In this edition:
There are many people across AHPRA, boards and committees who work really hard every day to achieve the goals of the National Scheme. The strong board and staff commitment to public safety and a desire to make the best possible contribution is a real strength.
Multi-profession policy is a continuing area of focus. An example of this is our response to misleading advertising of regulated health services by some health practitioners. In early 2017, AHPRA worked with all 14 National Boards to gain endorsement of a common approach to the enforcement component of our advertising compliance strategy to support the advertising requirements of the National Law. In implementing this strategy, we are focussing on the management of complaints about advertising. We are also directing our initial profession-specific policy work and stakeholder engagement to professions that have a larger number of complaints about advertising.
This is a tangible example of our commitment to working across professions in the public interest, and you’ll find more examples of collaboration across the National Scheme and beyond in this newsletter. We welcome your feedback on our activities.
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You may have recently read about the outcomes of an independent review we commissioned with the Medical Board of Australia (MBA) on the use of chaperones and whether it protects patients. The review was conducted by Professor Ron Paterson, Professor of Law at the University of Auckland and Distinguished Visiting Fellow at Melbourne Law School.
The review was triggered by the concerns of patients whose doctors abused their trust and involved extensive consultation with the community and the profession.
AHPRA and the MBA have accepted all recommendations from the review, including to:
You can read more about the review, its recommendations and how we will work to address them in our media release, which links to the report.
The report is also available on the National Health Practitioner Ombudsman and Privacy Commissioner website, where the terms of reference and submissions are also published.
We know how important the management of complaints and concerns (notifications) is for complainants (notifiers) and health practitioners. And we realise that we need to understand their experience if we want to improve it. So, we have been asking those who have recently been through this process to tell us about it, both through online surveys and in-depth interviews.
The information we are collecting from both groups is helping us to understand what aspects of the process they find the most stressful and why. We are asking them to give us feedback about a variety of issues, including our communication, timeliness and their satisfaction with decisions. Finally, we want to know how they found our overall management of their complaint or concern.
This is critical information for us and can assist us in making changes and improvements in how we manage complaints and concerns.
Changes that make a big difference often require relatively little effort. For example, we have recently sought feedback on the information we provide on our website about raising a concern or making a complaint. We launched a new survey to find out if people are getting the information they need from the complaints and concerns area of the website. We know that for an increasing proportion of the community, our website is their first and often primary contact with us and we want it to be an easy and positive experience.
We want to know if people coming to our website are finding what they need to know about making a complaint or raising a concern. We want to know if the information on our website is helpful. Understanding this will help us continue to improve the experience of anyone who wants to raise a concern with us. We are asking users to tell us about their experience navigating and locating information on our website.
These are just a few of the ways we are gathering information to help us improve the complainant and health practitioner experience in managing complaints and concerns.
The most serious matters under the National Law1 are heard by the relevant tribunal in each state and territory. These matters may be referred by the relevant National Board or by an individual health practitioner. AHPRA can prosecute individuals in some instances and these cases are heard by the relevant Magistrate’s Court.
Court and tribunal outcomes are independent and public. We publish summaries of these outcomes on the AHPRA and National Boards websites, as well as in our newsletters. This is important as it helps both registered practitioners and members of the public to see the acceptable levels of care and behaviour that health practitioners are expected to practise within.
A number of tribunal decisions are summarised below. For more information, follow the link in the summary, go to the Court and tribunal decisions page on the AHPRA website or access the full tribunal decisions on the Australian Legal Information Institute’s (AustLII) site.
AHPRA successfully prosecuted Mr Shyam Acharya for knowingly and recklessly holding out as a medical practitioner. Mr Acharya, who claimed to be UK-based doctor Dr Sarang Chitale while practising as a medical practitioner, received a criminal conviction in a New South Wales court. The court heard how he had used another doctor’s medical qualifications and identity to falsely gain medical registration in Australia.
