Last year, Australia’s health ministers appointed Kim Snowball, the former Director General of Health in WA, to conduct an independent review of the National Registration and Accreditation Scheme. In other words, he was asked to review how well the Medical Board, the 13 other health profession boards and AHPRA, are achieving the goals set for the scheme in 2010. Mr Snowball’s review findings are now with the ministers and are not yet public. They may or may not result in significant changes to the scheme. In the meantime, as anyone who undergoes accreditation or performance reviews knows, the process of preparing for a review and hearing feedback from others always provides opportunities for reflection, learning and improvement.
A great deal of work is now underway within AHPRA and the Boards to improve and streamline processes and communications, provide greater clarity and focus to our work and ensure that costs are controlled. We will continue to report on the progress of these efforts. Your feedback is always welcome.
Dr Joanna Flynn AM
Chair, Medical Board of Australia
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New approach to international criminal history checks
The Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board have introduced a new process for checking practitioners’ international criminal history to strengthen public protection.
The new process aims to strike a balance between public safety and regulatory burden for practitioners. It aligns our international criminal history checks with our domestic history checks and aims to be fair and reasonable for practitioners.
Under the Health Practitioner Regulation National Law, as in force in each state and territory (the National Law), the Medical Board must consider the criminal history of all applicants for registration, including any overseas criminal history.
The new approach requires certain applicants and practitioners to apply for an international criminal history check from an AHPRA-approved supplier.
Checks will be required for all new applicants who:
- declare a criminal history outside Australia and/or
- have lived or been primarily based in one or more countries other than Australia for six consecutive months or more since the age of 18.
Currently registered practitioners will require a check if they:
- are seeking to renew their registration or applying for a change in registration type, and:
- there has been a change to their criminal history in one or more countries other than Australia since their last declaration to AHPRA
- at any time of the year, inform the relevant National Board that they have been:
- charged with an offence outside Australia that is punishable by a sentence of 12 months' imprisonment or more, or
- convicted of, have pleaded guilty to or are the subject of a finding of guilt by a court for an offence, outside Australia, that is punishable by imprisonment.
Existing requirements for checking domestic criminal history will continue.
More information is available on the International criminal history checks page on the AHPRA website.
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Board and AHPRA strengthen national drug screening
Mandatory hair testing will be routine for all registered health practitioners with substance-related impairment, under a screening protocol to be introduced by AHPRA and the National Boards.
Under the protocol, all health practitioners who have restrictions on their registration linked to past substance abuse will have routine hair testing in addition to urine testing.
Routine hair testing helps provide comprehensive information about the use – over time – of a wide range of drugs (not just based on the practitioner’s drug-taking history).
The protocol provides a clear framework across professions for AHPRA’s advice to National Boards about the management of registered practitioners with drug-related impairment. It will make sure drug screening in the National Scheme is evidence based, effective and up to date.
National Boards will continue to make decisions about individual practitioners with impairment case by case, based on testing standards set out in the protocol. This includes:
- nationally consistent threshold limits, so all pathology providers conducting the tests use consistent testing baselines (e.g. will report all positive alcohol readings over 30pg/mg in hair)
- agreed ‘critical events’ – in addition to positive test results – requiring action and follow-up (e.g. unexplained delayed screening tests or results, failure to attend screening, diluted or unsuitable samples, etc.), and
- agreed triggers for National Boards to consider disciplinary action (e.g. positive test results, non-compliance with screening requirements, etc.).
AHPRA has established an expert panel to provide ongoing advice on the biological assessment, testing and monitoring of applicants and registrants with drug and/or alcohol misuse, including impairment. The panel includes Professor Olaf Drummer, Professor Jenny Martin and Dr Robert Ali. Terms of reference for the panel are published on the Expert Panel on Drug and Alcohol Screening page.
AHPRA is now seeking expressions of interest from pathology providers to provide drug screening services to AHPRA to support ongoing monitoring of practitioners known to have drug-related impairment.
