Woodville Forest outside Auckland. Struggling to survive was one thing. Struggling with ACC, she says, was a whole other trauma.
The truck sent her flying and left her bleeding and broken 100m from where she had been standing off the side of the road waiting for motocross friends to catch her up.
The truck's trailer "scooped me up and shuttled me down the road into a steel pole that was there to secure a steel gate and I smashed my head on that.
"The logging truck took out a piece of my left leg and the fence post broke my neck."
There were other injuries but you get the picture. Clarke was a mess.
A three-week coma and three months of hospitalisation were followed by extensive rehabilitation and plastic surgery.
Her comeback from near death was so extraordinary she featured in the TVNZ series The Survivor Files about the remarkable victims of terrible accidents.
The programme showed her fight for survival but behind the scenes her physiotherapist, Murray Hing, was having another fight with ACC over her physiotherapy treatments.
Hing and other physiotherapists have been staging this fight for a long time. They say their profession is in crisis and that patients are suffering.
Among the concerns at issue is a relatively new ACC system of how physios are paid.
The profession is divided over the scheme but physiotherapists who are opposed to it say ACC has resorted to bullying tactics to force them to sign.
They won't yield and in an effort to be taken seriously on a range of issues they are seeking political help.
They went to New Zealand First's ACC spokesman Peter Brown, who was astonished at what he heard.
Physiotherapists, he told the Weekend Review, are not a militant bunch "but I can tell you from some of the stories they're telling me they're feeling pretty darn awful".
Brown was so concerned he made sure that a review of the way physiotherapy services are funded and accredited by ACC was included in the Confidence and Supply Agreement between the Government and NZ First after the last election.
That review, headed by QC David Goddard, is under way and has received a number of submissions - but physiotherapists say it is the tip of a very large iceberg.
Comments made to the Herald, not always on the record, include that rather than opening a can of worms "it's a 40-gallon drum", "bigger than Erebus" and "bigger than the Winebox".
The current review is examining methods of payment for physiotherapy. Still to come, say physiotherapists, are various judicial reviews into aspects of ACC. And also imminent is another inquiry, headed by another QC, into the treatment of a woman who slipped in the shower.
Allegations include systemic failure, bullying and the falsification of evidence by ACC staff.
The crux of the payment inquiry is a new system of payments called Endorsed Provider Network, or EPN which was introduced by ACC in 2002.
Many senior physiotherapists, including those at the top of their game who treat Olympic-level athletes and other elite sportspeople, say this system puts financial goals ahead of patient ethics.
They say it changes the patient/physiotherapist relationship because instead of being contracted to the patient, EPN physiotherapists are contracted directly to ACC.
ACC, they claim, has total control over the physiotherapist. Those who join EPN receive a higher fee per treatment (at $35) but that's the limit and they cannot charge further.
Under the old regulated system, physiotherapists receive $19 per treatment but can charge extra.
Senior physiotherapists choosing to stay under the regulated system say if they join EPN they would get the same amount as a new graduate despite their years of experience and expertise.
They believe in some cases their practices may not survive.They say as patients flock to the EPN clinics, some physios are having to close their doors in a profession already short of practitioners.
They say that for EPN clinics to survive, physiotherapists have to churn through more patients to bring up their hourly wage and their concern is also the effectiveness of treatment, or lack of it, under the new system and a dumbing down of the profession.
Criticism is also levelled at the number of treatments patients are allowed for different injuries. Under an injury-profile system a particular injury is graded and a certain number of treatments allocated.
But physios say this takes no account of the range of severity of an injury in a category. A sprained ankle, for example, is treated the same regardless of how bad it is.
While they can apply for extra treatments, they say it is a fight to get them.
Lisa Clarke's physiotherapist, Murray Hing, a senior physiotherapist in Northcote who works with athletes and the public, was one of the physiotherapists who stood up publicly and spoke out against EPN.
There were consequences, he says, and believes it was no coincidence that shortly afterwards, his clinic of eight physiotherapists was audited by ACC's fraud unit.
Other physiotherapists also say they have been investigated by the fraud unit after speaking out.
ACC said Hing's was simply a random audit, but he believes there was nothing random about the fact all his physios were audited. Nothing was found.
"It's almost like standover Nazi tactics on the physio profession ...
"There's a whole lot of things which go on within this corporation which no one knows about."
Hing cites Lisa Clarke's case as an illustration of some of the problems. Even though she had a broken neck, broken pelvis, broken leg, broken ankle and broken arm, he had to continually fight for her "sending screeds and screeds of notes and evidence just to get additional treatment. And when they gave additional treatment they'd give me six [treatments] saying this is above the treatment numbers that our statistical research data has come up with."
Clarke says she received her treatments in the end but it was a hard fight and applied to every injury she had. She says the system of allocating treatments is "stupid".
"To give someone x many treatments for a neck whether it be broken, strained or just sore is kind of pathetic. It should be assessed on an individual basis. It sets you back because you've got other things to worry about, then you start worrying about your payments ... "
She is also highly critical of ACC case managers who dealt with her. At times she was made to feel like a criminal trying to scam the system. She says she was treated like "damaged goods".
Malcolm Hood, spokesman for the New Zealand Physiotherapy Trust, says he was another who was investigated for fraud.
Physiotherapists are leaving the country and leaving the profession, he says. "It's been extraordinary. We've got a 90 per cent loss of physiotherapists by the age of 50 from the profession."
Another submission to the review concerns Val Forster. She is the woman who slipped in the shower, and is the subject of another upcoming inquiry. Her son Warren Forster dedicated himself to her case after growing alarm at how she was being treated.
