Doctor and activist

Classification of Impairment

4 April 2023

I was lucky enough in my surgical training years to have most of a year working as neurosurgical registrar for Dr John Grant.  He set up the 1st spinal Injuries Unit  in Australia saying that while everyone was looking for a miracle cure that would allow injured spinal tissue to repair, most paraplegics were dying of bedsores or infections coming up their urinary catheters and much better practices and training was needed.

He went to England in 1960 and with Sir Ludwig Guttman started the Stoke Mandeville games, the precursor of the Paralympics. He developed the Paralympic Games to help his patients, who were mostly young men whose lives had been shattered after a catastrophic injury, often after doing something daring or unwise.  Wheelchair athletics was a major part of this, as it gave the young paraplegic people something to strive for.  John Grant became head of the Australian Paralympic movement and Chair of the Organising Committee of the Sydney 2000 Paralympic Games.  My part was merely to help treat the spinal patients. 

Later I moved into occupational medicine so as to fund my work in the anti-tobacco movement.  There I found impairment from workplace injury and had to decide who could work and who could not. This got a nasty edge to it as insurers wanted people classified as fit, so that if they would not work their pay could be suspended.  The Courts argued about this until the legal process was deemed so expensive that the American Medical Association worked with the insurance industry to devise a complicated medical examination which measured ‘Whole Body Impairment’  as a percentage.  This was not supposed to simply translate simply into how much money an injured person was awarded, but of course that is exactly what happened. Since pain cannot be measured it had to be left out of the calculation, so you can have terrible pain, but if you have only lost a few measurable degrees of back movement, your percentage impairment may be minimal.  The system also makes no distinction between an impairment and a disability. If you are a labourer and have a lower body injury and cannot work at all or are someone who works at a desk and can maintain their previous income, the impairment is the same.  I have never learned the details of the system, as I think it a bad farce, but it is used to assess impairment in Australia, makes a lot of money for the doctors who do the medicals, and saves the insurers a fortune.  Of course there are few who try to fake injury, but in my experience this is fairly rare, far rarer than insurance companies would  have you believe.

But making an objective assessment of what a person can and cannot do is not easy, and so one is to pity the classifiers who want a level playing field by classifying people for the Paralympic Games. Given that each country wants to pick a team of winners and they classify their own athletes, it is little wonder that in some countries ‘intellectually disabled’ are as smart as anyone else, or that you cannot even notice a limp in some of the runners.

The 4 corners of Monday 2 April looked at the whole Paralympic Classification system and produced damning figures that 10 of 12 of the gold medal winning Spanish basketball were not disabled at all, and that in some areas 69% of the winners had minimal disability.

As this sad farce continues there is a huge kerfuffle lest the tiny number of trans athletes with the genetic advantage of having had male hormones might get an advantage over females.

John Grant must be turning in his grave.

Arthur Chesterfield-Evans

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