- Email: [email protected]
Mistakes and compensation in NZ
input to forum considerations". essentially indicates Ottawa is now pre: The federal government will also keep a pared to plough ahead with the forum, : irrespective of provincial objections, given firm grasp over forum membership, the need to generate new "ideas and selecting and confirming through the advice" about the operations and financsummer. However, the provinces "have ing of the health-care system. In the long been asked to provide membership ’, run that may prove difficult, since the suggestions". In a background paper, Ottawa notes provinces are responsible for the administration of health care and Ottawa is essenthat the subjects that the forum "might" : address could include: "the policy implitially a passive funder. But Ottawa is leaving the door open for cations of the health determinants provincial participation. A September approach; the impact of technology on the gathering of the nation’s health ministers health system; the impact of an aging soci"could" involve "further review and dia-
logue regarding the forum". Provincial participation may also take the form of regional conferences, which some ministers have "expressed interest in holding". Marleau says she would be "pleased" to co-chair the gatherings, which "would provide opportunities for future public
Mistakes and
compensation in NZ
:
: Wrong diagnoses by an ailing pathologist at the provincial Wanganui Hospital have: exposed serious inadequacies in standards set for testing laboratories. The pathologist, believed to have Parkinson’s disease,: made errors in over 50 cases, and review of his work instituted by his employer, the crown health enterprise (CHE) Good Health Wanganui, has now extended back: to 1989. So far the review has revealed: that around 8 patients had unnecessary cancer treatment
including mastectomies,
while the same number were erroneously : given the all clear. This case has highlighted the lack of quality control and accreditation in labo- : ratories. The pathologist worked alone: and the CHE admits it had "no checks on this pathologist’s work". Laboratories can : be accredited by the Testing Laboratory: Registration Council of New Zealand: (TELARC). This sets standards for such: aspects as management, peer review, staff qualifications, and internal and external quality control. But only 45% of public
hospital laboratory complexes are regis- : tered for one or more fields of testing. Just over 70% of private community laboratory complexes are TELARC registered. ;: Not all pathologists belong to the Royal College of Pathologists of Australasia,: which will inaugurate compulsory peer : review and continuing medical education
Recommendations that metered dose inhalers (MDIs) for pulmonary disease be temporarily exempted from a Montreal Protocol agreement to cease production of chlorofluorocarbons (CFCs) by Jan 1, 1996, will be considered by a full meeting of parties to the protocol in October. The protocol is an international treaty to phase out ozone-depleting substances, and under the Copenhagen amendment developed country parties to the protocol are due to cease production of CFCs by 1996. However, the amendment allows temporary CFC production exemptions for "essential uses" according to strict criteria: * Necessary for health/safety or critical functioning of society No technically and economically feasible alternatives All feasible steps taken to minimise the essential use and associated emissions * Insufficient supplies available from
ety on the health system; unancing the health system of the future; long-term/ systemic issues related to drugs; the usefulness of national health goals; and research priorities to support health system renewal".
