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Finger pointed at Queensland Health as SMOs exonerated

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When the current Queensland Government unveiled controversial plans to force the State’s salaried medical officers (SMOs) onto individual contracts earlier this year, it used surprising allegations of impropriety against a small number of SMOs to justify the move.

The allegations came to prominence in two reports prepared and now released by the Queensland Audit Office (QAO) into private practice arrangements in Queensland public hospitals.

The first report was tabled in the Queensland Parliament in July 2013, and was prepared largely in response to a financial audit of private practice arrangements and alleged SMO impropriety which arose from it.

The second report was tabled in February this year, and looked at whether the intended health and financial benefits of Rights of Private Practice (RoPP) were being realised, whether RoPP were being administered efficiently, and whether practitioners were participating in full compliance with their contractual conditions.

Of great importance, the second report concluded, among other things, that basic administrative processes in certain areas had failed, that the responsibilities and requirements of those operating within these processes were unclear, and that allegations of misconduct are often based on a misapprehension by those making the allegation.

This report also concluded that lack of transparency regarding the private interests of SMOs was fuelling mistrust, and that the attendance patterns of some SMOs indicated that fatigue was not being managed effectively.

As is well known, last year, the Queensland Government began implementing a policy of forcing SMOs on to individual contracts, using these now repudiated reports to justify this move.

In January 2014, the QAO referred its second report to the Queensland Crime and Corruption Commission (CCC) to determine whether information it had obtained raised a suspicion of official misconduct and warranted investigation. The report identified 12 SMOs who were allegedly inappropriately treating and billing private patients in breach of their contracts.

The CCC engaged retired Supreme Court Justice Stanley Jones to independently review the information provided by the QAO, assess the allegations, and advise the CCC whether an investigation was warranted.

In relation to both sets of allegations, Mr Jones concluded that, while the material in some instances exposed conduct which justified the concerns raised by QAO, there was insufficient evidence of official misconduct to warrant investigation by the CCC.

Significantly, he found no evidence that the activities of the 12 SMOs identified in the report were dishonest or done so as to deliberately deceive hospital administrators. It was further found that some practices depended on the interpretation of contracts, and that different hospitals had adopted different interpretations of similar contractual terms.

The CCC accepted the assessment and determined not to investigate the matter further.

The Commission did identify information about two SMOs that it thought warranted further examination, but determined that these matters could be most appropriately dealt with by the relevant local Hospital and Health Service.

The results of these investigations highlight the profoundly misleading nature of the campaign conducted by the Queensland Government to justify the introduction of individual contracts, and the benefit of support from a relevant industrial organisation.

There are around 3000 SMOs working for Queensland Health, and it highly regrettable that the Government tried to use this material markedly out of proportion to its weight. The allegations involved a small number of SMOs, yet they were used to justify a try-on to cut the conditions of all of the hard working SMOs across the Queensland Health system, and undermine their good name.

The AMA considers that, as with any arrangement involving public money, RoPP must be conducted transparently and in full compliance of the law.  All Medical Practitioners must be answerable for their actions.

The independent review has now determined there was absolutely no substantive evidence that the doctors did anything but comply with the law.

Very specifically, AMA holds that administrative mismanagement on the part of any hospital or health authority does not mean doctors are acting inappropriately.

These investigations, conducted independently and at the highest levels by well-reputed investigators, have been thorough and are beyond question. 

The picture that has emerged is that of SMOs who work very long hours being caught up in the administrative deficiencies and misunderstandings of others, notably their directors. 

Inconsistent arrangements and a lack of clarity have not helped, with the SMOs doing their best in the circumstances. 

Yet these same SMOs now face the stress of negotiating individual employment contracts.

The Queensland Government no longer has any excuse to criticise SMOs regarding an entitlement to RoPP.

Any and all problems clearly lie at the feet of Queensland Health and hospital administrations.

While I hope you will never need it, industrial assistance can be obtained from your local AMA office, many of whom work co-operatively with the local employee union.

The full Queensland CCC report can be viewed at: http://www.ccc.qld.gov.au/research-and-publications/publications/ccc/ass…