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AHPRA backflip on “black mark” register

DOCTORS have had a win after hard campaigning, with the Medical Board of Australia (MBA) walking back its policy of publishing tribunal and court decisions on the Australian Health Practitioner Regulation Agency (AHPRA) website even when there were no adverse findings against the doctors concerned.

According to Australian Doctor, the MBA “says it has already erased links to court and tribunal decisions where no adverse findings were made against the doctor”, quoting board chair Dr Joanna Flynn as saying that the rethink strikes a “good balance” between transparency and fairness.

Adverse findings against doctors will remain on the AHPRA website, however.

Dr Steel Scott, the Melbourne radiologist who launched the online petition last month, told AusDoc that it was “a fantastic result for the medical community”.

“We have proven that as a community, we can take actions which protect our colleagues and the integrity of our profession,” he is quoted as saying.

“I feel the medical board has really violated the trust of doctors, and more than 16 000 people [who signed the petition] agreed. In effect it’s a vote of no confidence in their policy-making. The medical board now has a lot of work to do to rebuild that trust.”



AHPRA complaint story leads to doctor’s petition


Last month we wrote about AHPRA’s new policy with regards to its publicly accessible register of medical practitioners. This register will now link individual entries to court and tribunal rulings on complaints about doctors – even if the doctor in question was found to have done nothing wrong.

Our story was read by Victorian radiologist Dr Steel Scott, who was prompted to set up a petition to call for a stop to linking unfounded complaints on the AHPRA register. The petition has clearly hit a nerve with Australia’s medical community, with well over 11,000 people signing the petition at time of this publication.

In an update, Dr Scott says he has sent letters to AMA Victoria, the RACGP, Avant Mutual and to Federal Health Minister Greg Hunt. AMA Victoria has referred his letter to the national office, and the RACGP has responded to say it is preparing a communication to AHPRA to raise concerns on the issue. Avant says it supports the petition and further action, while Greg Hunt and AHPRA have yet to comment.

Dr Scott says that linking to rulings with no adverse findings is effectively tarring the innocent with the same brush as those who have been found guilty.

“With the dramatic statistics relating to medical practitioner mental health and suicidal ideology, and having first hand worked with colleagues who have sadly committed suicide due to the stress of our profession, it is clear that we need to help protect our fellow practitioners reputations and mental well-being,” Dr Scott writes.

“As such, it is crucial that we protect our colleagues from having the negative stigma, stress and violation of practitioner privacy, which will result from having our innocent colleagues tribunal results listed in perpetuity.”

But Dr Scott stresses that he supports adverse tribunal results being documented and registered against a guilty practitioner’s name, as this is in the best interests of patient safety.

The petition has prompted hundreds of written responses.

“There are already supports being put in place to assist doctors with the mental stress/anguish of having an AHPRA complaint put against them and yet here we are having to fight for the unfounded complaints to be stricken from our registration record,” writes one doctor. “How many doctor suicides does the board and AHPRA need to take this seriously? As a governing body for doctors there seems to be no advocacy for the rights of the individual doctor.”

Another writes: “This means anyone unlucky enough to come across an unreasonable patient would have his/her name stuck with mud. For such a complicated industry that requires extensive knowledge that hardly seems fair or helpful for anyone. A perfectly capable doctor might be avoided for all the wrong reasons.”

You can read our original story here, and access Dr Scott’s petition here.

AHPRA links complaints on its register, even unfounded ones


Have you had a complaint against you that was dismissed in a tribunal as without merit? Your entry in AHPRA’s publicly accessible online registry of practitioners will still list this complaint and link to the relevant court or tribunal ruling, the regulator has decided.

The Australian Health Practitioner Regulation Authority has announced that it has already begun to publicly link disciplinary and court decisions to the registration details of doctors, regardless of whether the doctor has been found guilty of anything.

Around 50 rulings made since February have already been added to the register, implementing a recommendation made by an independent review authored by Professor Ron Paterson on the practice of chaperoning to protect patients from doctors subject to allegations of sexual misconduct. In that review, Professor Paterson recommended that “the public register of health practitioners include web links to published disciplinary decisions and court rulings”.