AHPRA started an investigation into Mr Acharya after being alerted by the General Medical Council (UK) on 28 September 2016. Mr Acharya’s former employer had queried the fact that Mr Acharya had been claiming to be a medical practitioner and using Dr Chitale’s name, medical qualifications and UK registration number. At the hearing at Downing Centre Local Court Mr Acharya was fined $30,000 (the maximum fine) plus AHPRA’s legal costs of $22,000, and a criminal conviction was recorded.
The State Administrative Tribunal of WA has disqualified a former chiropractor from applying for registration for three years with the Chiropractic Board of Australia (the Board) after admitting to professional misconduct, including sexual contact and inappropriate conduct with female patients.
Dr John Horner was disqualified from applying for registration as a chiropractor for three years from the date of the order (3 March 2017), has been reprimanded and is prohibited from providing any health service that involves consultation with or touching any female patient until such time as he is returned to the register of health practitioners. He was also ordered to pay the Board’s legal costs of $10,000.
A New South Wales chiropractor has been convicted of false advertising after he claimed to be able to prevent, treat and cure cancer in his advertising.
Dr Hance Limboro was sentenced today at the Downing Centre Local Court in Sydney after he pleaded guilty to 13 charges filed by AHPRA in August 2016. Dr Limboro was convicted and fined $29,500 by the court and was also ordered to pay AHPRA’s legal costs. He was fined for using testimonials in his advertising, which is not permitted when advertising regulated health services.
Dr Limboro was convicted of unlawfully advertising a regulated health service and using testimonials under the National Law.
The State Administrative Tribunal of WA found that Ms Camille Faith Els behaved in a way that constituted professional misconduct, after she admitted to several failures to practise in accordance with the Code of professional conduct for nurses. Ms Els inappropriately discarded patients’ medications into a bin and then falsified the patients’ medications charts by signing the medications as given when she had not administered the medications.
The tribunal reprimanded Ms Els and found she had behaved in a way that constitutes professional misconduct. The tribunal also added conditions to Ms Els’ registration that require her (among other things) to be supervised when undertaking medication management and administration, and to have education on medication management and administration, clinical record-keeping and ethics. The tribunal also ordered her to pay the Board’s costs, fixed at $1,850.
The Victorian Civil and Administrative Tribunal (VCAT) found that Mr Gyu Sung Lee had behaved in a way that constitutes professional misconduct by misappropriating prescription pads from a hospital, producing false prescriptions and presenting the false prescriptions to various other pharmacists, and dishonestly obtaining, or attempting to obtain, prescription medications for his own use.
The Pharmacy Board referred Mr Lee to VCAT in March 2016. The matter concerned his conduct as a registered pharmacist in 2013 and 2014. VCAT found his conduct warranted cancellation of his registration as a pharmacist and his disqualification for re-applying for three years was appropriate.
Since January, we have published 17 other tribunal or court outcomes as a news item or media release on AHPRA and/or National Board websites, including:
To access the summaries for these matters, please go to the Court and tribunal decisions page on the AHPRA website.
In our last issue, we highlighted a new section on the AHPRA website dedicated to advertising resources for consumers and anyone who advertises a regulated health service. New information includes a strategy for the National Scheme2 to help keep health service consumers safe from misleading advertising.
While understanding what is and is not acceptable in advertising can be challenging for health practitioners, the National Law holds advertisers accountable for the way they advertise regulated health services.
The Advertising compliance and enforcement strategy explains how the National Boards and AHPRA will manage advertising complaints and compliance, including the regulatory powers available to deal with breaches of the National Law. This strategy builds on our previous education and enforcement work and shows we are serious about our approach to managing advertising complaints and taking appropriate action to achieve compliance.
Our message to practitioners is to always ensure that their advertising is not false, misleading or deceptive in any way.
Practitioners are encouraged to use the resources available on AHPRA’s website to check and, if necessary, correct their advertising to ensure they comply with National Law requirements and avoid the consequences of non-compliance. Helpful resources include information on what is an inappropriate claim, tips and words to be wary about and examples of unacceptable advertising.
