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SOME doctors are misusing the new mandatory reporting requirements for their own personal agendas, according to a medical defence organisation and other anecdotal reports.
The reports have led to calls for doctors who misuse mandatory reporting to be subjected to penalties.
Since 1 July 2010, all registered health professionals have been required to notify the Australian Health Practitioner Regulation Agency (AHPRA) if they have a “reasonable belief” that another health professional has placed the public at substantial harm.
In a comment article in this week’s MJA InSight, the chief executive officer of Avant, David Nathan, says that a quarter of members’ requests for support on mandatory reporting come from doctors who have been reported to AHPRA. (1)
“Unfortunately, several of these cases involve an undertone of market competition or a personal agenda driving the making of such reports”, Mr Nathan wrote.
Dr Mukesh Haikerwal, chair of the World Medical Association and former president of the AMA, said he was also aware of cases where reports had been made “not in good faith”.
In a submission to a Senate inquiry into AHPRA in May this year, Dr Haikerwal said the threshold to trigger a mandatory notification was low. (2)
“It follows that the mandatory notification process is potentially open to abuse by claims made in bad faith with the intention of adversely affecting the registration states and the subsequent employability of a health practitioner.”
In his submission, Dr Haikerwal outlined the case of an overseas-trained doctor who was reported to AHPRA by a former employer.
Dr Haikerwal says the reported doctor was issued with “show cause” documentation before any investigation into the legitimacy of the notification started. AHPRA also told Dr Haikerwal that the accused was a “dangerous doctor” who was not expected to be permitted to practice again.
Although the doctor was finally exonerated, Dr Haikerwal says the case left him in a state of “shell shock”.
He says APHRA was unable to determine whether the matter was reported in good faith, but the legal team handling the case for the notified doctor believed it was not.
Dr Steve Hambleton, president of the AMA, said cases like this were “reprehensible” and called for penalties for health professionals who misuse the mandatory reporting system.
“If there’s abuse of process, penalties need to be sanctioned”, he said.
Dr Joanna Flynn, chair of the Medical Board of Australia, said there were legal processes to deal with health professionals who made notifications “not in good faith”, for instance, such doctors could be sued.
Additionally, if the board felt that the notification amounted to unprofessional conduct they could take disciplinary action.
Dr Flynn said she was not aware of any cases where mandatory notifications against medical practitioners had been made due to a personal agenda.
“I have come across some cases where it’s been alleged by the doctor who has had the notification but nothing has been substantiated”, she said.
“On the whole, it would appear that mandatory notification is bringing things to the attention of the board that are appropriate.”
Dr Hambleton and Dr Haikerwal also raised ongoing concerns that the mandatory reporting requirement discouraged doctors from seeking medical care as needed.
The Senate inquiry into AHPRA heard that a doctor took his own life after his treating psychiatrist reported him to AHPRA in line with mandatory reporting requirements.
– Sophie McNamara
1. MJA InSight 31 October 2011
2. Senate: Inquiry into the administration of health practitioner registration by the Australian Health Practitioner Regulation Agency
Posted 31 October 2011
Unfortunately, such health professionals also do the same to patients.
If the person has a vexatious or malicious nature, then it makes little difference as to who they inflict their wrath on- as long as their flying monkey circus provides them with the naive support that they need to enable it.
The system is biased against patients- at least as health professionals you have the luxury of taking it to AHPRA and having it investigated, as well as being involved in the complaint handling process.
For patients, their chances of having their complaint impartially assessed- let alone disclosed to them and involved in the process, is virtually nil.
The same applies to the arrogant insurers these people make their notifications to such as Guild, and abuse the ease with which they make uninvestigated notifications about patients that the majority are none the wiser about which follow them around thanks to repeated privacy breaches between them all.
You all get to fall on your professional indemnity insurance, yet patients are expected to fork out several thousand dollars of their own accord, to right wrongs and have the provider continue to abuse their power over the patient with impunity.