Wayne Kondro
laboratories servicing the National Cervical Screening Programme "should be" . TELARC registered. : stock-piling or recycling. MDIs for pulmonary disease have been New Zealand’s health reforms are around for about 35 years and have focused on structural changes and costcontainment. The current furore indicates proved safe, effective, not too expensive, that improving health-care standards may and are liked by patients. However, they have been side-lined in the process. : contain CFCs 11 and 12. Requests from The Wanganui case also exposes the seventeen countries for exemptions from CFC production beyond 1996 for MDIs gross limitations of the Accident Rehabiliwere assessed earlier this year by two tation and Compensation Insurance Act, United Nations Environment Commitwhich replaced New Zealand’s intemathe Technical Option Committees. Both tionally admired accident compensation tee (TOC) and the Technology and system in 1992. The Wanganui cases may Economic Assessment Panel (TEAP) well be covered by the act, but the comrecommended acceptance of unanimously pensation available is now worth the MDI as an essential use, for all counLoss of comnothing. earnings may be tries for exemption in 1996 nominating but pensated, lump-sum payments for and some countries for 1997. These and and loss of funcpain suffering bodily tion have all been abolished. A disability: exemptions would require an estimated 13 allowance is available, but strict criteriathousand tonnes of CFC for 1996 (world apply. Only those with severe injuries such: CFC production was approximately 1 million tonnes in 1986). This recommenas paraplegia would qualify for the maxi: mum of NZ$40 weekly. : dation was presented to the Open Ended In a recent similar case involving the Working Group (the planning meeting for : the Parties) in Nairobi on July 6 and same CHE, a woman who had her breast unnecessarily removed on the basis of a endorsed for consideration by the full fine-needle aspiration alone was told by meeting in October. Two major strategies should be the accident compensation corporation: to reduce dependence on CFC : employed that it would her case, but (ACC) accept in MDIs. In the short term, the TEAP : it would pay only$1687 towards the a major effort from governrecommended $6000 cost of breast reconstruction. To ments and the pharmaceutical industry to add insult to injury, the ACC said it: inform and physicians of alternapatients : would require her to be assessed by a psytive inhaled therapy, including drug powchiatrist first. : Because of cases such as this, the ARCI : der inhalers (DPIs). However DPIs Act is widely viewed as inhumane and: comprise only 15% of the approximately unjust. Ironically, the new act was pro- : 400 million inhalers manufactured each moted by Mr Bill Birch, the then Minister year and are not available for all drugs in : : all countries or suitable for all patients. of Labour, as a "fairer scheme". ACC coverage prevents a person being Thus, MDIs are still likely to remain an able to sue. In the current case, the CHE important mode of inhaled therapy. In the medium term, the pharmaceutical induscan hide behind the legislation, and avoid: : try has been trying to develop non-ozoneits financial for omissions. any liability depleting propellants for MDIs (mainly There is a growing call for the right to sue hydrofluoroalkanes 134a and 227). Since to be restored. the new propellants have different chemi: cal properties from CFCs, each individual
in 1995, and successive governments have stalled plans to require doctors to re- : license every five or ten years. : The neglect of laboratory standards is : evidenced at all levels. The purchaser of : Good Health Wanganui’s laboratory ser- : vices, the Central Regional Health: Authority, did not require TELARC accreditation in its contracts, and the Minister of Health’s recent Policy Guidelines for Regional Health Authorities makes scant mention of laboratories. OnlySandra
182
CFCs and inhalers
virtually
Coney
. drug requires reformulation, toxicology
logue regarding the forum". Provincial participation may also take the form of regional conferences, which some ministers have "expressed interest in holding". Marleau says she would be "pleased" to co-chair the gatherings, which "would provide opportunities for future public
Mistakes and
compensation in NZ
:
: Wrong diagnoses by an ailing pathologist at the provincial Wanganui Hospital have: exposed serious inadequacies in standards set for testing laboratories. The pathologist, believed to have Parkinson’s disease,: made errors in over 50 cases, and review of his work instituted by his employer, the crown health enterprise (CHE) Good Health Wanganui, has now extended back: to 1989. So far the review has revealed: that around 8 patients had unnecessary cancer treatment
including mastectomies,
while the same number were erroneously : given the all clear. This case has highlighted the lack of quality control and accreditation in labo- : ratories. The pathologist worked alone: and the CHE admits it had "no checks on this pathologist’s work". Laboratories can : be accredited by the Testing Laboratory: Registration Council of New Zealand: (TELARC). This sets standards for such: aspects as management, peer review, staff qualifications, and internal and external quality control. But only 45% of public
hospital laboratory complexes are regis- : tered for one or more fields of testing. Just over 70% of private community laboratory complexes are TELARC registered. ;: Not all pathologists belong to the Royal College of Pathologists of Australasia,: which will inaugurate compulsory peer : review and continuing medical education
Recommendations that metered dose inhalers (MDIs) for pulmonary disease be temporarily exempted from a Montreal Protocol agreement to cease production of chlorofluorocarbons (CFCs) by Jan 1, 1996, will be considered by a full meeting of parties to the protocol in October. The protocol is an international treaty to phase out ozone-depleting substances, and under the Copenhagen amendment developed country parties to the protocol are due to cease production of CFCs by 1996. However, the amendment allows temporary CFC production exemptions for "essential uses" according to strict criteria: * Necessary for health/safety or critical functioning of society No technically and economically feasible alternatives All feasible steps taken to minimise the essential use and associated emissions * Insufficient supplies available from
ety on the health system; unancing the health system of the future; long-term/ systemic issues related to drugs; the usefulness of national health goals; and research priorities to support health system renewal".
