New Zealand's National Artificial Limb Service (NZASL) is facing growing criticism from amputees who claim the service is failing to meet their needs. While the service reports 'incredibly high' satisfaction rates, several individuals have come forward to describe their experiences with delays, poor communication, and a lack of choice in prosthetic options. ### The Closed Contract System One of the most significant criticisms is that the NZASL operates under a 'closed contract' with ACC (the Accident Compensation Corporation), which effectively limits competition and innovation. Independent prosthetist Lizzy Carey, who runs her own business, X-Tremity Prosthetics & Orthotics, argues that ACC's funding for alternative providers is 'very limited,' with access to her services granted to less than 1% of amputees in the country. This has led to long waiting times and, in some cases, patients being left immobile for months. Carey highlights a case where she was asked to build a prosthetic for a patient who was waiting for an approved limb from NZASL. While she provided the limb to alleviate the patient's suffering, ACC refused to reimburse her for her work, stating that the limb centre had already decided on a different course of action. ### Patient Stories - **Blue Butler**, a 67-year-old builder, lost his leg 37 years ago and has been in constant pain for the past two years due to an ill-fitting socket. He described the situation as 'driving him mad' and noted that he has developed ulcers and is in significant discomfort. Despite multiple attempts to get the socket fixed, he feels his concerns have been ignored. - **Wayne Johnson**, who lost his arm in an industrial accident, expressed frustration with the lack of options provided by NZASL. He noted that during a visit to Australia for amputee golf, he discovered prosthetics and technologies that NZASL had never informed him about. - **Blue Butler** and **Wayne Johnson** both rely on independent prosthetist Lizzy Carey for their care, but they are unsure whether ACC will cover the costs. Carey believes that many amputees cannot afford to pay for her services out of pocket, leaving them trapped in a system that prioritizes a single provider over patient choice. ### The Health and Disability Act and Choice The Health and Disability Act in New Zealand states that patients should have the right to choose their healthcare providers. However, Carey argues that the current system does not truly offer this choice. She points out that while ACC allows patients to seek care from independent providers, the approval process is slow, and reimbursement is often denied. This, she says, is not 'real choice' and violates the spirit of the Act. ### NZASL's Response NZASL Chief Executive Sean Gray acknowledges the criticisms and welcomes the discussion. He stated that the organization is committed to continuous improvement and invited those with concerns to contact him directly. Gray emphasized that NZASL is at the forefront of prosthetic innovation in New Zealand, particularly in 3D printing technology for below-knee sockets. He also noted that the service regularly sends staff to international conferences and maintains strong relationships with high-tech component suppliers. ### ACC's Stance ACC has stated that any alternative funding for appointments or the supply of new prosthetics must first be approved. If approved, ACC may reimburse costs at its standard rate, but any extra charges are the client's responsibility. Unapproved items cannot be reimbursed. ACC Minister Scott Simpson described issues relating to service delivery as 'operational' and referred the Herald back to ACC. ### Conclusion While NZASL reports high satisfaction rates, the voices of those who have experienced significant delays and poor service are growing louder. The closed contract system and limited access to alternative providers appear to be at the heart of the issue. As more amputees become aware of the options available to them, the pressure on ACC and NZASL to reform the system is likely to increase.