Also quoted in that review is the Chair of the Medical Board of Australia Dr Joanna Flynn, who says that “the public has a right to know if there are conditions on a doctor’s registration or if there have been serious disciplinary or criminal offences proven against a doctor. It’s long overdue.”

The register will now include links to all court and tribunal rulings concerning a doctor, except for those which involve the doctor’s health.

But many are concerned that posting all rulings in the register, even when no rulings are made against the doctor, is going a step too far.

Medical defence organisation Avant says the move is “unfair and punitive, particularly for practitioners with no adverse findings against them”. Although the Medical Board of Australia has said that “no adverse finding” will be noted on the register, Avant says it is “concerned that this will be misinterpreted and misunderstood”, and that the allegations will be given more weight than the findings.

Earlier this year, Avant’s Chief Medical Officer Dr Penny Browne spoke on the issue at the AMA’s National Conference.

“A finding made many years before, that has no relation to the doctor’s current practice or conditions, will remain linked to the AHPRA register in perpetuity,” she told delegates.

“Imagine that you or I have been through the stress of a tribunal hearing and finally the findings state ‘allegations not proven’. It’s all over. You then try to move on with your life and later discover that the link to the decision is placed against your name on the AHPRA register with a subscript stating ‘allegations not proven’.”

She said that while transparency was important, the medical complaints process was already stressful for doctors.

AHPRA’s most recent annual report notes that of the 2718 matters involving medical practitioners settled over the year, the vast majority (71.2%) resulted in no further regulatory action.

How safe are older doctors?


Older doctors are considerably more likely to be the subject of an AHPRA notification than their younger peers, according to new research.

The University of Melbourne study, which looked at all 12,878 notifications lodged with Australian medical regulators over a four-year period, found doctors over the age of 65 had 37% more notifications than their younger peers, aged 36 to 60.

The type of notification varied substantially between the two age groups. Health-related notifications, covering both physical illness and cognitive decline, were twice as high among older doctors. They were 40% higher for conduct-related notifications and 10% higher for performance-related notifications, compared with younger doctors.

The researchers from the Melbourne School of Population and Global Health said they had identified several “hot spots” of risk for older doctors. One of these was the prescribing, use and supply of medicines.

“Some older doctors are known to maintain registration in order to prescribe for themselves of for families and friends. Whilst this practice is in breach of ‘Good medical practice: a code of conduct for doctors in Australia’, some older doctors have been slow to adapt to evolving professional standards,” the researchers noted.

They also pointed to some older doctors’ failure to keep abreast of new drugs or changes in drug regimens, their reversion to older, more familiar patterns of practice, and their reluctance or inability to follow new protocols.

“Well documented age-related declines in cognition and physical abilities in the general population are likely to be reflected in the health practitioner community with possible implications for safe clinical decision-making,” the authors write.

“Previous research suggests that some health practitioners lack the ability or insight to self-assess competence and may not be aware of a decline in their cognitive ability or skills.”

But the authors note there are no internationally recognised thresholds of cognitive impairment at which a doctor is considered to be a risk to the public.

The study follows reforms proposed by the Medical Board of Australia late last year that would require doctors aged 70 and over to prove they are competent to continue practising. The reforms would require peer review and health checks for these doctors to be incorporated into their CPD requirements. The health checks would include issues such as cognitive function, eyesight and hearing. But there have been no moves towards introducing a mandatory retirement age for doctors.

There are over 6,600 doctors over 70 registered in Australia, with more than 85% of them still practising.

You can access the study on older doctors and notifications here.

Spike in mandatory reporting of doctors


As stakeholders get ready for mooted changes to mandatory reporting procedures, AHPRA has announced a dramatic increase in the number of doctors reported in 2016/2017.

In its newly released annual report, the regulatory authority records a 32.1% increase in the number of mandatory notifications of health practitioners, totalling 1,142 notifications, compared with 980 the previous year.