Wayne Kondro
laboratories servicing the National Cervical Screening Programme "should be" . TELARC registered. : stock-piling or recycling. MDIs for pulmonary disease have been New Zealand’s health reforms are around for about 35 years and have focused on structural changes and costcontainment. The current furore indicates proved safe, effective, not too expensive, that improving health-care standards may and are liked by patients. However, they have been side-lined in the process. : contain CFCs 11 and 12. Requests from The Wanganui case also exposes the seventeen countries for exemptions from CFC production beyond 1996 for MDIs gross limitations of the Accident Rehabiliwere assessed earlier this year by two tation and Compensation Insurance Act, United Nations Environment Commitwhich replaced New Zealand’s intemathe Technical Option Committees. Both tionally admired accident compensation tee (TOC) and the Technology and system in 1992. The Wanganui cases may Economic Assessment Panel (TEAP) well be covered by the act, but the comrecommended acceptance of unanimously pensation available is now worth the MDI as an essential use, for all counLoss of comnothing. earnings may be tries for exemption in 1996 nominating but pensated, lump-sum payments for and some countries for 1997. These and and loss of funcpain suffering bodily tion have all been abolished. A disability: exemptions would require an estimated 13 allowance is available, but strict criteriathousand tonnes of CFC for 1996 (world apply. Only those with severe injuries such: CFC production was approximately 1 million tonnes in 1986). This recommenas paraplegia would qualify for the maxi: mum of NZ$40 weekly. : dation was presented to the Open Ended In a recent similar case involving the Working Group (the planning meeting for : the Parties) in Nairobi on July 6 and same CHE, a woman who had her breast unnecessarily removed on the basis of a endorsed for consideration by the full fine-needle aspiration alone was told by meeting in October. Two major strategies should be the accident compensation corporation: to reduce dependence on CFC : employed that it would her case, but (ACC) accept in MDIs. In the short term, the TEAP : it would pay only$1687 towards the a major effort from governrecommended $6000 cost of breast reconstruction. To ments and the pharmaceutical industry to add insult to injury, the ACC said it: inform and physicians of alternapatients : would require her to be assessed by a psytive inhaled therapy, including drug powchiatrist first. : Because of cases such as this, the ARCI : der inhalers (DPIs). However DPIs Act is widely viewed as inhumane and: comprise only 15% of the approximately unjust. Ironically, the new act was pro- : 400 million inhalers manufactured each moted by Mr Bill Birch, the then Minister year and are not available for all drugs in : : all countries or suitable for all patients. of Labour, as a "fairer scheme". ACC coverage prevents a person being Thus, MDIs are still likely to remain an able to sue. In the current case, the CHE important mode of inhaled therapy. In the medium term, the pharmaceutical induscan hide behind the legislation, and avoid: : try has been trying to develop non-ozoneits financial for omissions. any liability depleting propellants for MDIs (mainly There is a growing call for the right to sue hydrofluoroalkanes 134a and 227). Since to be restored. the new propellants have different chemi: cal properties from CFCs, each individual
in 1995, and successive governments have stalled plans to require doctors to re- : license every five or ten years. : The neglect of laboratory standards is : evidenced at all levels. The purchaser of : Good Health Wanganui’s laboratory ser- : vices, the Central Regional Health: Authority, did not require TELARC accreditation in its contracts, and the Minister of Health’s recent Policy Guidelines for Regional Health Authorities makes scant mention of laboratories. OnlySandra
182
CFCs and inhalers
virtually
Coney
. drug requires reformulation, toxicology