The drug screening protocol is part of a wider, national strategy to effectively manage compliance and monitoring across the National Scheme. The strategy, progressively implemented from July 2014:
- applies to AHPRA’s management, on behalf of National Boards, of all registered health practitioners with limitations on their registration related to health, conduct, performance or registration
- includes structural change, with the appointment of a national director, compliance and monitoring, and
- ensures coordination across all states and territories of AHPRA’s compliance and monitoring program.
AHPRA introduced an interim drug screening protocol nationally in July 2014 to guide the monitoring of practitioners with drug-related impairment.
The interim protocol was reviewed by independent expert Professor Olaf Drummer from Victorian Institute of Forensic Medicine, to ensure the approach to biological testing in the National Scheme was evidence based and up to date. His report is published on the Monitoring and compliance page.
AHPRA has updated the interim protocol in response to Professor Drummer’s findings, including making it more specific about the drugs to be tested, the cut off levels for testing and introducing the use of hair testing. It will be further refined, fully implemented and published when AHPRA has selected an ongoing provider of pathology testing services. The proposed new protocol is published on the Monitoring and compliance page.
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Revised guidelines for pre-employment structured clinical interviews (PESCI)
Revised guidelines on pre-employment structured clinical interviews (PESCI) will take effect on 1 March 2015.
A PESCI is an objective assessment of an international medical graduate’s (IMG) knowledge, skills, clinical experience and attributes. It involves a structured clinical interview using scenarios and is conducted by organisations approved by the Australian Medical Council (AMC).
IMGs applying for limited registration or provisional registration may be required to undergo a PESCI. The Board considers information from the PESCI, along with other information, when deciding whether the IMG is suitable to practise in a specific position for which they are seeking registration.
The Board-approved revised guidelines – developed by the AMC – provide an overview of when a PESCI is required, what a PESCI involves, the roles and responsibilities of stakeholders and the criteria the AMC will use to assess PESCI providers. Under the guideline, only approved providers can deliver PESCIs.
The guidelines – Pre-employment structured clinical interview guidelines and criteria for AMC approval of PESCI providers – are published on the Board’s website. The Board has also updated the reporting templates that are used by PESCI providers to report the outcome of a PESCI to the Board and to the applicant.
More information on the PESCI is available on the Board’s website.
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Electronic communication with patients
A recent case in the NSW Civil and Administrative Tribunal highlighted the risks when doctors use social media and electronic messaging to communicate with their patients.
In this case, the tribunal heard that the medical practitioner communicated with patients through various means including text messaging, email, Skype and Facebook.
While the tribunal also considered other issues related to professional conduct and professional boundaries, the case raised issues about appropriate communication between a practitioner and their patient on social media.
The tribunal heard concerns about the security and privacy of Facebook communications, particularly when the practitioner used Facebook to provide results of blood tests. The practitioner posted some messages on the patient’s ‘wall’, which were visible to the patient’s Facebook friends.
The tribunal noted the practical benefits of using text messages to confirm patient appointments, but identified a need for guidelines for health practitioners when using social media, that highlight the importance of practitioners protecting patient confidentiality.
In 2014, the Medical Board of Australia, with the other 13 National Boards, published a Social media policy to help practitioners understand their obligations when using social media. The policy states that standards of professional conduct do not change, regardless of the means of communication.
The Medical Board’s code of conduct, Good medical practice, sets out the standards of professional behaviour the Board expects of registered medical practitioners whether they are interacting in person or online. The code also sets out standards in relation to privacy and confidentiality, including when using social media.
When using social media on sites such as Facebook, medical practitioners should be aware of their obligations under the National Law, Good medical practice, the advertising guidelines and other relevant legislation, such as privacy legislation.
When assessing concerns about medical practitioners, the Board holds practitioners to account against the standards set out in these publications and other relevant Board guidance.
The Social media policy, Good medical practice and the Guidelines for advertising regulated health services are accessible on the Board’s website on the Codes and guidelines page.
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News and alerts
Clinical Communiqué – Lessons from the Coroner
The Victorian Institute of Forensic Medicine (VIFM) has relaunched its Clinical Communiqué – a newsletter written by clinicians, for clinicians, about lessons learned from deaths investigated by coroners’ courts.
