11 Apr 2017
The Medical Board of Australia (MBA) and Australian Health Practitioner Regulation Agency (AHPRA) today released the report Independent review of the use of chaperones to protect patients in Australia and have accepted all its recommendations.
The review found the use of chaperones does not meet community expectations and does not always keep patients safe.
In August 2016, the MBA and AHPRA commissioned the review to consider whether, and if so in what circumstances, it is appropriate to impose a chaperone condition on the registration of a health practitioner to protect patients while allegations of sexual misconduct are investigated.
It is common practice for regulators around the world to use chaperone conditions in this way. Chaperone conditions have also been imposed as a protective measure at the end of a disciplinary process.
The review was triggered by the concerns of patients whose doctors abused their trust.
The review was undertaken by Professor Ron Paterson, Professor of Law at the University of Auckland and Distinguished Visiting Fellow at Melbourne Law School and an internationally recognised advocate for patient safety. The review involved extensive consultation with the community and the profession.
The report recommends three areas for regulatory reform:
- 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 our handling of sexual misconduct complaints, and
- strengthening monitoring and providing more information to patients in the exceptional cases when chaperone conditions are in place.
The Board and AHPRA have adopted all the recommendations made in the report which will mean:
- using more effective ways to protect patients when allegations of sexual misconduct are made, including gender-based restrictions, restricting patient contact or suspending the doctor’s practice
- establishing a specialist, national, medical board committee to make decisions about all these cases, supported by a specialist team within AHPRA to manage all these sexual misconduct notifications, auditing all open notifications about allegations of sexual misconduct by doctors and reviewing all doctors currently subject to chaperone conditions, and
- writing to all police departments in Australian states and territories to establish clear inter-agency protocols.
AHPRA will strengthen and rename its chaperone protocol - to be called the Practice monitoring protocol - to reflect all the report’s recommendations. The changes are designed to improve information provided to patients so they can make more informed decisions, and improve the monitoring of practitioners’ compliance with chaperone conditions. The protocol will apply whenever chaperone conditions remain in place. This may include exceptional cases in the future when chaperone conditions are imposed, or when the conditions were imposed in the past and cannot legally be replaced unless there is evidence of increased risk to the public.
Medical Board of Australia Chair, Dr Joanna Flynn AM, said the report clearly sets out the problems with chaperone conditions and makes a compelling case for change.
‘We’ve been told very clearly that chaperone conditions don’t do the job we need them to do and don’t match current community expectations,’ Dr Flynn said.
‘The Board has accepted all of Professor Paterson’s recommendations and we are making big changes to the way we deal with concerns about sexual boundary violations,’ she said.
‘We are confident that the vast majority of registered medical practitioners understand the importance of trust in the doctor patient relationship and want us to deal fairly and firmly with anyone who exploits this trust,’ she said.
AHPRA CEO, Mr Martin Fletcher, said the report makes a clear statement to regulators, courts and legislators about how to strengthen public protection and keep the system fair to practitioners.
‘Using chaperones as an interim step to protect patients has been common regulatory practice internationally,’ Mr Fletcher said.
‘The report contains important recommendations for AHPRA to deal with these matters as quickly as possible and have clear arrangements in place with other bodies such as the police to ensure good communication and appropriate information sharing,’ Mr Fletcher said.
‘A range of legislative amendments are already underway, and in the meantime we are making changes that will better protect and inform patients,’ he said.
AHPRA and the Board will now bring this report to the attention of other health practitioner regulators and tribunals, so there is a common understanding by decision-makers of the risks of chaperone conditions, best-practice in keeping patients safe while allegations of sexual misconduct are investigated, and what is needed to make chaperone conditions work when they are in place.
Professor Paterson recognised the complex challenge for regulators when faced with allegations of sexual misconduct and welcomed the cooperation of the Board and AHPRA with his review.
‘I spoke to people with first-hand knowledge of the use of chaperones and examined evidence from within Australia and internationally to ensure my recommendations best serve the community,’ said Professor Paterson.
‘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, despite chaperones being widely used across many countries,’ he said.
‘I am pleased that the Medical Board and AHPRA have adopted all my recommendations to better protect patients.’
Download the Independent review of the use of chaperones to protect patients in Australia (629 KB,PDF), Word version (989 KB,DOCX)
You can find out more about what the MBA and AHPRA are doing in response to the report’s recommendation below:
Response to the recommendations of the Independent review of the use of chaperones to protect patients in Australia (225 KB,PDF), Word version (236 KB,DOCX)
The report is also available on the National Health Practitioner Ombudsman and Privacy Commissioner website, where submissions are also published.
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