18 Jul 2017
Our primary objective, working with 14 national health practitioner boards, is to ensure the protection of the public. We can and do take regulatory action when we receive a notification (complaint) about individual registered health practitioners to ensure patient safety.
Our processes for managing notifications (complaints) about registered health practitioners have been subject to extensive scrutiny. This is welcomed because our work is important for the safety of the community.
The issues identified in the 7.30 Report have already been the subject of a number of statements from AHPRA and extensive review.
In particular, we wish to recap the information we have already shared publicly about the tragic death of babies at Djerriwarrh Health Service and the actions we took to investigate individual health practitioners as soon as we were alerted to a wider patient safety issue at the health service. Details of our previous statements relating to this issue follow.
We have taken actions in response to allegations of sexual misconduct by health practitioners that are in line with community expectations. Details of our previous statements relating to this issue also follow.
We will continue to do as much as we are able, as regulators of individual health practitioners, to protect the public from potential harm. We are limited in the details of individual matters we can share publicly by confidentiality provisions in our legislation1. However, information about current restrictions on any registered health practitioner are published on the online register.
We also publish regular quarterly data on our regulatory work in each state and territory. Our Annual Report contains extensive information on the outcomes of notifications, including information by profession and by state and territory.
In 2015 the Department of Health and Human Services (the Department) in Victoria was alerted to a cluster of potentially avoidable newborn and stillborn deaths at Bacchus Marsh Hospital (Djerriwarrh Health Services).
At the time, the Minister of Health described the tragedy at Djerriwarrh Health service as a “catastrophic failure” of clinical governance within the health service.
This led to the Department commissioning Professor Stephen Duckett to review hospital safety and quality assurance in Victoria, which has led to sweeping changes across the Victorian health service.
AHPRA, the Medical Board of Australia and the Nursing and Midwifery Board of Australia first learned of these wider concerns in July 2015. Immediately, AHPRA used its powers to require the Djerriwarrh Health Service to provide information to enable close regulatory scrutiny of care provided by registered health practitioners at the service. AHPRA straightaway commissioned expert review of the information provided.
On receipt of the expert review, the Victorian Board of the Nursing and Midwifery Board of Australia and the Victorian Board of the Medical Board of Australia initiated investigations into a number of registered practitioners who provided care at the Bacchus Marsh Hospital.
From August 2015, AHPRA began investigating a number of registered health practitioners who practised at Bacchus Marsh Hospital at the time of this tragedy and other matters that have been notified to us. As a risk-based regulator, our priority has been to make sure that any ongoing risk to the public from individual health practitioners has been addressed so patients are safer in the future.
We have now completed a number of investigations into health practitioners who worked at Bacchus Marsh Hospital at that time. For families who have suffered terrible loss, our focus has been on ensuring each investigation is thorough and fair and that they are properly informed about the outcome of an investigation.
In March 2017, we published a statement that provided an update on the number of investigations that have been closed and information on the range of outcomes that have resulted.
Confidentiality provisions in the National Law limit what we can say about actions taken about individual practitioners beyond what is on the public register. So far, we have dealt with 101 matters concerning 40 practitioners and have finalised 58 matters, the largest single investigation we have ever undertaken.
One of the long-serving doctors at the health service had previously been subject to regulatory action by the Medical Board of Australia because of concerns about his care of a mother after the stillbirth of her baby at the hospital. This matter did not relate to the tragic death of the baby, but rather the care of the baby’s mother. We released a statement in October 2015 in which we acknowledged that it took longer than it should have to investigate that complaint, which related to a single case and the follow-up care provided to a mother after birth.
At the time of this complaint, AHPRA and the Boards did not receive any information about abnormally high perinatal mortality rates at the health service, nor about any concerns about that doctor’s care of other patients, or concerns about the quality of obstetric or midwifery care provided at the Djerriwarrh Health Service. This led to our call for all Victorian health practitioners and services to report their concerns about poor quality care, so regulators can act when needed to keep the public safe.
After receiving the complaint about the medical practitioner in 2013, the Victorian Board of the Medical Board of Australia investigated that doctor and then took regulatory action, imposing conditions on his registration requiring education and mentoring. The conditions were published on the public Register of practitioners from 25 June 2015 to 1 October 2015, at which point the doctor surrendered his registration, so he was no longer able to practise medicine after that date and his name was removed from the register.
AHPRA commissioned an independent review of its management of notifications, which found that improvements already made to AHPRA’s notifications management had addressed systems gaps exposed in the management of the case. The review and our response are published on the AHPRA website, see Improving the notifications process report.
In addition to the investigations into individual health practitioners, we have also worked on how we can contribute to system-wide improvements. This has included working with Victorian health services to increase awareness of mandatory reporting requirements as well as looking at ways we can work with Safer Care Victoria to help detect and respond to concerns about standards and safety.
We have also established a regulatory compact with the Department of Health and Human Services which sets out the ways we share and manage information in the public interest and within the National Law to improve patient safety.
In August 2016, the Medical Board of Australia and AHPRA commissioned an independent 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. This included allegations in relation to Dr Andrew Churchyard and a statement was released by the Medical Board of Australia and AHPRA at that time.
The review was completed 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 recommended three areas for regulatory reform:
The Board and AHPRA adopted all the recommendations made in the report which means:
AHPRA and the Board have also brought 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, what is 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.
It’s important to note that local tribunals in each state and territory are completely independent bodies and may decide to impose conditions, including chaperone conditions. This is not within the control of AHPRA and the National Boards.
AHPRA has started the audit of all open notifications where sexual boundary violations/misconduct was alleged with a view to ensuring there is no unmanaged risk while investigations are brought to conclusion.
We have a positive working relationship with police across Australia. We recently wrote to Police Commissioners to progress Memoranda of Understanding to ensure clear working relationships. There can often be crossover between what is an investigation into criminal behaviour (which can only be dealt by the police), and professional misconduct or unprofessional conduct which we can deal with as the regulator.
The police have told us that it is better if they hear directly from the victim. So what we do is encourage the person to contact the police directly and then we follow up with the person and/or police, depending on the circumstances. We also recognise the trauma for victims and the need to deal sensitively with that.
We cooperate fully and lawfully when the police request information and we respond in the way they need us to, to support their own investigations.
Patients and members of the public with concerns about the care they receive from individual practitioners can call AHPRA on 1300 419 495.
1The Health Practitioner Regulation National Law, as in force in each state and territory (the National Law), and privacy law as applicable.