Issue 12 / 4 April 2016

LET me tell you a story.

Once upon a time, in the state of New South Wales, there lived a nurse called SJ. She loved her job. She was proud of being a nurse and helping others through her work.

SJ had recently been separated from her husband. The separation was messy and SJ felt trapped in her situation. She became increasingly depressed and sought help from several doctors and psychologists, but always felt limited by her poor financial situation. Her depression worsened and she became suicidal. SJ made plans to end her life.

She stopped working as a nurse as she became increasingly desperate in her suicidality. A close friend discovered her suicide plan and convinced her to be assessed in hospital.

SJ was admitted to hospital and, while there, tried to hang herself. After this, she became an involuntary patient and the treating psychiatrist told her he was obliged to notify the Australian Health Practitioner Regulation Agency (AHPRA).

This distressed her immensely and she pleaded that the notification was unnecessary as she had voluntarily stopped her nursing work and had no plans to work in future until she felt better.

It must be reinforced here that Australian national mandatory reporting law does not specifically require all involuntary admissions of health practitioners to be reported.

This is a real story and obviously the identity of SJ is deliberately hidden. On further investigation, it appears this issue is unique to NSW and has been an area of debate ever since national reporting laws were introduced in 2010. In recent research published in the MJA, Marie Bismark and colleagues describe the issues of mandatory reporting and challenges of preserving the treating doctor–patient therapeutic relationship.

Certainly, SJ found it very difficult to trust future treating doctors when trying to report her suicidal feelings and thoughts, as there was constant threat of being reported again to AHPRA. In fact, on seeking a second opinion from a psychiatrist, it was once again reinforced to her that another admission to hospital with suicidality would trigger another mandatory report.

Clearly the law is intended to provide protection to the public from impaired health practitioners, as well as direct treatment and health care for the practitioner, but the tragedy is that it engenders lack of trust in treating professionals.

It should always be at the discretion of the treating professional as to when to report an impaired health practitioner to the national authority and when exemptions can be judiciously applied.

For example, voluntary removal from work is reasonable grounds to not require a notification. Why NSW law is interpreted as requiring mandatory notification of all involuntary hospital admissions of nurses and doctors to their respective councils and to AHPRA, while the rest of Australia does not require this, is a matter of concern for all health practitioners.

The NSW Nursing and Midwifery Council website has no specific details of such a mandatory requirement, but SJ’s case has shown me that the same interpretation for nurses is being applied in that state.

As a medical practitioner in Queensland, if I treat another doctor or a nurse for a depressive illness with acute suicidality, I am not automatically required to report them to AHPRA, even if I enact involuntary assessment legislation under the Queensland Mental Health Act.

Psychiatrists in Queensland can admit and treat involuntary patients who are health practitioners, and it is up to their discretion to report impairment to AHPRA. The relevant Queensland Health Ombudsman information sheet on the issue is clearly different to the NSW interpretation.

In Western Australia, the National Law was amended on its introduction in 2010 to include an exemption to mandatory reporting if a health professional is treating another health professional. A reasonable belief of impairment must exist for a reporting trigger to be reached. This was deliberately included to ensure that health professionals are not discouraged from seeking appropriate care, for fear of being reported. The Honourable Nick Goiran and colleagues argued this case well.

SJ has not been deregistered and can still work as a nurse in NSW. She has had to undertake a health assessment and appear before a review panel. The stress and trauma of this entire process has made for an incredibly difficult recovery from her depression and she continues to lack trust in NSW health professionals, given the system of reporting there.

Sure, lets protect the public, but let’s not make the cure worse than the illness.

Dr Minh Le Cong works for the Royal Flying Doctor Service in Queensland and is the chief editor of the PHARM (Prehospital and Retrieval Medicine) blog site and podcast, the FOAM4GP blog site and the Ketamine Leadership Academy blog site.


Poll

Would you report an impaired colleague to AHPRA?
  • Only if I thought there was a danger to the public (89%, 202 Votes)
  • No (6%, 14 Votes)
  • Yes (5%, 12 Votes)

Total Voters: 228

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9 thoughts on “Mandatory reporting: cure worse than illness?

  1. Frank New says:

    Seems to me from the information provided (always a limiting factor to being confident as to what actually happened) that this is yet another disappointing and very worrying case of misinterpretation of the law.

    This still occurs, despite efforts by MBA to better explain the requirements.

    Very destructive to the practitioner / patient.

