Patient with disabling arthritis loses bid for NDIS access

A woman who is confined to a hospital bed due to morbid obesity and chronic disabling osteoarthritis (OA) of the knee has been deemed ineligible for the National Disability Insurance Scheme, after a tribunal ruled her impairments could be medically treated.

The decision was handed down by the Administrative Appeals Tribunal (AAT) in response to an appeal on behalf of a NSW woman who had morbid obesity, bilateral knee arthritis, scoliosis and ventral hernia.

In 2017, the NSW woman’s request to access the NDIS was rejected on the grounds that she did not meet the eligibility criteria of having a permanent impairment that could not be managed through other systems.

The tribunal heard that the woman had been placed on an medically-supervised weight loss regime consisting of shakes and clear liquids after a stint in hospital due to small bowel obstruction. It was also recommended that she attend a metabolic clinic and consider bariatric surgery, with a rehabilitation plan to commence if she lost weight.

After returning home, the woman had to use a wheeled walker to get around and needed help getting in and out of bed and with self-care and domestic tasks. But transport problems prevented her from attending the medical appointments with the metabolic clinic, rheumatologist and bariatric surgeon. The woman’s daughter told the tribunal that her mother’s wheelchair could only fit in a bariatric ambulance.

Things became even more difficult when the woman moved into a new property with steps at the front entrance. The woman could not navigate them and became housebound.

In January 2018, the woman was admitted to hospital with abdominal pain, where she required three people with sling hoist transfers to get her from the bed to wheelchair.

There it emerged she had been bedbound for the past eight months, rendering her unfit for rehabilitation.

The tribunal was told that the woman remained as an inpatient at the hospital “due to the lack of services that are necessary to support her to live an ordinary life”.

According to a report by an occupational therapist, the woman improved each time she stayed in hospital, but deteriorated after she went home, with poor adherence to the interventions recommended by her care team perpetuating the cycle.

Considering the requirement for 24-hour assistance, her current care needs “may be best met by increased services in the community or in a facility which can provide her with 24 hour care”, the tribunal heard.

In her application to the NDIS, the woman’s daughter said doctors had advised her mother was too overweight to have gastric band or knee surgery.

She sought access for her mother to the NDIS to provide home modifications and support from a dietician and physiotherapist.

But in a decision on March 6, the tribunal ruled that there could be medical treatments to remedy the woman’s impairments, suggesting they were not permanent.

It noted that chronic osteoarthritis was recognised as a disability by the NDIS, but there was a question of whether treatments were available to improve it.

“The medical evidence shows there may be treatments to remedy the applicant’s impairments of osteoarthritis and morbid obesity. I am not satisfied either of these impairments are permanent,” the tribunal  chair said.

There was also no evidence the woman was still sticking to a weight-loss diet and there was minimal medical evidence regarding the potential for her to undergo gastric surgery, the tribunal found.

“I am satisfied that the applicants impairments are health conditions that are most appropriately treated and provided for through the health system,” the tribunal concluded.

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