In this edition:
Welcome to our summer 2020 update.
This update highlights our annual report for 2019-20 and our response to the unprecedented challenges of COVID-19 for health practitioners and the health system more widely.
Like many organisations we have had to adapt and respond to ensure that we can continue to provide all of our services to the Australian community.
I want to thank Ahpra staff, National Boards and committees and our partners for the ways in which we have worked together to make changes, often very rapidly.
And to acknowledge the exceptional work of frontline health practitioners. This year more than ever has shown how much we rely on these health practitioners to keep us all safe.
Thank you for your interest and continuing support. Best wishes for a relaxing and restorative festive season, and for those of you working in healthcare over the holiday period, please take care and stay safe.
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In November, Ahpra released the 2019/20 annual report, highlighting our regulatory work with National Boards and our response to the unprecedented challenges of the COVID-19 pandemic.
2020 marked the tenth year of national registration. Australia now has more than 800,000 registered health practitioners, including around 35,000 recently retired health practitioners in eight professions who were returned to registration as part of our pandemic sub-register to support the health system response to COVID-19.
The pandemic meant that Ahpra became a virtual organisation within weeks. We also worked with National Boards to introduce many changes to allow our regulatory work to continue and provided flexibility where it was safe. This included updated guidance about issues such as telehealth services, scope of practice and CPD requirements.
Maintaining public safety remained paramount across all our regulatory work. More widely, we implemented changes to the National Law on mandatory reporting, initiated an independent review of our management of sexual boundary notifications and continued our work with Aboriginal and Torres Strait Islander partners to eliminate racism from the health system and ensure cultural safety.
Insights from the year include:
To view and download the 2019/20 annual report, visit the Ahpra website.
Amid the changing parameters of national and state and territory lockdowns and public health requirements, we’ve had to be nimble in planning a return to work for each of our offices. As of December, in line with current health department advice in each state and territory, we have staff at work in all our capital city offices consistent with COVID-19 safe protocols.
Since our last Ahpra Report issue in early September, Ahpra and National Boards have continued working with government, health services and others to support health practitioners. Boards made changes to continuing professional development (CPD) and recency of practice requirements where safe to do so, to accommodate practitioners unable to meet the usual requirements due to lockdown, illness, carer responsibilities, practice restrictions and the unavailability of clinical education and employment. Boards in many cases froze or even reduced registration renewal fees and they offered financial hardship plans to those in need.
We’ve communicated this by profession-specific email updates, Board news items and e-newsletters and our COVID-19 portal to ensure practitioners could renew online on time, supported by our Customer Service team.
Registering as a health practitioner can be stressful for new graduates, and this year, some students and graduates have also had to cope with disruptions to their clinical education as a result of COVID-19 impacts. For some final-year students, clinical placements were cut short or delayed. Professions with interns, such as pharmacy and psychology, transferred their national face-to-face exams to online platforms and reorganised exam proctoring for virtual exams. Massive organisation and communication efforts enabled this rapid transformation.
We opened the graduate campaign early with a raft of new resources featuring a short, animated video and a staged email and web communications campaign that outlined everything they needed to know about registering, all linked to supporting information from Boards and Ahpra. For the first time, the National Boards’ regular e-newsletters to registered practitioners were sent to students and graduates from August onwards with targeted information and advice.
We’ve had a great response with over 22,000 graduate applications received so far.
Have you tuned into Ahpra’s podcast, Taking care? Launched in November 2019, it has been a vibrant platform for a range of practitioner, regulator and consumer voices across the health sector during the COVID-19 pandemic. We host 30-minute conversations and interviews and discuss current issues, address myths and common questions, and think about what we can do to best protect the public. You can listen to episodes about topics such as telehealth, practitioner wellbeing, the impact of the pandemic, collaboration across professions, notifications issues, and rural and remote practice.
Download and listen to the latest Ahpra Taking care podcast or pick any episode from our catalogue – there are now 25 of them to choose from. You can also listen and subscribe on Spotify, Apple Podcasts and by searching ‘Taking care’ in your podcast player.
Ahpra marked NAIDOC Week 2020 by releasing our inaugural Aboriginal and Torres Strait Islander Employment Strategy 2020-2025.
The goal of our employment strategy is to increase Aboriginal and Torres Strait Islander participation within Ahpra through the development of a culturally safe work environment that reflects the diversity of the communities in which we operate and serve.
It is a major component of the National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020–2025, which aims to improve cultural safety, increase workforce participation, strive for greater access and close the gap in health outcomes between Aboriginal and Torres Strait Islander Peoples and other Australians.
