07 Jul 2023
New data reveals 841 allegations of boundary violations, including sexual misconduct, were made to the Australian Health Practitioner Regulation Agency (Ahpra) in 2022-23. The allegations relate to 728 registered health practitioners.
The latest data are almost 50% higher than the number of boundary violation notifications reported two years ago, when Ahpra introduced new concern types as part of wider measures to condemn and stamp out sexism, sexual harassment or gendered violence in healthcare. This year’s complaints also follow on from a record 925 boundary violation notifications received last year.
The types of complaints range from inappropriate or sexualised remarks, intimate touching of a patient without consent, personal relationships where there is an imbalance of power, to aggressive sexual, criminal offending. A boundary violation is behaviour that blurs professional and personal relationships with patients or involves unethical behaviour of a criminal or sexual nature with a patient or other person.
This data also underlines the importance of a continuing push to better support patients speaking up, and the investment made by Ahpra in an increased number of specialist investigators and support services.
‘While it’s distressing to hear about any case of sexual misconduct in the health system, it’s even more devastating if these incidents go unreported,’ Ahpra CEO Martin Fletcher said.
‘Greater reporting provides greater opportunity to act. When we are told of instances where practitioners are failing to behave ethically and professionally, we have opportunities to respond.
‘Increasing the number of team members dealing with these matters means we can reduce investigation times and reach an outcome quicker. More specialist investigators and social workers are being deployed to support people who are reporting their experiences with Ahpra,’ Mr Fletcher said.
Ahpra’s specialist investigation team has been bolstered by another 10 full-time staff, growing the unit’s capacity by another 13.5% over the next year, on top of steadily increased investment in resources and training since the team’s inception in 2018.
Ahpra has also expanded its Notifier Support Service led by social workers which provides support and help to victims and survivors navigate the regulatory and Tribunal process. The NSS pilot program has proven to meet a significant need, receiving 278 referrals since its commencement in September 2021.
More than 850,000 health practitioners are registered in Australia and fewer than 2% have a notification made relating to their practice or behaviour for any reasons each year.
More than 1,000 boundary violation notifications were dealt with across the financial year, with a record 114 referred to independent tribunals for disciplinary action. A further 239 resulted in regulatory actions such as restricted practice, education or cautions.
Across the 16 professions, doctors remain the most complained about with 359 notifications followed by 215 complaints about nurses and 120 about psychologists. There has also been a steady rise in complaints about physiotherapists, with 33 sexual boundary notifications relating to that profession in 2022-23.
Christine Gee AM has been close to this work for many years as one of the founding members of the Medical Board of Australia’s specialist committee, established in 2017. Ms Gee has seen first-hand the changes in approach to these cases as well as the change in the public conversation about sexual misconduct in health settings.
‘The whole system has been improved and strengthened. Any hint of departure from appropriate professional boundaries is escalated quickly,’ Ms Gee said.
‘The committee has zero tolerance for sexual misconduct, and we will recommend immediate action to place strict conditions or temporarily suspend a practitioner if we’re concerned about risk to the public while we investigate.
‘It is so encouraging to see more patients reaching out each year to tell us about their experiences, as difficult as it is for victims to share their stories.’
An investigator in the Ahpra specialist investigation unit, trained to respond to these matters and support notifiers as the one direct contact throughout their journey with Ahpra said:
‘It’s about creating a safe space to tell these stories. Some of them are hard to hear, but all are important to report. We want to hear the big and small matters, because sometimes the small ones lead us to identifying bigger problems,’ the specialist investigator said.
And it isn’t just new matters that they are hearing about.
‘We recently had a victim share their story about an incident that occurred in the 1980’s. The incident was so significant for them that they hadn’t shared it with their partner at the time. For them, it was an opportunity to have their story heard, and to be assured that the practitioner is no longer practising. That is powerful. We strongly encourage reporting of any incidents whenever they happened.’
Since outlining its blueprint agenda in February, Ahpra has been progressing much of its work to improve patient safety. Early work has focused on exploring what additional commitments Ahpra can make to those impacted by sexual misconduct, scoping research about sexual misconduct matters to inform strengthening of our approach, and preparing for a targeted public consultation about the Criminal History registration standard. Other relevant work underway includes strengthening the referral process to speed up time from conviction for a criminal offence to referral to tribunal, developing greater resources for patients and practitioners on the informed consent process during a consultation, and working to ensure investigations are trauma informed and nationally consistent.
‘Such ambitious reform takes time, but we’re making important inroads and we’re in this for the long haul,’ Mr Fletcher said.
1. Matters managed by Ahpra where the conduct occurred outside NSW.
2. Matters referred by OHO, or assigned during joint consideration with OHO, and managed by Ahpra and the National Boards.
Over the past seven years Ahpra and National Boards have overhauled processes to strengthen the management and oversight of notifications, improve support provided to notifiers, and raise the expectations of practitioners to remain respectful in professional practice. This has included:
Aug 2016 – MBA and Ahpra commissioned an independent review of the use of chaperone conditions as a regulatory tool to manage allegations of sexual misconduct.
Sept 2016 – Independent review invited submissions on the use of chaperones.
April 2017 – MBA and Ahpra adopted all recommendations of chaperone report. Historic chaperone arrangements were ended and replaced with more effective ways to protect patients when allegations of sexual misconduct are investigated, including gender-based restrictions, restricting patient contact or suspending the doctor’s practice. The overhauls also include;
March 2018 – Overhaul the public register of practitioners to improve consumer access to public information.
Nov 2018 - MBA releases revised Guidelines: Sexual boundaries in the doctor-patient relationship, which took effect in December 2018.
July 2020 – Three years on: Changes in regulatory practice since Independent review of the use of chaperones to protect patients in Australia
August 2020 - Changes in the regulatory management of sexual misconduct have had a profound impact.
Late 2020 – National Boards and Ahpra reset their approach to investigations to complete more investigations, faster.
August 2021 – Notifier Support Service pilot begins. Staffed by qualified social workers to guide notifiers through the notifications process, while referring them to other relevant health or community services (such as psychological, sexual assault, family violence, or other relevant specialist services), based on their individual needs, as well as:
February 2023 - Ahpra and National Boards launch their blueprint for reform, which paves the way for both the specialist investigation team and NSS to be expanded among a host of ongoing measures.
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