The Clinical Communiqué is an electronic educational resource for medical practitioners and health professionals, with a focus on patient safety in acute healthcare settings. Edited by Dr Nicola Cunningham, a forensic and emergency physician, it uses a narrative case-study approach to report lessons from preventable deaths investigated by coroners’ courts.
The Communiqué is published quarterly and uses coronial cases from local and international jurisdictions to explore the challenges that clinicians face every day in providing clinical care. Key patient safety themes are identified in each issue, such as communication, supervision, decision-making and recognising the deteriorating patient. The Communiqué brings together the cases, lessons and expert commentaries in one publication.
The next edition is due out in March. The first two editions of the Communiqué are available on the VIFM website. Subscription is free and available at VIFM Communiqués.
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Panel, court and tribunal decisions
Latest tribunal decisions published online
AHPRA on behalf of the 14 National Boards publishes a record of panel, court and tribunal decisions about registered health practitioners. Summaries are published when there is clinical and educational value.
Court and tribunal decisions
Under the National Law, the Board must refer a matter about a registered medical practitioner or student to a tribunal if the Board reasonably believes that the practitioner has behaved in a way that constitutes professional misconduct; or the practitioner’s registration was improperly obtained because the Board was given false or misleading information. The Board must also refer the matter to a tribunal if a panel established by the Board requires the Board to do so.
Medical practitioners may also appeal certain decisions of the Board to a tribunal or court.
AHPRA publishes summaries of tribunal or court cases. These can be sourced at Publications>Tribunal decisions on the AHPRA website. A full library of published hearing decisions from tribunals or courts relating to complaints and notifications made about health practitioners or students is available on the Austlii website.
Recent decisions of tribunals:
Dekker v Medical Board of Australia
The WA Court of Appeal has set aside a WA State Administrative Tribunal’s finding that Dr Leila Dekker was guilty of improper conduct. Read more in the media release.
Liyanage v Medical Board of Australia
The Northern Territory Health Professional Review Tribunal has lifted the suspension of Dr Wijeneka Liyanage. Read more in the media release.
Medical Board of Australia v Dr I
The South Australian Health Practitioners Tribunal has reprimanded a medical practitioner and imposed conditions on their registration due to professional misconduct. The tribunal ordered that the practitioner’s personal details be suppressed. Read more in the media release.
Medical Board of Australia v Dieu
The Victorian Civil and Administrative Tribunal has reprimanded medical practitioners Dr Tam Dieu and Dr Mervyn Cass and placed conditions on their registrations. Read more in the media release.
When investigating a notification, state and territory committees of the Medical Board of Australia may refer a medical practitioner to a health panel hearing, or a performance and professional standards panel hearing.
Under the National Law, panel hearings are not open to the public. AHPRA publishes a record of panel hearing decisions made since July 2010. Summaries have been provided when there is educational and clinical value. These summaries are accessible from hyperlinks within the table. Practitioners' names are not published, consistent with the requirements of the National Law. This table does not include summaries of panel decisions made under previous legislation, even if these were held after July 2010.
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Contacting the Board
- The Medical Board of Australia and AHPRA can be contacted by phone on 1300 419 495.
- For more information, see the Medical Board of Australia website and the AHPRA website.
- Lodge an enquiry form through the website under Contact us at the bottom of every web page.
- Mail correspondence can be addressed to: Dr Joanna Flynn AM, Chair, Medical Board of Australia, GPO Box 9958, Melbourne, VIC 3001.
Please note: Practitioners are responsible for keeping up to date with the Board’s expectations about their professional obligations. The Board publishes standards, codes and guidelines as well as alerts in its newsletter. If you unsubscribe from this newsletter you are still required to keep up to date with information published on the Board’s website.
Comment on the Board newsletter is welcome and should be sent to email@example.com.
For registration enquiries or contact detail changes, call the AHPRA customer service team on 1300 419 495 (from within Australia).
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