A lawyer says the government's artificial limb service needs an overhaul because amputees in New Zealand are receiving substandard treatment compared with other countries.
There are about 4000 amputees in New Zealand, the majority of whom are under the care of the New Zealand Artificial Limb Service (NZALS) - the only provider with contracts with district health boards and ACC.
But some amputees have refused to be treated by the Crown agency, saying despite spending years in its care, they never got limbs that fit properly.
Lawyer Martha Coleman, who represents a number of amputees, said some prosthetists did not have the skills required and were underqualified to do the job of a clinician.
About 50 percent of NZALS's prosthetists - the people who evaluate, fabricate and fit artificial limbs - hold degree qualifications. The rest hold diplomas.
In countries like Canada, the United Kingdom and the United States, prosthetists are required to hold at least a degree.
"If other jurisdictions believe that a degree, or in the case of North America, a post-graduate degree is the minimum qualification, it is unfathomable why it should be a lesser qualification in New Zealand," Ms Coleman said.
"The answer must be that they're not doing a good enough job, and it's got to change."
Ms Coleman has written to ACC, the Health Minister and Social Development and Disabilities Minister Carmel Sepuloni, requesting they make it mandatory for prosthetists to hold a degree.
While nurses, physiotherapists and doctors were all required to hold a degree qualification, she said there was no reason why the prosthetic industry should be any different.
"Those with degrees should be able to do the more advanced work."
Ms Coleman was also calling for the industry to be regulated under the Health Professionals Competency Assurance Act.
The industry is self-regulated by New Zealand Orthotics and Prosthetics Association, which appoints members with degrees and diplomas, unlike Australia, where those with diplomas can still practice but struggle to access funding.
NZALS chief executive Sean Gray said while his staff hold a mix of diplomas and degrees, they were all qualified to work with amputees.
"There are no people on our team who are not qualified to do the job," Mr Gray said.
"Everybody has qualifications, and in saying that a large part of our prosthetists are polytech or CIT qualified and I believe that those types of qualifications all New Zealanders should be able to rely on them now and into the future. That part of my workforce is doing a great job."
A diploma in prosthetics was offered in New Zealand in the past, but there is now no degree or diploma offered here, which means New Zealand is increasingly reliant on an international workforce.
Checkpoint has spoken to several amputees who, after years under NZALS' care, have refused to return and ACC eventually agreed to send them to one of the few private providers in the country.
Robinoneleg Robinoneleg says he never had a leg that properly fit him in 20 years of being an amputee. Photo: RNZ / Richard Tindiller
Robinoneleg Robinoneleg, who legally changed his name after losing his leg in a car accident 20 years ago, said he never had a leg that properly fit him.
"I have never had a fitting, comfortable socket inside this country in 20 years of being an amputee. It has given me ulcers, pain, suffering and not even the ability to walk without excruciating pain."
Like many amputees, his care is funded through ACC, which has only ever contracted the NZALS as a provider for prosthetic services.
Mr Robinoneleg said he was forced into the system because as a Ministry of Health or ACC amputee client, NZALS was the only option.
"I'm just one amputee in the 4000, from what I believe there are many amputees in this position and many of them have got to the point where they are fed up with having to waste their time going to a limb centre, wherever it may be, and not actually walking away comfortable and happy."
Mr Robinoneleg needed a new leg about a year ago and said NZALS tried, but failed to make one that fit properly in that time.
"I have been on relatively strong painkillers, just to be able to survive with the pain and the suffering and the stress that I'm under," he said.
"I use a wheelchair … I have home help provided to me by ACC because I'm not in a position where I'm capable to do it all on my own without a fitting prosthetic leg."
His request to be seen by a private provider was approved last month, but it took 20 years to get to this point, he said.
ACC's latest contract with NZALS has been in place for a decade, but it is now re-designing it and plans to put it out to tender next year.
Mr Gray said his staff worked closely with universities and academia to integrate their innovative thinking.
"The whole team, I'll put my hand on my heart and say, we come in everyday to help people but when we hear these stories that are isolated and few, they're really disappointing to the whole team," Mr Gray said.
"We do our best every day to make sure we are up to date on our training, that we know what new technologies are out to help them."
Minister of Health David Clark said he was considering a response to Martha Coleman's letter, and would not comment in the meantime.
Minister responsible for NZALS Carmel Sepuloni said she was also considering a response to the issues raised by Ms Coleman and declined an interview.
However, in a statement she wrote: "I've received a letter from a lawyer representing amputees questioning the standard of care amputees received from the NZALS, and raising concerns regarding standards here versus overseas.
"These concerns are complex and require careful consideration. I will respond to the lawyer once I have thoroughly explored the issues raised with me, and will not be commenting further until that time."