The employment strategy contains five priority areas to help achieve our goal:
The employment strategy recognises the need to build the cultural capability of all Ahpra employees to enable a proactive and leadership approach. Read more in the media release.
In October, Ahpra welcomed the announcement by Australia’s health ministers of appointments to the Ahpra Agency Management Committee (AManC) and that the future recruitment round will include an identified position for an Aboriginal and/or Torres Strait Islander person.
The committee is responsible for determining and agreeing Ahpra policies, setting the strategic direction for the National Scheme and assuring its performance. Three new members have been appointed for the next three years:
Three current members have been reappointed for a further three years: Ms Jenny Taing OAM, Dr Susan Young and Ms Barbara Yeoh AM.
These appointees will join three current members: Ms Gill Callister PSM (Chair), Adjunct Professor Karen Crawshaw PSM and Dr Peggy Brown AO. One member, Dr Philippa Smith AM, completed her three-year term. You can read the ministerial announcement on the COAG Health Council website.
In October we released the National Scheme engagement strategy 2020-2025, outlining our goal of building trust and confidence among our stakeholders in our work to protect public health and safety. The engagement strategy supports the vision, mission and strategic themes of our National Registration and Accreditation Scheme Strategy 2020-2025 and its purpose is to support Ahpra and the National Boards to deliver on the goals and objectives of the broader National Scheme strategy.
Read more on the Engagement strategy page, including priority objectives.
Ahpra and National Boards have released results from the second annual survey of stakeholder understanding and perceptions of our role and work. The results help us to better understand what the community, regulated health professions, and our stakeholders think and feel about us, particularly in areas of understanding, confidence and trust. The insights gained will inform how we can improve our engagement with both the professions and the community.
The report provides the results from anonymous surveys conducted in late 2019 of a random sample of registered practitioners and a random sample of members of the public across communities in Australia. There were nearly 6,000 responses from practitioners and 2,000 from the broader community. Both surveys were managed by an independent consultant.
Overall, the results show positive perceptions of Ahpra and National Boards. The surveys were, in the main, the same as ones carried out in 2018 and enable comparison of changes in awareness and sentiment over the period. The reports in PDF format are available in the news item.
National Boards and Ahpra stand for safe, professional healthcare practice. All health practitioners and the workplaces at which they practise have roles to play in ensuring public safety. We are improving the way we manage our regulatory investigations to better account for our collective responsibilities.
We know that the public are best protected when we support practitioners, their employers and places of practice to improve safety and professionalism in the delivery of health services. We want to focus on matters where there are gaps in safe practice that create ongoing risk to the public and which may require a regulatory response.
Our revised approach aims to improve the experience of notifiers and practitioners by completing most investigations faster. There is a stronger focus on speaking directly to the practitioner so we can gather early information about their individual practice, reflection and actions in response to notifications. This, along with engagement with notifiers to explain the steps being taken, is the key to closing concerns about low-risk practitioners faster and concentrating our investigations on practitioners that represent higher risk.
More information, including the ways practitioners can help us, is available on Ahpra’s Concerns about practitioners page.
The most serious matters under the National Law 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 Magistrates’ 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 understand the acceptable levels of care and behaviour expected of health practitioners.
In the interest of transparency we also publish links to disciplinary decisions about a practitioner on the online national register of practitioners. The decisions we link to are those which involve adverse findings and which were delivered after the start of the National Scheme in 2010. These decisions are also publicly available on the websites mentioned below.
Below are some examples of recent decisions. 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.
Further information on tribunal decisions about practitioners in New South Wales is also published on the Health Care Complaints Commission website.
All the matters listed here were referred to the court or tribunal by the relevant National Board.
An Aboriginal and Torres Strait Islander Health Practitioner has been reprimanded and has had her registration suspended for four months after she admitted to inappropriately viewing patient records. Ms Amorette Lockyer admitted that she had inappropriately viewed patient medical records at her workplace 3,125 times without any clinical justification or authorisation. This included records of 1,361 individual patients, some of which were accessed multiple times, and included those of her colleagues and family members, as well as patients who had declined to discuss their presenting complaint with her. Ms Lockyer deliberately accessed the records in a way that would not leave an audit trail in the patient's record. In July 2020 the State Administrative Tribunal of Western Australia also imposed conditions on her registration requiring her to do education on ethical decision-making and patient confidentiality, and to be supervised while practising. Mitigating factors included the 15-month suspension Ms Lockyer had already been subject to at the time of the orders, her willingness to reach an agreement in the matter and the absence of any previous disciplinary action against her. Ms Lockyer showed significant remorse and had already faced consequences of her actions as a resident of a remote community.
