I have this post up at my ACC blog

Section 26(3) of the Accident Compensation Act 2001 (ACA) makes it clear that personal injury does not include a cardiovascular or cerebrovasular accident/episode. There are however two qualifications to this:

1. where the cardiovascular or cerebrovasular episode is caused by physical effort or physical strain in performing his or her employment (the physical strain must be abnormal in application or excessive in intensity for the person concerned): and;

2. where the cardiovascular or cerebrovascular episode can be considered to be a treatment injury suffered by the person.

In O’Flaherty v ARCIC [1994] NZAR, it was held that the strain or stress causing the cardiovascular episode needed to be physical, not mental. In this case the appellant, a nurse at Rimutaka prison, was the subject of extreme verbal abuse and threats by an inmate. After this she experienced a myocardial infarction. Because the abuse was verbal, it made the stress mental or psychological rather than physical and therefore it could not be covered under the legislation.

What twaddle.

The adrenal gland sits on top of the kidney. The adrenal gland is actually two endocrine glands wrapped around each other. For my purposes here, the adrenal medulla secretes catecholamines [epinephrine, nor-epinephrine, and dopamine].

The catecholamines prepare the body for ‘fight or flight’ and target a number of effector organs and tissues in the body. Would it surprise you to find that one of the organs that is an effector for epinephrine, or its more commonly known name ‘adrenaline’, was the cardiac muscle?

Epinephrine binds to cardiac musculature and effects it in two ways: [i] it increases the strength or force of the contraction, [ii] it increases the rate of contractions. The sum total is that cardiac output is significantly increased.

A myocardial infarction is the bursting of a ventricle due to the death of cardiac muscle. What causes the burst? A rapid increase in cardiac output that overwhelms the adaptive ability of the tissues involved, viz, the cardiac muscle tissue.

The rise in epinephrine was caused by the verbal abuse and threats of the inmate. I have been to Rimutaka prison. It is medium/high risk prisoners. Its inmates are intimidating. I guarantee you that if you were verbally abused and threatened by one of these chaps your heart rate [due to an increased secretion of epinephrine] would significantly rise.

The response to the abuse was physical. It was causative of a rapid and significant increase in cardiac function, which overwhelmed the body’s adaptive ability.

The case was wrongly decided.