No wonder there are so many psychopaths in fields such as allied health in particular.
I have recently come across quite a few of them acting as part of a pack mob for vexatious and covertly concealed reasons, who believe without question, that they are simply entitled to- while simultaneously claiming to respect patients and be upstanding professionals!
If only they knew!
It is certainly not in our interests to have a mentally distressed individual working when they are not fit.
On the other hand, our current system repeatedly traumatises reported individuals in a way that is obvious to any of us who have seen our friends subjected to Medical Board proceedings. It is simply not necessary to take an adversarial approach to health investigations.
Equally, a good number of health investigations prove to be unfounded and subject the recipients to repeated trauma that was totally unnecessary.
In this context I believe that while health investigations are necessary it should be matter of course that the investigating board ensures the emotional well being of the individual being investigated and funds the necessary legal and health support of that individual throughout the investgation. Any support required should naturally be surrounded by ironclad patient therapist confidentiality agreements. AHPRA should also provide compensation for any time off work required by the person being investigated due to stress, or need to cover the logistical requirements of the investigation
I do not think, though, that it is beyond the wit of the professions to produce a system that achieve this without the casual brutality of the existing system.
AHPHA’s conduct of late has moved beyond the realm of ordinary incompetence and has become a form of “performance art”. This incompetence, combined with the above noted brutality should be enough to give any practitioner nightmares. Fortunately our university educations are very effective at stunting the imagination.
reference:
http://www.youtube.com/watch?v=iG9CE55wbtY
“Sir Ken Robinson: Do Schools Kill Creativity?”
(Documentation supporting my assertions is available).
The mandatory reporting requirements have created a situation where none of us can be confident in the confidentiality of any consultation.
In this circumstance, any medical practitioner with any mental health issues would be well advised to put on a “good front” when seeing his treating doctor.
Thankfully there are many complementary therapists who have excellent counselling skills who are not bound by these requirements.
Mira says “Mothers are victimised by hospitals which seek to deny their right of choice.” This is a very unusual take on the concept of “choice” – the aim is to restrict the practice of clinicians whose professional practice is not up to the standards of their profession. How many people would argue for the “choice” to attend medical practitioners who have been deregistered for poor or unethical performance? In the end, notification leads to investigation. Shouldn’t every professional practitioner be open to investigation. Community standards should not be surrendered in the name of “choice”.
Malicious reporting is not contained to medical practitioners. Currently there seems (from the disproportionate rate of notifications) to be a campaign to diminish the scope of practice of independent home birth midwives who attend hospital with their patients in the event of transfer to hospital. Mothers are victimised by hospitals which seek to deny their right of choice. This amounts to a politicisation of the notification scheme.
Mandatory reporting is an absolute disaster because of “unconscious bias”, failure to conduct complaints “in good faith” and misuse of the term “a reasonable belief”.
As medical students we were educated in psychiatry to recognise there are individuals in society who have sociopathic or psychopathic personalities. Mandatory reporting provides fertile ground for such individuals who have these personality disorders. Everyone should read Dr John Clarke’s book “Working with Monsters” to appreciate why I have been calling for reform of the legislation since its inception. The majority of public health officials are in denial that we are unjustly exposed to malicious and vexatious complaints through this legislation and that it leads to severe stress and anxiety with destruction of our careers and professional reputations. The subsequent investigation of these distorted complaints by the relevant authorities is needlessly prolonged, careless and incompetent in their application. This incompetent legislation enacted through Parliment is a Democles sword that hangs over each and every one of us. Personally I would like to see this legislation applied to the legislators and administraors who dreamed up these ill concieved reforms. Mandatory reporting is an instrument that will be abused by sociopaths to destroy our reputations and careers and it is definitely not in the “public interest” in its current form.
Minimal credibility appertains to the witchhunt against Jayant Patel in Bundaberg, who in some respects, was a convenient scapegoat, for Queensland Health bureaucracy failings, and politicians, aided by the media who like a good story at the expense of the truth. The excessive jail sentences meted out to Jayant Patel, and the previous Health Minister Gordon Nuttall, warrant the attention of Amnesty International, as both Jayant Patel and Gordon Nuttall could be regarded as political prisoners.