A Chinese medicine practitioner convicted of raping a patient has been disqualified by a tribunal from applying for registration for 15 years. The Chinese Medicine Board of Australia referred Mr Zhou to the South Australian Civil and Administrative Tribunal in May 2019 for professional misconduct after he was convicted of raping a patient, alleging that he was not a fit and proper person to hold registration. The tribunal expressed its significant concern over Mr Zhou’s failure to accept responsibility for his conduct, to provide any explanation for it, or to offer any observations of concern for the welfare of the patient. The tribunal said Mr Zhou’s conduct required a severe disciplinary response to ensure protection of the public and to make it clear to him, other practitioners and the public the seriousness with which the tribunal views such conduct towards vulnerable persons in a professional consultation, and that the standards of the Chinese medicine profession should be upheld.
A dentist has been reprimanded after a tribunal found that he performed a procedure for which he did not have sufficient expertise or experience. Among the Western Australia State Administrative Tribunal’s findings were that, on 31 August 2017, Dr Justin Soon performed gingival laser depigmentation incorrectly, failed to initially treat a small patch of gingival tissue, and performed the procedure when he did not have sufficient expertise or experience of using a diode laser in gingival laser depigmentation. The tribunal was also critical of Dr Soon’s clinical record-keeping which did not meet dental practitioner obligations around health records in the Dental Board of Australia’s Code of conduct or the guidance in its Guidelines on dental records.
A tribunal has cancelled a medical practitioner’s registration for arranging a non-registered person to issue prescriptions to patients in the doctor’s name, while he was overseas. The Medical Board of Australia referred Dr Bhagwant Singh to the South Australian Civil and Administrative Tribunal after he allowed a practice employee, who did not hold medical registration, to write prescriptions for some of his patients while the doctor was overseas. Dr Singh was disqualified from applying for registration for 18 months. The tribunal noted there was no evidence of Dr Singh attempting to arrange a locum or make arrangements with patients to ensure continuity of medication instead of the arrangement agreed to with the employee and the dispensing pharmacist. The tribunal said patients being prescribed medication by a person who was not a registered medical practitioner and when no consultation by a medical practitioner had occurred, was ‘extremely serious’. Dr Singh’s abdication of care for his patients gave rise to the greatest risk to the patients.
A tribunal has disqualified a medical practitioner for 12 months for harassing a fellow health practitioner. In July 2019, the Medical Board of Australia referred Dr Jason Lehr to the Victorian Civil Administrative Tribunal for professional misconduct. In late 2015, Dr Lehr met Dr Y and during the course of their employment, they became friends. In mid-2016, Dr Lehr told Dr Y that he had feelings for her. Dr Y advised Dr Lehr that she did not have the same feelings for him and they subsequently ceased socialising together. Dr Lehr’s harassing messages began in February 2017 and ceased in October 2017. In December 2017, Dr Lehr was charged with stalking and in 2018 was convicted of using a carriage service to harass. On 14 May 2020, the tribunal found Dr Lehr’s conduct amounted to professional misconduct, reprimanded him and disqualified him from practising as a medical practitioner for 12 months. The tribunal noted that the conduct occurred over an eight-month period. It was not a one-off lapse of judgement; it was targeted and planned harassment of Dr Y via her mobile and publicly via social media. The conduct impaired Dr Y’s ability to engage in and contribute to the medical community, and had significant detrimental impact on her personally and professionally. Dr Lehr resigned from practice in December 2017 and surrendered his registration in early 2019 and has said that he does not intend to reapply for registration.
A registered nurse has had his registration cancelled and been disqualified from applying for registration for engaging in professional misconduct. In November 2016, Mr Grant Burrows was charged with the criminal offence of indecent treatment of a child under 12 years with a circumstance of aggravation. The alleged offence occurred in 1998. Mr Burrows was not a registered health practitioner at the time. His employer informed Ahpra in November 2016 that Mr Burrows had been arrested and was being held in custody. Mr Burrows was also required under the National Law to give the Nursing and Midwifery Board of Australia written notice of the criminal charges and conviction within seven days, which he did not do. Mr Burrows’ registration was suspended on 14 December 2016 and an investigation began. On 26 July 2017, Mr Burrows was convicted in the District Court of Queensland, on a guilty plea, of indecent treatment of a child under 12 years with a circumstance of aggravation. He was sentenced to imprisonment for a period of two years, suspended after serving a period of six months.
