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This month marks the end of the second term of the Medical Board of Australia and will mark a change in Board membership. The National Board has a practitioner member from each jurisdiction and four community members. Last month Australia’s health ministers announced appointments to the Board for the next three years. We welcomed new members in the last Update.
I would now like to acknowledge the contributions of members who are retiring from the National Board. Professor Peter Procopis (NSW), Dr Charles Kilburn (NT) and Mr Paul Laris (SA) were founding members of the Medical Board of Australia, served for two terms on the National Board and were also involved in medical regulation locally.
Dr Rakesh Mohindra (SA), Mr Robert Little (ACT) and Adjunct Professor Peter Wallace (WA) each served one term on the National Board and continue to be involved in medical regulation in their state or territory.
Each of the retiring members brought wisdom and practical experience of issues in healthcare and the concerns of the community to the deliberations of the National Board. They have been extraordinarily generous with their time and shown great dedication to ensuring high standards of medical practice and medical regulation in Australia. We will miss them. On behalf of my colleagues continuing on the Board, I would like to thank them for their contribution. Dr Joanna Flynn AM Chair, Medical Board of Australia
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The registration renewal campaign for medical practitioners is now underway and medical practitioners who have provided an email address to the Board will have received their first email reminder from AHPRA.
During September, paper reminders will be posted to medical practitioners who have not renewed.
The Board has set the registration fee at $724, limiting the increase to the national consumer price index (CPI). The fee covers the registration period for most practitioners from 1 October 2015 to 30 September 2016. The fees schedule is available on the website.
Registration renewal for medical practitioners with general, specialist and non-practising registration is due 30 September 2015. Renewal applications received during October will incur a late payment fee.
Under the National Law1, practitioners who do not renew their registration within one month of their registration expiry date must be removed from the register of medical practitioners. Their registration will lapse and they will not be able to practise medicine in Australia. A fast-track application can be made, but the practitioner cannot practise until the application is processed and the national register is updated. This can take time.
The Board has dealt with a number of cases recently that highlight the problems that may arise when medical practitioners treat people with whom they have a close personal relationship.
The article refers to ‘family and friends’ but includes anyone with whom the doctor has a close personal relationship.
The Board is publishing this article to remind doctors of the risks of treating family and friends and to encourage doctors to reflect on whether it is appropriate to treat in the circumstances.
Typically, the cases relate to medical practitioners:
Prescribing issues
In the cases referred to the Board, prescribing usually followed a request from a family member in pain, suffering from insomnia or anxiety. While not always the case, often the doctor had prescribed schedule 8 and/or psychotropic medication.
Tribunals have noted the significant risk of harm associated with prescribing these drugs outside a formal consultation. This is especially the case when these drugs are, without the doctor’s knowledge, combined with other prescription or illicit drugs with sometimes tragic consequences. In one case, the practitioner’s adult child had taken a fatal overdose of a medication prescribed by the practitioner.
Inadequate assessment
In a recent case that was heard by a tribunal, a medical practitioner’s decision to not call an ambulance for their unconscious friend and to monitor them instead, resulted in that friend’s death from a medication overdose. The doctor was inappropriately influenced by the friend’s family’s potential embarrassment.
Performing elective surgery
The Board has received notifications about practitioners who have performed elective surgery on family members, including cosmetic procedures. The notifications have usually been made by other practitioners who have been involved in the care of the patient and have been concerned by the practitioner’s apparent lack of insight that this might be inappropriate practice.
The standard of care provided to family and friends can be compromised, because the close relationship can cloud professional objectivity and affect professional judgement. The close relationship can make it difficult to obtain a complete medical history and to perform a full and proper examination. It can also lead to an informal approach towards record keeping.
When a prescription is provided informally, it may be done without the appropriate assessment. The regular ongoing monitoring for adverse side effects or interactions that we provide as part of our usual practice may be neglected. Without adequate clinical records there is no documentation of the diagnosis or the patient’s progress.
Family and friends can sometimes exert pressure for treatment that is difficult to resist. This is particularly when the doctor is being asked for diagnosis and treatment outside their area of expertise.
Doctors may have a role in advocating and supporting family and friends in relation to their medical needs. However, medical practitioners should encourage family members to have an independent and trusted general practitioner who can coordinate their care. They should avoid being the primary treating doctor of a family member, but may be required to take on this role in an emergency or when other medical care is not accessible.
Practitioners are also reminded of section 3.14 of Good medical practice which provides guidance:
3.14 Personal relationships
Whenever possible, avoid providing medical care to anyone with whom you have a close personal relationship. In most cases, providing care to close friends, those you work with and family members is inappropriate because of the lack of objectivity, possible discontinuity of care, and risks to the doctor and patient. In some cases, providing care to those close to you is unavoidable. Whenever this is the case, good medical practice requires recognition and careful management of these issues.
The Australian Health Workforce Ministerial Council met on 7 August 2015 at the COAG Health Council meeting to consider the final report of the independent review of the National Registration and Accreditation Scheme.
The purpose of the independent review was to identify what is working well in the National Scheme and the opportunities to improve and strengthen the operation of the scheme in regulating health professions to protect the public.
Ministers expressed strong support for the work of the National Scheme, noted that it was now embedded in the health system and was among the most significant and effective reforms of health profession regulation in Australia and internationally.
More information about the review can be found on the COAG Health Council website and on AHPRA’s website.
The Medical Board has warned doctors to look out for a fraudulent letter purporting to be jointly from the Board and the Department of Human Services.
The letter urges doctors to review their practice for overservicing and refers to the Department of Human Services’ Practitioner Review Program. The letter appears to closely reflect the content of authorised letters from the Department of Human Services to practitioners on this issue.
The fraudulent letter uses both the Medical Board of Australia logo and the Department of Human Services’ Medicare logo without authorisation and includes the medical practitioner’s registration number.
If you receive a joint letter from the Medical Board of Australia and the Department of Human Services on this issue it is likely to be unauthorised. Authorised letters on this issue are sent to practitioners from the Department of Human Services only.
If you have recently received one of these letters or you have more information about these letters you should contact the Health Practitioner Section at the Department of Human Services on 02 6143 6040.
The Royal Australian College of General Practitioners (RACGP) has released a new guide for general practitioners on prescribing benzodiazepines, focusing on patient-centred care, accountable prescribing and harm reduction.
Also available is a clinical governance framework for prescribing drugs of dependence in general practice. This provides practices with principles, strategies and tools in relation to prescribing drugs of dependence.
The guides are available on the RACGP website.
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.
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 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.
Medical Board of Australia v Barnes
The State Administrative Tribunal of Western Australia has reprimanded Dr William Barnes, suspending him for three months and imposing conditions on his registration. 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.
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 protected].
For registration enquiries or contact detail changes, call the AHPRA customer service team on 1300 419 495 (from within Australia).