Mandatory reporting can save patients lives, take the case
in Bundaberg, doctors and nurses were aware of the harm caused to patients and the deaths that occured, hiding patients was not the answer, nor fear of speaking out, how much pain and suffering would have been avoided if it was mandatory to report Patel.
If there is vindictive reporting then there should be consequenses of these actions.
You need to teach the next generation of clinicians that it is not acceptable to stay silent. “Do no harm” should also include “don’t allow others to do harm and stay silent”.
The whole notion of mandatory reporting has been engineered to keep otherwise unemployable bureaucrats in a job. There always will be some sub-standard medical practitioners. Their own patients and colleagues generally figure a way to squeeze them out of circulation simply by avoiding them. There are plenty of examples. The traditional view that medical practitioners should not advertise did serve to protect the public from charlatans, though the premise has been eroded in recent years. The Lawyers have diluted their standards in a similar fashion. In the final analysis, word of mouth is a more potent arbiter of medical practice than any contrived statute.
Mandatory reporting is only going to work, and be used, if the agency reported to handles the reports sensitively and have an index of suspicion about the possibility of vindictive reporting; at the moment it is hard to be confident that the agency handling reports has sufficient administrative competence to deal with much at all, from what I hear.
Dr Flynn’s lack of awareness of any vindictive reporting to the MBA is unbelievable and typifies the elitist, uncaring attitude that the Medical Board of Victoria was notorious for. She & her team are not detectives & their so called investigations lack the expertise to tease out the complexities involved in malicious notifications. They will not see if they don’t know where & how to look. Vindictive reports are very similar to scams, cons & fraud, crimes that often require specialised techniques such as undercover work & surveillance to detect & solve. Without proper training akin to that provided to law enforcement investigators, most malicious reports, especially in the adversarial setting of the MBA, will not be detected & miscarriages of justice are inevitable.
This mandatory reporting (which I support by the way, since we keep on hearing of too many cases where the doctor kept on doing his aberrant “thing” but which was unreported for far too long such as the “Beast of Bega”), also extends to the nursing staff who can lodge a vindictive report from their hospital computer keyboard. As an O&G rural locum, I have had a very small number of such reports filed by midwives over the years from two or three hospitals I and internet listings would rate as dysfunctional. Each time I have been totally vindicated and exonerated, with a resultant direction to the director of nursing to counsel their staff. Such staff seem to get a bee in their bonnets, which clouds their objectivity, and their resultant reports from the same hospital with strikingly similar wording smacks of collusion.
As is the situation with a number of previous respondents, I believe the mandatory reporting has been misused. In my situation, the chief executive of the hospital I had worked in for 18 years placed me on report. I was cleared of this, and subsequently a NSW Supreme Court judge named this person as carrying out improper procedural practices concerning myself. I would have thought that people who report others should be subject to review themselves, if it transpires the allegations are incorrect and an independent 3rd party confirms that the reporter has been carrying out improper practices.
I have been subjected to a process of systematic ‘bastardization’ behind my back by my fellow specialists.
Despite there having been:
1. no complaints from patients;
2. proper peer review by colleagues and the Medical Council of NSW (MCNSW) that have formally cleared me of any malpractice.
And in processes that lacked any form of natural justice, I remain suspended from my two working hospitals.
The MCNSW have been waiting to do a performance assessment of my operating for several months now but I need a hospital to operate at (catch 22!).
I was reported to APHRA and took ‘voluntary’ suspension from all but minor surgery one year ago. It took 10 months!! for my case to get to an inquistitoral meeting with the Medical Council NSW and is still nowhere near resolved!!
My once healthy practice of almost 30 years has been decimated and I am rapidly drifting towards bankruptcy and financial ruin. My house is on the market and that may need to be a ‘fire sale’. My reputation has been shattered.