    Often undertaken for the self protection of the referring practitioner, unnecessarily. 

  2. Stan Doumani says:

    Mandatory reporting laws, it seems to me, have been interpreted incorrectly by the profession, Before you report anyone, you have to be comfortable that they are a danger to the public. You are not absolved of the responsibility of making a professional judgement by these laws and professional judgment implies due care and consideration of consequences.

  3. Stephen James Hyde says:

    Clearly this is a lose-lose situation with deleterious consequences for the medical professional whose recovery has been impeded, for others involved who are required to provide reports, to the council who have to spend precious time making judgements on very dubious grounds and for the public who have to fund the whole sorry mess.

  4. Mary Cook says:

    That’s certainly not taking the Road to recovery!
    PTSD Support And Recovery

     I am so glad I work for RichmondPRA they support workers not condem them  

  5. Gwenda Moore says:

    The yes no answers makes it very difficult to answer this questionaire. I would hope that a yes was only after a great deal of consideration, evaluation with an esteemed and thoughtful collegue, but most important discussion with the nurse concerned giving them the opportunity to see the problem and a chance to correct behaviour or seek treatment. 

    Then there is the other situation where if the nurse is given a chance to improve but they then leave one job and move on to another job or even move interstate then that is proof that they have no intention to improve performance and I would then consider myself negligent in not reporting. 

    So my answer is there is no simple yes or no and I think that by putting this as a questionaire I can only see that we are expected to find a simplistic answer to a complex issue.

  6. Nicole Dillon says:

        

    Would it  be best to have a reporting body within APRHA that specifically looks ar all cases and aids in the rehabilitation and not stigmatisation of the individual. As a professional practitioner how could you not report? What if your client decided to take their own life and others in the workplace? Perhaps a very small risk, but a risk nevertheless. Would it stop something like the sad event at RNS where the disgruntled and unstable worker murdered the Nurse Unit Manager? Perhaps it would if AHPRA worked with the individual in seeking rehabilitation and finding supporting roles at work that may not mean face to face contact is required.

    AHPRA needs to review some of the competency standards that nurses are expected to abide by and apply some of the same rules to their part.

  7. Janine Anderson says:

    I became depressed due to my attempts to improve care in a very remote health service. It never impacted on my ability to provide care as I took leave when I believed I needed time away from work to spend time on helping myself. I’d asked for assistance from a case manager with the local mental health team and my requests were ignored. So I sought voluntary admission to my hospital, unfortunately ending up as a patient on my own ward.

    When I was told I needed ECT I refused as I’d seen the devastating impact on the memory of some friends who’d been given ECT in the past. My refusal resulted in my being scheduled, and I was sent away via RFDS to a psychiatric hospital to have the ECT. It didn’t help with my depression, but my memory was so badly affected I still have no memories of approximately 15 years of my life. I also have ongoing memory issues. 

    I’d eventually been coerced to have ECT when the psychiatric hospital said I wouldn’t then be reported to the nursing board. I was reported anyway as my health service believed they had no choice but to report me, due to mandatory notification.

    The very long process of many flights to the capital city to see a psychiatrist and the impairment panel was extremely traumatic. It was little different to being scheduled and kept in a facility against my will, or the realisation that I had no say in what was done to me. The tone of the letters and the members of the panel had me believing that at amy time they could prevent me from continuing with my career, yet I had done nothing wrong.

    The result was that I would’ve been extremely reluctant to seek help if I relapsed in the future. The board’s response to my illness was too traumatising.

  8. Andrew Nielsen says:

    My interpretation of the mandatory notification laws is that someone has to be reported if they “placed the public at substantial risk of harm”, literally. So, if someone has a severe illness and did not place the public at risk of harm, then the compulsory notification rule is not triggered – as in, it actually already happened in the past. (I would be ok with pre-emptively reporting if someone insisted on returning to work when they should not.)

    There is no delicate way of saying this. Some of my idiot colleagues stupidly think that if someone is impaired but NOT practicing, that mandatory reporting still applies. There are enough idiots out there that it is not safe for someone to seek care. The situation is a disgrace.

  9. Andrew Nielsen says:

    Adit. As a treating psychiatrist, you have all the power you need. You can tell the person, “Don’t go back to work until you are well enough, otherwise I might be forced to tell AHPRA just to protect myself”. Then they don’t work (probably), until they are well enough (which does not mean cured). Everyone wins, and there is no danger that someone will be unnecessarily reported to AHPRA. Simple.

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