No-fault Compensation for Treatment Injury
in New Zealand: Identifying Threats to
Patient Safety in Primary Care

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

FROM:   British Medical Journal Quality & Safety 2011 (Jul); 20 (7): 587–591

Katharine Wallis, Susan Dovey

Department of General Practice and Rural Health,
Dunedin School of Medicine,
University of Otago, Dunedin, New Zealand.

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Background   In 2005, the injury compensation legislation in New Zealand was reformed to extend coverage for medical injury removing both 'error' and 'severity' from eligibility criteria. This led to an increase in claiming and claims acceptance rate, thus enlarging the treatment injury claims database. This database provides an unusual 'no-fault' perspective of patient safety events.

Methods   The authors analysed the first 4 years of primary care treatment injury claims data to identify the type, incidence, severity and cause of injury in primary care.

Results:   There were 6007 primary care treatment injury claims; 64% were accepted as treatment injuries. Most claims arose in general practice (62%), and most claimants were female (62%). Most claims were assessed as minor (83%), 12% major, 4% serious and 1% sentinel. Medication caused most injuries (38%) and most serious and sentinel injuries (60%). Dental treatment caused 16% of injuries; injections and vaccinations combined caused 10%; and venepuncture, cryotherapy and ear syringing combined caused 13.5% of injuries, mostly minor. 'Delay in diagnosis' caused few injuries overall (2%), but a disproportionate number of serious and sentinel injuries (16%) and deaths (50%). Spinal/neck manipulation caused 2% of serious and sentinel injuries.

Conclusions:   New Zealand's no-fault treatment injury claims database provides information about primary care patient safety events from an unusual 'no-fault' perspective. This analysis reinforces previous research identifying medication as a high-risk primary care activity and further identifies other primary care activities (dental care, injections, venepuncture, cryotherapy and ear syringing) as carrying important risks for patient harm.

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Breakdown of the Statistics:

4 years worth of claims included 6007 injuries -->  64% verified = 3844 injuries

Causes of any Injury (3844)
------------------------------------------------------------------------------------
 Medication    Dental    Venipuncture     Injections      Delayed      Spinal             
                         Ear Syringing    Vaccinations    Diagnosis    Manipulation
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     38%         16%     13.5%            10%              2%            2%--> only 81.5% 
   (1460)       (615)    (519)           (384)            (77)          (77)    accounted for.
------------------------------------------------------------------------------------


Assessment of those Injuries (3844)
---------------------------------------------------------
 Minor          Major          Serious          Sentinel*
---------------------------------------------------------
  83%            12%             4%               1%
 (3190)         (461)           (153)            (38)
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                                |            ↓          |
                                -------------------------
                                (191) or 5% of all these injuries are
                                rated as serious or sentinal
                                  60% caused by medication (115)
                                  16% caused by "delayed diagnosis" (31)
                                  50% of all deaths caused by "delayed diagnosis" (???)
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* A Sentinel Event is defined as any unanticipated event in a healthcare setting, resulting in death or serious physical or psychological injury to a patient or patients, not related to the natural course of the patient's illness.

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