Supporting the public to make informed healthcare choices with the right information at the right time is extremely important and advertising can heavily influence a patient’s decision-making around their healthcare needs. The National Boards and AHPRA will continue to work with professional organisations to help practitioners understand their professional and legal advertising obligations.
If you have concerns about advertising, please contact AHPRA.
1The Health Practitioner National Law, as in force in each state and territory.
2The National Registration and Accreditation Scheme.
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On 28 April 2017, another step towards national regulation of paramedics was made when AHPRA issued a call for interest in being appointed to the inaugural Paramedicine Board of Australia (applications closed on 29 May 2017). The call was made with the agreement of the Australian Health Workforce Ministerial Council, however, the National Law must be first be amended to enable both the national regulation of paramedics and the Paramedicine Board of Australia to be established.
You can keep up to date with what is happening with the regulation of paramedics under the National Scheme on our website under Registration> Regulation of paramedics.
Annual report summaries for each of the 14 professions regulated under the National Law have been published online. These reports draw on data from the 2015/16 annual report published by AHPRA and the National Boards, and offer unique insights into the registrant base for each health profession. For example:
The summary reports also document the number of complaints and concerns that were lodged with AHPRA throughout the year to 30 June 2016, including the number of matters opened and closed throughout the year per profession, types of complaint, and segmentation of data by state and territory.
At times, the data illustrate the range of regulatory issues across professions, such as:
To download any or all of these reports, state and territory summary reports, or the complete 2015/16 annual report, visit our microsite.
On Wednesday 10 May, the Australian Senate Committee for Community Affairs tabled its report on the complaints mechanism administered under the National Law in the Senate. The inquiry, announced on 1 December 2016, has been looking at the complaints process in the National Scheme, including vexatious complaints, fairness for practitioners in the complaints process, and timely decision-making on complaints. During the course of the inquiry, AHPRA, the Medical Board of Australia and AHPRA’s Community Reference Group have provided submissions and evidence to the Senate Committee.
The report, which includes 14 recommendations, is being further considered by AHPRA and National Boards.
This year has seen the launch of a new national telehealth support program for nurses and midwives, and the expansion of existing health support services for medical practitioners across Australia.
Nurses and midwives now have 24-hour access to confidential health support anywhere in Australia, after Nurse & Midwife Support launched on 8 March. The new service, which is a Nursing and Midwifery Board of Australia initiative, is run independently by Turning Point, a leading addiction treatment, research and education organisation in Australia.
Nurse & Midwife Support offers a round-the-clock telephone service as well as online support, providing advice and referral on health issues for Australia’s nurses, midwives and nursing and midwifery students. The service also provides education and support on health impairment3 as defined in the National Law for nurses, midwives, students, education providers and employers.
To access Nurse & Midwife Support, call 1800 667 877 or visit the Nurse & Midwife Support website.
Doctors and medical students in all states and territories can now access help and support through the expanded network of doctors’ health advisory and referral services.
The national network of services is coordinated by Doctors’ Health Services Pty Ltd, a wholly-owned subsidiary of the Australian Medical Association (AMA), and funded by the Medical Board of Australia.
The Medical Board has significantly boosted resources to doctors’ health, sourced from within existing funds from registration fees paid by medical practitioners. The partnership with the AMA enables the health programs to be administered at arms’ length from the Medical Board and AHPRA.
Confidential advice and support is available across Australia on the following help-lines:
Visit the drs4drs website to find out more.
3Health (Impairment) (s. 5): Physical or mental impairment, disability, condition or disorder (including substance abuse or dependence), that detrimentally affects or is likely to detrimentally affect a registered health practitioner’s capacity to safely practise the profession or a student’s capacity to undertake clinical training.
