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Mandatory reporting burden to be eased

 

New, nationally consistent laws will ensure doctors are no longer obliged to report colleagues under their care to AHPRA over mental health issues.

In a statement following last week’s meeting of the COAG Health Council, Federal, State and Territory Health Ministers agreed unanimously to “strengthen the law to remove barriers for registered health professionals to seek appropriate treatment for impairments including mental health”.

They agreed to a nationally consistent approach with “exemptions from the reporting of notifiable conduct by treating practitioners”, with new legislation that will have to be passed by the various State and Territory legislative bodies. Western Australia already has such laws, which it says it will retain as is.

Currently, doctors in all states other than Western Australia are legally obliged to report the mental health impairments of any registered health professional under their care to AHPRA or the Medical Board of Australia. In some cases, this can lead to a suspension of a doctor’s registration and right to practise. The issue of mandatory reporting has been a point of simmering tension in the medical community following a tragic spate of doctor suicides. The AMA, the RACGP and other representative bodies have argued that under the current regime, doctors battling with depression or other mental health issues often avoid seeking help for fear of being reported to AHPRA and losing their registration.

Under the new approach, doctors would still be under the obligation to report “past, present and the risk of future sexual misconduct”, as well as “current and the risk of future instances of intoxication at work and practices outside of accepted standards”.

The statement from the COAG Health Council meeting has been met with cautious approval from doctors’ organisations. AMA President Dr Michael Gannon said the Ministers had acknowledged the AMA’s concerns and that he was confident better laws could be crafted and implemented.

“It is clear that all the Health Ministers are committed to removing barriers from doctors seeking help from other doctors about their mental health or stress-related conditions,” he said.

But he took issue with some of the wording in the COAG statement, in particular with regard to the “future misconduct” of health professionals.

“It is unreasonable and unworkable to expect treating doctors to predict the future behaviour of any patients, including their colleagues,” he noted.

The RACGP’s response was a little more measured. The GP body described the COAG statement as a step in the right direction, but cautioned that it left “significant room for doubt and confusion”.

RACGP President Dr Bastien Seidel said the proposed changes were “short on detail” and that the retention of requirements for reporting a health professional practising “at a lower standard” left doubt for doctors seeking healthcare.

“Much of the conduct identified as grounds for mandatory reporting is subjective, open to interpretation by both the health professional and their treating practitioner,” he said.

“If there is room for doubt on what should or shouldn’t be reported, the fundamental issue of there being barriers to healthcare remains,” he added.

AMSA, the body representing Australia’s 17,000 medical students, applauded the rethink on mandatory reporting.

“It sends a strong message about the culture of medicine, that we encourage people to talk about their mental health, to seek help early, and that doctors who find themselves on the other side as patients deserve the same access to care as everyone else,” the body said in a statement.

But it also was worried about the wording around future misconduct.

“Predicting future behaviour is a complicated area, and leaving this as grounds to affect a doctor’s registration and career is troubling. In revision of the reporting procedures, we hope that it is remembered that the aim is to help doctors, not punish them.”

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.

Mandatory reporting: the “low hanging fruit” in doctors’ health

Mandatory reporting came under fire at a panel discussion on doctors’ health at the AMA National Conference held in Melbourne late last month.

Currently all states, with the exception of Western Australia, have regulations which require health practitioners to report colleagues who they feel may be a threat to their patients to AHPRA or the Medical Board of Australia.

Although mandatory reporting requirements are well-intentioned efforts to protect patients, many professionals worry they are a major barrier to doctors seeking help for their mental health issues.

Speaking on the panel, Dr Bav Manoharan, a Queensland-based radiology registrar who has been involved in resilience building projects, said there was confusion around mandatory reporting legislation and what the threshold was for reporting colleagues to AHPRA.

“That is a real concern,” he said. “There’s a stigma around a doctor approaching a health service and asking for help in environments where there is mandatory reporting.”

He said that changes to manadatory reporting requirements and a clearer understanding of them were the “low-hanging fruit” in the debate around doctors’ health.

Dr Janette Randall, a Queensland-based GP who is chair of Doctors Health Services Pty Ltd, noted that the threshold for reporting was actually quite high but there was a lot of subjectivity and doctors were getting inappropriately reported.

“We have a strong sense of fear and reluctance to present for care and this is one of the barriers. I do think the time has come to remove the onus on treating practitioners to report. That’s not to say we don’t all retain an ethical and professional responsibility in that space, but we’ve got to be able to create safe environments for people to seek care.”

Marie Jepson, who has been involved in research into depression in the legal community, said mandatory reporting tended to drive mental health issues underground.

“We found there were lawyers who would deliberately not go to the doctor, even though they were quite ill, so they didn’t have to lie on their application for a practising certificate. It meant that they complied with the regulation, but it was a timebomb waiting to go off.”

The issue of revamping mandatory reporting requirements does seem to be gaining traction, particularly in New South Wales, where Health Minister Brad Hazzard has announced he will review the legislation.

Mr Hazzard met with health stakeholders at a forum this week in Sydney to discuss measures to improve the mental health of doctors, after several high profile cases of doctor suicides in the state.

“It’s really critical for people with mental health issues to be able to talk to someone with absolute confidence and know that person is there to help and not to judge them – that’s the critical problem with mandatory reporting,” Mr Hazzard told the forum.

“Having listened to the young doctors it may be that the mandatory reporting requirements are technically not the problem, but practically they are, because that perception among young doctors is by seeking mental health help they may be damaging their career. It looks to me that mandatory reporting provisions do need changing.”

For more information about health issues for doctors, access a range of online resources from Doctors’ Health Services Pty Ltd.