Forster says he has spent the last 18 months researching ACC and has written an 1800-page report for the inquiry into her case, claiming he has identified hundreds of systemic failures.
Mrs Forster slipped in the shower in her Whangarei home in 2005 and damaged her hip. She spent 18 months on strong drugs and in agony. Her son says she was allowed 12 physiotherapy treatments but no more. He put in a review application and says evidence was falsified.
Mrs Forster now lives in Australia. "I don't think I'll be coming back to New Zealand, no," she said on the phone. "I loathe ACC with a vengeance. They've ruined my son's life and ruined our life and I don't really want to have anything to do with them again.
"Most people who are like I was, totally out to it on drugs and pain - you can't cope and you're forced into such a corner; you wonder how the hell you're ever going to get out of it."
Mrs Forster has worked as a volunteer for agencies such as the United Nations and says she has never had time off, that she was - is - a good citizen.
"To be treated the way I was was just appalling, absolutely appalling."
ACC staff were contemptuous and extremely arrogant, she says. She wants them held accountable and she wants an apology.
Warren Forster accuses ACC of falsifying evidence, conflicts of interest and breaches of principles of natural justice. ACC says they cannot comment on an individual case.
* To read the submissions so far go to: www.dol.govt.nz
ACC backs review, but says patients must come first
In response to complaints by some physiotherapists about their treatment, the ACC says it is fully committed to the review being conducted - but will not litigate the process through the newspaper.
However, spokesman Laurie Edwards makes a number of points.
He says the multibillion-dollar corporation deals with 1.7 million claims a year and funds around 2.6 million physiotherapy visits a year.
Spending on physiotherapy has been increasing with an increase in claims. In June 2004 there were around 60,000 claims but now there are more than 80,000.
Out of all claims, a few thousand people may not agree with a decision but very few are about physiotherapy.
Edwards says that although the Endorsed Provider Network (EPN) system is part of the review, both it and the physiotherapy payment profiles were developed by ACC and physiotherapists.
"We didn't just impose these things on them, [there was] the usual Government process: you make a working party, you develop something everyone's happy with, you go out and consult on it and everyone's happy, you push the button and away you go."
Edwards says ACC does not set the number of physiotherapy visits: "We're not a gatekeeper on the physios, so people don't have to ask our permission to get physio. You don't have to go to a GP, you can walk straight into a physiotherapist and they themselves can assess whether you have an ACC claim or not and can send in the forms themselves."
ACC becomes involved when a physiotherapist wants to go over the specified number of treatments and this is usually approved. ACC staff are not medical clinicians, he says.
"If they [physiotherapists] come and say, 'Look, I'd like to go over the agreed number of treatments because of x, y and z', well, who are we to argue?"
ACC acknowledges physiotherapists derive much of their income from ACC work but Edwards points out they also have businesses to run.
"I guess, from ACC's point of view, we would resist the suggestion sometimes made that we're responsible for supporting their businesses. We're not. The role of ACC is to help injured people, not support physiotherapy as an industry."
Told that some physiotherapists say their industry is in crisis, Edwards says: "They may be right. The question becomes though, is that ACC's responsibility? Is it our responsibility to be the guardian of the physiotherapy industry, or is it our responsibility to make sure that injured people get the service they need?"
On bullying, he says that if ACC finds any evidence of this it will be dealt with very seriously.
"There's no place for that at ACC at all."
Regarding fraud investigations generally, he says the fraud team is separate from the rest of ACC and looks for what is called "outliers".
This is a business which may be showing a trend outside what is considered normal, for example, a clinic putting through a lot more claims than another clinic of the same size. This has nothing to do with whether a physiotherapist belongs to EPN.
"There are many physios in New Zealand who aren't in the EPN and very few of them are being investigated for fraud."
Edwards says ACC cannot comment on individual cases but points out that Lisa Clarke and Val Forster are two cases out of 80,000 people who receive treatment.
"I'm not being facetious ... I'm just saying you've got a long way to go before you start to make a scratch on 80,000."
It is a "long stretch of the bow" to say that because someone has a difficult time there is something wrong with the process.
People have recourse to independent reviews and if not satisfied can go all the way to the Court of Appeal.
"You'd also have to say in the vast majority of cases the courts uphold our decision because we're a creature of statute.
"We do what the law says and people sometimes think the way to change the law is to challenge the organisation that implements it, [but that's] not the way to change the law.
"If you want to change the law you've got to go to the Beehive and get those people to change the law. We just do what the law says.
"What I'm saying is that we are governed by a statute, there are profiles. The physios don't have carte blanche to do whatever they like, whenever they like.
"As an organisation ACC has to be a good steward of levy-payers' money and we have to balance that with our probably more pressing duty which is to help injured people."
ACC is not perfect, he says, but people often find it difficult to distinguish between what they want and what ACC is able to give.
"It's no consolation to individuals but I do think sometimes people do need to actually be thankful for what they've got, because if you're in the same situation in Australia, America, the UK, or anywhere else, you wouldn't be getting a bean.
Dr Kevin Morris, ACC's director of clinical services, stresses that physiotherapy is an important part of a patient's rehabilitation - and EPN has been brought in to ensure patients have access to free treatment.
"I think that's something we've seen patients all around the country appreciate, the fact that they can get physiotherapy at no cost to themselves.
"It's definitely not [about] cost-saving. The fact that we've gone from paying a regulated amount to paying the full cost wasn't ever going to save us any cost."
The Minister for ACC, Ruth Dyson, would not comment while the review is going on but said through a spokesperson that the final report is due in September.