AHPRA, the National Boards and accreditation authorities have begun working in partnership with leaders from the Aboriginal and Torres Islander health sector to develop an Aboriginal and Torres Strait Islander health strategy for the National Scheme.
In February 2017, Aboriginal and Torres Strait Islander health sector leaders and representatives from accreditation entities, National Boards, AHPRA and the Chair of AHPRA’s Agency Management Committee, got together to discuss how best to start this important work. The goal of the workshop was to identify the National Scheme’s strategy and role in ensuring patient safety for Aboriginal and Torres Strait Islander peoples in Australia’s health system.
The group agreed on the vision: ‘Patient safety for Aboriginal and Torres Strait Islander peoples in Australia’s health system is the norm, as defined by Aboriginal and Torres Strait Islander peoples’.
This strategy will focus on these streams:
The next workshop to progress this work will be held in June 2017.
More information about this group and its work, including communiques after each meeting, is published on the AHPRA website.
This month a delegation from the Chinese Medicine Board of Australia has been able to take its first ever visit to China thanks to funding support from an Australia-China Council (ACC) Grant.
‘This trip has supported our ongoing work applying a risk-based approach to policy development and implementation,’ Chinese Medicine Board of Australia Chair, Professor Charlie Xue, said.
‘In the interest of the Australian community, this has been a valuable opportunity to share learning, build relationships and gather information in partnership with other international authorities that regulate Chinese medicine practice.’
Professor Xue said one outcome of the visit was increased information sharing between the two countries and regulatory systems.
‘Through talking to and developing relationships with international regulators we have continued to establish a network that strengthens our respective roles of protecting the public.’
‘It’s clear that Chinese medicine leaders in China share our ideals to protect the public and enable the continued development of a flexible, responsive and sustainable Australian registered health workforce.’
More information about the Board’s trip is available on the Board’s website. If you are interested in learning more about the ACC, the grants program of seeing the full list of successful grant recipients you can visit the Australia-China Council website.
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The information we collect about registered health practitioners provides a unique and important data set for heath workforce mapping and planning nationally. You can view our quarterly registration data on our Statistics page.
Melbourne researcher Marie Bismark and her colleagues recently published a study tracking the outcomes of notifications (complaints) about the health, performance, and conduct of health practitioners from ten professions in Australia lodged in 2011 and 2012. The study identified factors associated with the imposition of restrictions on practitioners’ registration: restrictions can include conditions on practice, undertakings by the practitioner to do or not do something, suspension and cancellation of registration.
The team’s goal was to advance understanding of how the National Scheme operates. They were particularly interested in generating information that has the potential to help National Boards settle these matters efficiently, and to guide efforts to prevent further incidents and issues that lead to complaints.
They hypothesised that there would be systematic differences in rates of notification between professions, and that there would be relatively high rates of restrictive action against practitioners from certain professions (for example, psychologists) and for notifications about certain issues (for example, drug or alcohol misuse).
There were 8,307 notifications followed in the study. Some highlights of the findings were:
Restrictive actions are the strongest measures health practitioner boards can take to protect the public from harm and these actions can have profound effects on the livelihood, reputations and wellbeing of practitioners. In Australia, restrictive actions are rarely imposed and there is variation in their use depending on the source of the notification, the type of issue involved, and the profession of the practitioner.
The full research article is available online: Outcomes of notifications to health practitioner boards: a retrospective cohort study – Matthew J Spittal, David M Studdert, Ron Paterson and Marie M Bismark: BMC Medicine, December 2016.
The National Boards publish regular e-newsletters and communiqués on their activities, which you can read on their websites. Recent publications and projects are listed below.
Calls for applications were advertised for persons interested in being appointed to the inaugural Paramedicine Board of Australia, National Boards, state and territory boards of the National Scheme and state and territory committees of the National Board.
AHPRA and National Boards launched their Advertising compliance and enforcement strategy for the National Scheme.
Annual report summaries for each of the 14 professions regulated under the National Law and individual annual report summaries for each state and territory were published online.