In June 2019, the Board started disciplinary proceedings in the Queensland Civil and Administrative Tribunal (QCAT), which noted the seriousness of the offence that involved a young child abused in her own home. QCAT considered it had occurred a long time ago, involved a single occasion, and no penetration, and also noted Mr Burrows’ remorse and that there had been no sexual offence against a child or any other serious sexual offence since. References suggested Mr Burrows was highly regarded in his work. On 27 May 2020, the QCAT decided that Mr Burrows had behaved in a way that constitutes professional misconduct. His registration was cancelled and he was disqualified from reapplying for registration for four years from the date of the order.
A nurse who had a relationship with a patient has been reprimanded for professional boundary violations and banned from working as a nurse or from providing any health services for 10 years. The South Australian Civil and Administrative Tribunal found Robert Monteduro acted in a manner that amounts to professional misconduct when he failed to observe a proper professional relationship with a patient ‘VXJ’ while she was an inpatient and after her discharge from hospital in May 2012. Mr Monteduro carried out formal risk assessments of VXJ and was directly involved in her care during a psychiatric inpatient episode at the Lyell McEwin Hospital from late March 2012.
The relationship between Mr Monteduro and VXJ was a sexual one from at least July 2012 until November 2015. The tribunal found that Mr Monteduro manipulated VXJ into not receiving ongoing psychiatric care during their relationship, prompted her to take out a lease of a rental unit, established a joint self-managed superannuation fund with her and represented to Centrelink that he was VXJ’s carer. The Nursing and Midwifery Board of Australia received a notification that the patient was living with Mr Monteduro and in July 2013 took immediate action and accepted an undertaking from Mr Monteduro not to practise after information came to light that contradicted his version of events provided at an earlier interview. Mr Monteduro has not practised since that time. On 4 May 2020, the tribunal reprimanded Mr Monteduro,cancelled his registration as a nurse, disqualified him from applying for registration for 10 years and prohibited him from providing any health service for 10 years. The tribunal also found that Mr Monteduro provided false and misleading explanations during the Board’s investigation.
A pharmacist has been suspended for six months after a tribunal finding of professional misconduct, for conduct described as a ‘fundamental failure of responsibility’. The South Australian Civil and Administrative Tribunal also reprimanded Mr Andrew Nguyen and ordered that conditions be imposed on his registration at the end of the suspension period. Mr Nguyen provided prescription medication to patients knowing that the prescriptions had not been issued by a registered medical practitioner. He also provided medication without prescriptions at all on the basis that certain patients could be supplied with regular medication without a prescription and then obtain a retrospective prescription. Mr Nguyen also dispensed medications on repeats where no retrospective approval had been received following the initial unsigned prescription. The medications, some of which were Schedule 8 drugs, were supplied on 69 occasions over 21 months in 2014 and 2015. Mr Nguyen told the tribunal he believed the prescriptions had been generated by an employee, who did not hold medical registration, from the private medical centre nearby with the knowledge of a registered medical practitioner. That practitioner, also known to Mr Nguyen, had either not seen the patient because he was on leave or was unable to do so. The tribunal said that by placing his trust in another person and the medical practitioner, Mr Nguyen was abdicating the responsibility of a pharmacist to care for the persons to whom the medications were dispensed. The tribunal recognised that Mr Nguyen had substantially reduced his practice over the four years following these events and that he had done further education.
A pharmacist has been reprimanded and disqualified for three years for engaging in professional misconduct and improperly obtaining his registration. The pharmacist (Pharmacist) obtained a Bachelor of Pharmacy from an overseas university in 2002. From October 2005 to June 2015, the Pharmacist lived and practised as a pharmacist in various countries. On 22 June 2015 he was convicted of one count of healthcare fraud conspiracy and 15 counts of conspiracy to distribute controlled substances, sentenced to probation for a term of six months and ordered to pay restitution. His licence to practise pharmacy in the second overseas country was revoked on 18 November 2015. The Pharmacist applied for provisional registration and supervised practice as a pharmacist in Australia in July 2018. In his application, he made a false declaration about his criminal history, countries of former residence, registration history, disciplinary history, and practice history. His curriculum vitae contained false information including work history and did not disclose his full practice history. Registration was granted in September 2018 based on this false information. On 19 December 2018, the Pharmacy Board of Australia took immediate action by suspending the Pharmacist’s registration and referred him to the State Administrative Tribunal of Western Australia.