Just under 300 doctors were on the wrong end of a mandatory notification, up from 272 the previous year.

On investigation, around half of those cases required no further action. Forty-three doctors received a caution or reprimand, 15 accepted a specific undertaking, and 32 had conditions imposed on their practice.

Six doctors agreed to surrender their registration, five had their registration suspended and two had their registration cancelled.

The majority of doctors were reported for poor standard of clinical care, with a further 57 reported for impairment, 11 for drug or alcohol misuse and 29 for sexual misconduct.

In its report, AHPRA said that this year it had received the highest number of general notifications overall in any financial year since the national scheme was set up.

Nearly 6,000 complaints were logged against doctors, up considerably from 5,371 the previous year. Around three-quarters of these were about significant departures from standards of clinical care.

Around 5% of all doctors were subject to a notification in 2016/2017.

Immediate action was taken in 259 cases. No further action was taken in two thirds of cases, while 2% of cases ended in a surrendering or cancellation of registration.

The top three reasons for notification of a health practitioner were clinical care (43%), pharmacy or medication (12%) and health impairment (8%).

Nearly 30% of health, performance and conduct matters resulted in regulatory action, and over 90% of matters decided by tribunal resulted in regulatory action.

AHPRA monitored over 3,000 practitioners for health, performance and/or conduct during the year.

You can access the full AHPRA report here.

Why sexual advances towards a patient are never OK, even if ‘consensual’

In a recent independent review, I recommended chaperones no longer be used as an interim protective measure to keep patients safe while allegations of sexual misconduct by a doctor are investigated. The Conversation

The review was commissioned by the Medical Board of Australia and the Australian Health Practitioner Regulation Agency (AHPRA), following media reports that a Melbourne neurologist was facing criminal charges for sexually assaulting a patient.

Dr Andrew Churchyard was allowed to keep practising after the alleged sex abuse. But this was subject to a condition on his registration that an approved chaperone be present for all consultations with male patients.

The Medical Board of Australia and AHPRA have accepted my recommendations that the current system of using chaperones is outdated and paternalistic. In future cases where a doctor is accused of sexual misconduct, and interim protection is considered necessary, restrictions may be imposed after an assessment of the allegations by a specialist board committee.

They will include prohibitions on contact with patients of a specified gender, prohibitions on any patient contact, or suspension from practice.

Sadly, cases of sexual misconduct are likely to continue. It’s important patients know the warning signs and where to seek help if they suspect their doctor is behaving inappropriately.

Ethical boundaries

The Hippocratic Oath states that in their professional lives, doctors will:

abstain from all intentional wrongdoing and harm, especially from abusing the bodies of man or woman.

The oath frames sexual contact with patients as a type of intentional harm that is forbidden. Much has changed in medical practice since the days of the ancient Greeks, but Hippocrates’ clear-eyed prohibition on sexual contact with patients, and categorisation of such conduct as a form of abuse, remains apt.

It seems likely that the disciplinary findings and criminal convictions that come to media attention are only the tip of the iceberg of doctor-patient sexual contact.

International studies indicate that the prevalence of sexual boundary violations by health practitioners may be as high as 6 to 7%. A Canadian survey of 8,000 members of the public in 1992 found that 4.1% of respondents (4.7% of women, 1.3% of men) reported touching of a private body part by their doctor “for what seemed to be sexual reasons”.

During my review, I heard first-hand accounts of the harm sexual contact from their doctor causes patients. The harrowing stories from abused patients and their families confirm what the literature says.

Patients who are sexually exploited by their doctor suffer from major depressive disorders, suicidal and self-destructive behaviour, and relationship problems. They experience feelings of shame, guilt, isolation, poor self-esteem and denial. They may also delay seeking medical help.

Their trust in their doctor, and in the consultation room as a safe place to share problems and seek advice, is shattered.

Consensual relationships?

The impact on patients who have been indecently assaulted – by being subjected to unnecessary and inappropriate clinical examinations – has much in common with the effects of sexual abuse on victims in other, non-clinical contexts.