My wife has given up her charity which raises money for medical resarch for our local teaching hospital. She has been psychologically traumatised and is on sedation but despite that is looking for a job.
There is a LARGE undertone of market competion and personal agenda in all the reports against me.
For many years, we have seen doctors whose practise of medicine is not at a standard acceptable to ensure the safety of patients. Doctors tend to shy away from criticising colleagues for various reasons.
It concerns me that reporting does not always result in optimal management of the issues that arise with an underperforming doctor.
Educating those who are not practising at a reasonable standard should be the main aim after a mandatory report has been received and proven to be true. Punishment will not fix the problem. Our practise of medicine should be to ensure that patients receive the best care possible to achieve optimal outcomes.
Those with a drug or alcohol problem need to be managed appropriately. Many are unaware that their addiction affects not only their patients but their colleagues, families and friends. Mandatory reporting may actually force these doctors to face their problems and address them appropriately.
Doctors who recognise and address their problems by seeking assistance from a specialist appropriately should not be reported under mandatory reporting and this is perhaps where the mandatory reporting issue is not so clear or even misused by unscrupulous colleagues. The problem with mandatory reporting is that there is no system to protect a person who is the subject of vindictive behaviour. If the report was found to be vindictive, then the person who undertook to make the report should be punished. This would reduce the number of vexatious complaints. It would also make it easier for doctors to make genuine complaints without fear of retribution
Doctors who enter into a sexual relationship with patients need to be reported because they have misused their authority and position and have often harmed the patient. This type of behaviour may indicate that the personality of the doctor requires deeper inspection by a psychiatrist.
The conscience of these doctors may be very questionable.
Mandatory reporting, unfortunately, has been used in a vindictive manner by some of those unscrupulous doctors who do not have the fortitude to recognise that they may have an issue and need to resolve it in a mature manner with a colleague. I have worked in a practice where a colleaugue who was a bully, had problems with anger management issues and created havoc in the workplace with an unpleasant and discriminatory attitude toward many of the staff and colleagues. I was silly enough to try to protect some of the staff and complained that this doctor’s behaviour was unacceptable and tried to discuss it with the person. I chose to leave the toxic practice and moved onto a pleasant normal practice away form this behaviour. The doctor threatened via email to report me under mandatory reporting in a vindictive manner. Upon calling the board I was reassured by the board that I would not have any problems at all and should the doctor decide to report me and they also reassured me that under these circumstances they do check the doctor who is doing the reporting.The person I spoke to also said that the tone of the email was nasty and they could see it was purely vindictive and should the report form the doctor arrive at the board, they may choose to investigate the reporting doctor.
Mandatory reporting is not working.
Mandatory reporting is not working. The problem seems to be the heavy handed bureaucratic response, which causes a great deal of distress to the accused doctor, and perhaps, at least on occasion, an apparently prejudicial attitude.
The aim of the process should be to protect the public; not to assume a punitive attitude towards the doctor. To that end, the first step should be a one-on-one chat with a peer, to counsel the doctor, attempt to acertain the validity of the report, and to hasten a change that immediately and voluntarily removes any ongoing risk to the public.
Until such time as the process following a report can adopt such a non-prejudicial attitude aimed at helping the “offending” doctor to practise appropriately can be put in place, mandatory reporting should be seen as a process of last resort.
There should first be an initial review by the doctor’s peer group. Only on their having determined that they are unable to influence the behaviour to adequately protect the public, should the doctor concerned by subjected to the mandatory reporting process.
Mandatory reporting should not be the first step except in extreme circumstances. Penalties for delaying reporting while other due processes are taking place as above, should not apply.
So… if I have a specialist staff member and nursing staff working with him say he is a danger and I fail to report I’m in trouble but if I do report I can be in trouble. Which of us is penalised can come down to an enquiry that will refuse to interview the nurses involved.
I’ve had this experience and am most reluctant to ever report again