A tribunal has disqualified a podiatrist for six months for transgressing professional boundaries. The Podiatry Board of Australia referred Mr Phillip Lawson to the Victorian Civil and Administration Tribunal (VCAT) for professional misconduct and unprofessional conduct in relation to his treatment of a client, including by having a sexual relationship with her; failing to maintain proper and transparent financial commercial dealings by inappropriately billing the Department of Veterans’ Affairs in respect of his treatment of the client; providing podiatry services that were not clinically indicated or justified; and failing to maintain accurate or adequate clinical records. On 5 February 2020, VCAT found Mr Lawson guilty of professional misconduct and unprofessional conduct and disqualified him from practising for six months. He was also reprimanded. The tribunal took into consideration Mr Lawson’s early admission of the sexual misconduct allegations; that he had surrendered his registration in 2017 when he moved overseas; the absence of previous disciplinary history and his early undertaking to cease practise.
Since January, we have published 53 other tribunal or court outcomes as news items or media releases on Ahpra and/or National Board websites. Most of these cases have involved medical practitioners and nurses.
Medical practitioners, nurses and midwives have benefited from established support services DRS4DRS and Nurse and Midwife Support, more so than ever during the COVID-19 pandemic, and the Dental Board of Australia saw a need for a similar program for dental practitioners. The start date for the service was brought forward with a view to supporting dental practitioners during the pandemic, bearing in mind the increased stress on the profession during lockdown and practice restrictions nationwide.
Dental Practitioner (DP) Support was launched on 6 July 2020. While Board-funded, it is an independently run health and wellbeing support service: the first national 24/7 telephone and online service for all dental practitioners, plus students, educators, employers, Australian Dental Council exam candidates and concerned family members. Callers can remain anonymous and have access to an experienced team who can provide confidential advice and referral on a wide range of issues, including mental and physical health and general wellbeing.
The service has received very positive feedback. Professional associations and other stakeholders have helped the Board to promote the service to their members and other interested groups.
Between July and September, 25% of all callers were dentists and the majority of calls to the service were from Victoria, 38%. Of the dental practitioners who have used the service, 100% reported a positive experience.
Associate Professor Lynette Cusack’s term as the Nursing and Midwifery Board (NMBA) Chair ended in October after six and a half years in this leadership role. Professor Cusack is a registered nurse and midwife. Here she speaks about her reflections on nursing and midwifery, Ahpra and the NMBA.
I had several colleagues involved in regulation and when the Chair’s role came up on the former Nursing Board of South Australia, I was asked if I would put in an application and I was successful.
I soon realised that while I thought I understood the whole of the nursing and midwifery professions – I’d been a union member for many years, I was active in a professional association – I didn’t really understand regulation and how that fitted into the professions. I found it to be such an important part of what we do and another way that as a nurse and midwife I could work to keep the public safe.
The way that the NMBA is using the data and evidence that we now have available to us – we’re making well-informed, evidence-based decisions as a Board. The huge consultation with the public and the professions that we carried out to update the codes of conduct for nurses and midwives was a big achievement, particularly our work with Aboriginal and Torres Strait Islander nurses and midwives through CATSINaM and the definition of cultural safety for the nursing and midwifery professions.
I’m very proud of the establishment of Nurse and Midwife Support, which is a wonderful initiative of the Board to support nurses and midwives who in turn look after the public.
I’m also proud of the close collaboration we have had with our Commonwealth and state and territory Chief Nursing and Midwifery Officers. And we’ve established strong networks with international regulators who have similar regulatory systems to us, which has allowed us to share knowledge and look towards the future and the impact of globalisation on the professions.
I think the biggest challenge has been moving from separate silos of different professions and organisations into seeing ourselves as being part of a national scheme. We’ve had to be open to exploring where we have similarities and can work together, while managing the differences between the professions.
I’ve heard of so many amazing things that nurses and midwives have done that I can’t identify just one innovation. I want to acknowledge that when the challenge of this pandemic was set, it was once again nurses and midwives who rose to the occasion and did what they had to do.
Nurses and midwives must continue to move and innovate with the bio-psychosocial needs of individuals and the community. We need to use research to stay ahead of trends so we’re prepared.
One challenge will be the integration of new technology into our practice environment while ensuring that’s in the interest of the public. Another is to continue to effectively partner with Aboriginal and Torres Strait Islander Peoples to improve their health outcomes. I encourage those who follow after me to support and encourage more young Aboriginal and Torres Strait Islanders into our professions.
No matter what your context of practice, whether it’s education, policy, management or clinical work, it’s important to continue to maintain the trust the public has in us and to do that we must use the NMBA’s professional practice framework. As educators and leaders, we need to advocate to ensure that appropriate resources are available in the workplace and education system to enable our nurses and midwives to meet the standards of care expected by our community.
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