MEDICAL practitioners are very familiar with the concept of accountability. Whether we work in private practice, community practice or hospitals, we are subject to a structured regulatory system.
Formal complaints are assessed and acted upon, resulting in sanctions where appropriate. In NSW, a separately administered Health Care Complaints Commission (HCCC) is involved in a coregulatory model with the NSW board of the Medical Board of Australia.
The HCCC was in the NSW Supreme Court late last month supporting the principle of accountability — not the accountability of doctors or nurses this time, but of an anti-vaccination organisation.
In July 2010, following investigation of a complaint, the HCCC issued a warning against an anti-vaccination group calling itself the Australian Vaccination Network. The HCCC found that the AVN “misleads readers by using reliable and peer-reviewed research, but quoting selectively from it, often in contradiction to the conclusions or findings of the studies themselves”.
When the AVN failed to comply with the HCCC’s recommendation to post a warning on its website, the HCCC issued the following warning against the AVN: “The AVN’s failure to include a notice on its website of the nature recommended by the Commission may result in members of the public making improperly informed decisions about whether or not to vaccinate, and therefore poses a risk to public health and safety”.
The AVN’s action in the Supreme Court questioned the HCCC’s jurisdiction over it. According to Section 7 of the Health Care Complaints Act 1993, the requirement for a complaint to be made about a health service includes “(b) a health service which affects the clinical management or care of an individual client”.
The Supreme Court judge found that the AVN did supply a “health service”, but that had not been shown to affect the clinical management or care of an individual client. It was therefore found that the HCCC had no right to issue a warning against the AVN.
The finding of the Supreme Court says nothing, however, about the quality of information provided by the AVN. As noted by research scientist and commentator Dr Rachael Dunlop, “There is no suggestion that the AVN’s information can now be declared scientifically valid and accurate”.
What mechanisms are left, then, to hold the AVN to account? How can unregistered providers of “health care information” be held accountable for the information they disseminate?
Since August 2008, the HCCC’s powers in relation to unregistered health practitioners have been broadened under the Health Legislation Amendment (Unregistered Health Practitioners) Act 2006. These powers now extend to previously registered practitioners, as well as other providers such as naturopaths, acupuncturists, psychotherapists, therapeutic masseurs, social workers, occupational therapists and homeopaths.
An associated code of conduct “requires that practitioners must provide services in a safe and ethical manner”.
Providers of “health care information” should be included under these powers and this code of conduct.
Health misinformation can cause both direct and indirect harm. Perhaps it is time to end the polite tolerance of this harm and hold these providers to account.
Dr Sue Ieraci is a specialist emergency physician with 25 years’ experience in the public hospital system. Her particular interests include policy development and health system design, and she has held roles in medical regulation and management.
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