Two new papers were published about key aspects of the accreditation functions under the National Scheme.
AHPRA noted the release of the Queensland Government’s Health, Communities, Disability Services and Domestic and Family Violence Prevention Committee report on their inquiry into the performance of the Health Ombudsman's functions.
July to September 2016 quarterly performance reports for AHPRA and the National Boards were published.
Quarterly registration data released.
Update on the Board’s review of Infection prevention and control guidelines for acupuncture practice.
Board members departed for China on the Australia-China Council Grant Project. They took with them hard copies of the 2015/16 annual report summary on Chinese medicine, translated into simplified Chinese.
Invite to upcoming forum invitation for practitioners, students and stakeholders of Chinese medicine.
Published a Quick reference guide for Chinese herbal dispensers in English and Chinese.
New position statement on endangered species and Chinese medicine in Australia released.
A New South Wales chiropractor was convicted of false advertising after he claimed to be able to prevent, treat and cure cancer in his advertising.
New vodcast released which stresses the importance of professionalism to patient care.
Launched a video for dental practitioners: An overview of your obligations as a registered dental practitioner.
Updated information for dental hygienists, dental therapists and oral health therapists.
Approved a new program of study ‒ the University of Sydney’s Doctor of Clinical Dentistry (Oral Surgery) program.
Published a communique after meeting involving the Board, AHPRA and the AMA to discuss how notifications are managed in the National Scheme.
Released with AHPRA the report Independent review of the use of chaperones to protect patients in Australia and accepted all its recommendations.
MBA revalidation consultation submissions published, along with the consultation papers.
Quarterly registration data released.
First national health support service for nurses and midwives launched giving nurses and midwives 24-hour access to confidential health support anywhere in Australia.
Public consultation opened on the revised Code of conduct for nurses and Code of conduct for midwives.
Provided an update on outcomes-based assessment for internationally qualified nurses and midwives.
Thanked midwives on International Day of the Midwife.
One renewal campaign reminding nurses and midwives to read the Board’s new standards.
Published vodcast raising awareness that nursing and midwifery registration standards and guidelines have changed.
Revised midwifery-specific registration standard and guidelines take effect on 1 January 2017.
Public consultation webinars on proposed revised competency standards for occupational therapists.
Published a consultation paper on proposed revised competency standards for occupational therapists.
Public consultation on revised competency standards ‒ focus group invite.
Public consultation on revised endorsement for scheduled medicines registration standard and related guidelines (closed 31 March 2017).
Request for quote released for the revised Capabilities for osteopathic practice.
Published Board position statement on paediatric care.
Pilot survey of pharmacy interns and preceptors underway.
Physiotherapy-specific annual report summary that looks into the work of the Board over the year to 30 June 2016 published.
Communique published from Podiatry Board of Australia Forum.
Psychologists were warned that a hoax email is being sent which pretends to be from AHPRA.
New guideline for transitional programs published.
News sent to Board-approved supervisors.
Transition information for the revised 4+2 internship guidelines published.
Revised provisional registration standard and 4+2 internship guidelines were published.
In August 2016, the Medical Board of Australia (MBA) and AHPRA commissioned an independent review of the use of chaperones as an immediate action to protect patients while medical practitioners are investigated for alleged sexual misconduct. The review was commissioned in the wake of a number of reports that chaperone conditions were not keeping patients safe. You can read more about the review and report in this issue.
Ron Paterson, Professor of Law at the University of Auckland and Distinguished Visiting Fellow at Melbourne Law School, conducted the review. We spoke to Professor Paterson about the review.
The first thing I did was spend a week in late August at AHPRA National Office, being briefed on when chaperone conditions were being imposed and how they were monitored. I was then able to help shape the review’s terms of reference, plan the call for submissions and face-to-face meetings with patients, doctors and key stakeholders, and arrange for the assistance of the National Health Practitioner Ombudsman and Privacy Commissioner (NHPOPC) to be the independent ‘host’ organisation for the review.