But patients who engage in “consensual” sexual relations with their doctor also suffer harm. Issues of vulnerability, transference and breach of trust are well recognised for current patients. Yet even former patients may be harmed by entering a sexual relationship with their former doctor.

Critics of a “zero tolerance” approach to doctor-patient contact suggest notions of vulnerable patients being exploited by their doctor are old-fashioned. They argue that a mature, consenting adult should be free to enter a consensual sexual relationship with their doctor, once the doctor-patient relationship has ended. Such views are misguided.

It is one thing to accept that a doctor may later become romantically involved with a patient after fleeting professional contact. But if the doctor-patient relationship has endured for some time, and has involved confidential disclosures and advice, any subsequent sexual relationship risks harm to the patient, and damaging professional consequences for the doctor.

Warning signs

It may be very difficult to discern whether an examination of the genitalia is warranted. For all the rhetoric about empowered patients, when we are unwell and consulting a doctor (especially someone new) for diagnosis and treatment, it can feel awkward to ask whether it is really necessary to disrobe for a full examination.

During my review, one patient recalled seeing a specialist about his severe migraines. He thought a full body examination was unusual, but said: “How was I meant to know what was normal?”

Ideally, patients will know that it’s always ok to ask why an examination or procedure is necessary, to request to have a support person present, and to raise any concerns with a practice manager after a consultation.

Patients concerned that their doctor may have acted improperly can contact support services such as CASA House in Victoria, which provides information and counselling to victims of sexual assault.

Patients should be alert to signs that their doctor’s interest is more than professional. Scheduling appointments for the end of the day, asking personal questions unrelated to the presenting problem, and providing their mobile number may all be warning signs.

Doctors should always be willing to question their own motives and, if in doubt, to seek advice from a professional mentor.

Sexual advances or sexual assault by doctors causes significant harm. A strict “zero tolerance” approach protects patients and doctors.

Ron Paterson, Professor of Health Law and Policy, University of Auckland

This article was originally published on The Conversation. Read the original article.

Chaperones scrapped for doctors facing sexual allegations

Doctors will no longer be allowed to practice with a chaperone while they are the subject of an investigation for sexual misconduct.

Instead, practitioners under investigation will be subject to gender-based restrictions, restrictions on patient contact, or will simply have their licence suspended.

The changes follow recommendations from an independent report into the chaperone system, which AHPRA and the Medical Board of Australia have said they will implement in full.

The report, authored by Ron Patterson, a Professor of Law at Auckland University, found the use of chaperones while allegations of sexual misconduct are being investigated or as a protective measure in the disciplinary process “does not meet community expectations and does not always keep patients safe”.

Professor Paterson recommends:

  • No longer using chaperones as an interim restriction while allegations of sexual misconduct are investigated;
  • Establishing a specialist team within AHPRA working with the MBA to improve handling of sexual misconduct complaints;
  • Strengthening monitoring and providing more information to patients in the exceptional cases where chaperone conditions remain in place.

Professor Paterson said that despite the widespread use of chaperones in many countries, “I was left in no doubt that there are better ways to protect and inform patients when allegations of sexual misconduct are made about a health practitioner”.

In a media statement, AHPRA has said it will strengthen its chaperone protocol to reflect all the report’s recommendations.

Dr Joanne Flynn, chair of the Medical Board of Australia, said the report makes a compelling case for change.

“We’ve been told very clearly that the chaperone conditions don’t do the job we need them to do and don’t match current community expectations,” she said. “We are making big changes to the way we deal with concerns about sexual boundary violations.”

The report was commissioned following the case of Melbourne neurologist Dr Andrew Churchyard, who allegedly continued to molest patients while already under investigation and with chaperone conditions on his practice.

In at least one case, Dr Churchyard allegedly molested a patient behind a curtain while a chaperone was present in the room.

There are currently 39 doctors in Australia working with a chaperone restriction, all of whom are in private practice. Chaperone conditions remain in place for an average of almost two years.

Under the current rules, doctors are not obliged to inform their patients that they have restrictions on their practice, although the information is available on the AHPRA registry.

You can read the report here.