The public call for submissions was made in early September. Forty-five submissions were received from patients and/or family members of patients, health practitioners, colleges and professional organisations, medical defence organisations, health complaints entities, and regulators (not just AHPRA), state and territory health departments and other interested parties.
Meetings were held with submitters who wished to be seen in person (using the offices of the Health Services Commissioner). To understand how the current system works, I visited AHPRA state offices in Victoria, Queensland and South Australia. I also met with health regulators in New South Wales and Queensland, and participated in a consumer forum organised by the Health Issues Centre in Melbourne.
A forum at the IAMRA conference in Melbourne in September gave me a chance to hear how leading international medical regulators handle the issue of interim protection when a doctor is accused of sexual misconduct. I also took time out from a holiday in Canada in October to visit the key provincial regulators in British Columbia, Ontario and Quebec.
One of the great strengths of AHPRA is its data. I was able to undertake an in-depth analysis of MBA case studies and AHPRA data, policies and processes. I found everyone very helpful and benefitted from discussions with AHPRA staff and members of the MBA (including Chairs of local Boards) and the Agency Management Committee.
The majority challenged the effectiveness of chaperone conditions in protecting the public while practitioners were under investigation. Many felt that practitioners shouldn’t be able to practise at all while being investigated about alleged sexual misconduct – it would never be able to happen in the case of allegations against a childcare worker, for example. Some submitters cited examples of practitioners continuing to act inappropriately while under the ‘watch’ of a chaperone.
Some found chaperone conditions ineffective due to the logistic difficulties in monitoring compliance. Others felt the conditions suggest to patients that there may be something untoward about the practitioner before a finding of guilt has been made.
I concluded that it’s time to abandon chaperone conditions as an interim protection during investigations into alleged sexual misconduct. The term ‘chaperone’ is outdated, chaperone conditions don’t meet community expectations in 2017, and their effectiveness is dubious – there are holes in the safety net they are meant to create. Predatory practitioners can find ways around chaperone conditions and still cause harm to patients.
I identified a number of areas for improvement in the handling of sexual misconduct cases by AHPRA and the MBA, particularly around ensuring that notifiers (complainants) ‒ often the victims ‒ are treated with empathy, and that immediate action decisions and investigations are undertaken speedily.
Many improvements can be made without any law change. Health ministers have already approved a suite of proposed reforms to the National Law in response to recommendations made by AHPRA and a review of the National Scheme in 2014 (the Snowball review). If these reforms are put into effect, some of the problems noted in my chaperone review will be remedied.
I considered that the Regulatory principles for the National Scheme do not need amendment. However, more consistency is needed when it comes to taking immediate action. My report highlights the need for highly specialised staff and investigators for handling sexual misconduct investigations, and a highly specialised MBA delegate decision-making process for immediate action decisions in these cases.
While chaperone conditions remain in place, changes are needed to the Chaperone protocol. More detailed information should be included on a practitioner’s entry on the national register. Greater information sharing should occur between AHPRA and the police, and chaperones should be registered health practitioners who are fully briefed and trained.
I’ve also recommended that a national specialist team be appointed by AHPRA, which is responsible for monitoring and compliance of chaperone conditions rather than cases being managed separately within each state and territory office.
In response, AHPRA and the MBA have accepted all of Professor Paterson's recommendations.
The Council on Licensure, Enforcement and Regulation (CLEAR) is hosting its International Congress on Professional and Occupational Regulation in Melbourne, Australia, for the first time this November.
The congress brings together regulatory stakeholders from around the world to share global perspectives on licensure and regulation. Occurring every two years, the International Congress is a unique opportunity to listen to local and international experts as well as network with colleagues from around the world in a format that combines presentations and group discussion. Visit the CLEAR website for more information.
AHPRA is proud to be the local co-host for this event.
If you have any comments or suggestions about AHPRA report, please send them to firstname.lastname@example.org
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