Issue 25 / 8 July 2013

LEGISLATION proposed by the Queensland Health Minister to create a Health Ombudsman as “the lynchpin of a new and accountable complaints reporting system” represents a reactive, state-based, retrograde approach to an important issue that requires a national reform agenda.

Minister Lawrence Springborg announced dramatic changes to the administration of health complaints and notifications in Queensland earlier this year, following the tabling of two damning reports.

A three-member panel convened by Mr Springborg found that 363 of 596 files examined (about 60%) were not handled in a manner that was timely and/or appropriate and/or in compliance with legislative objectives.

The panel, headed by a former assistant commissioner of the Health Quality and Complaints Commission, Dr Kim Forrester, reported that in one case it took 2368 days — nearly 6½ years — for the responsible agencies to reach a final decision.

In recent years there have been a number of public policy decisions that have led to a plethora of failed experiments in the delivery of health care. One obvious explanation for these is that political leaders in various Australian governments have a tendency to underestimate the time, costs and risks of their decisions while at the same time overestimating the benefits.

The introduction of the Australian Health Practitioner Regulation Agency (AHPRA) has been an interesting experiment.

The Health Practitioner Regulation National Law Act 2009 was heralded as a new era in professional regulation, with 14 health professions regulated by nationally consistent legislation that would “reduce red tape, improve standards, and improve safety for the Australian community”.

However, a subsequent Senate Inquiry in 2011 revealed AHPRA was not particularly successful in delivering the desired outcomes. In fact, the Senate report was critical of a number of the agency’s failures, and suggested that these could have compromised the nation’s health services.

Unfortunately, 2 years after the Inquiry’s recommendations were made, some problems still remain. There has been limited consultation with stakeholders regarding the recommendations, particularly medical indemnity insurers.

The Forrester report also painted a disturbing picture of how AHPRA and the Medical Board of Australia operate. However, while Minister Springborg alleges that “AHPRA and the Medical Board afforded much more lenient treatment to doctors than other regulated professions”, MDA National believes that AHPRA’s inefficiencies in Queensland have cut both ways.

MDA National agrees there is a “maze of confusion” and inconsistency in how complaints in Queensland have been handled, but the Minister’s description of a complaints “merry-go-round” has disadvantaged patients and doctors alike.

MDA National has observed that complaints in Queensland have not been managed in a timely, consistent or effective manner.

However, it remains doubtful whether the introduction of a Health Ombudsman would add to the efficiency of complaints handling in Queensland, given it would still operate alongside the national scheme.

Finessing the existing structure and making AHPRA and the Medical Board work in a more functional way is a better approach than introducing an entirely new mechanism.

MDA National has serious reservations about the role of Queensland’s proposed Health Ombudsman, given that the draft laws propose that someone (possibly without medical training) would have broad powers to restrict a doctor’s practice of medicine and potentially “name and shame” doctors without consideration of procedural fairness.

It is ironic that, in 2009, the Queensland Parliament was the first to pass legislation to establish the national law to regulate health practitioners, including the creation of AHPRA. AHPRA remains accountable to all state health ministers, including Queensland’s, via the Australian Health Minister’s Advisory Council, so unilateral action outside this forum is difficult to comprehend.

MDA National also advocates for greater awareness of the importance of cultural change in improving complaints handling and registration issues in Queensland. Certainly, our experience of medicolegal matters in other jurisdictions supports the observation that less adversarial models, such as the Victorian Health Services Commissioner, are perceived by complainants as being better.

MDA National strongly supports the 2011 Senate Inquiry recommendation that AHPRA establish consultative groups with professional organisations and health providers, and welcomes further dialogue in relation to any proposed changes.

AHPRA should consider greater cooperation with the medical profession to improve regulation. By focusing on the development of a culture of good faith with practitioners, as well as finding ways to cultivate greater professionalism, there will likely be greater system safety that ultimately protects the public.

Associate Professor Julian L Rait is the President of MDA National and a practising ophthalmologist.

5 thoughts on “Julian Rait: Complaints disquiet

  1. Andrew Bryant says:

    The current and planned complaint system in Queensland encourages vexacious behaviour at the expense of sensible discussion and mediation.  It is also glacial in dealing with issues that, if resolved in a timely manner, would lead to mutually satisfying outcomes in most cases.  I have no confidence in the system either currently or Mr Springborg’s proposed ombudsman.

  2. Robyn Pogmore says:

    I would like to add that the HCC’s spontaneous press releases,two of which were about me,are nothing more than libellous malicious un-called-for character assassination. 

    and I understand that a recent court decision vindicated a psychiatrist who sued another psychiatrist for libel,—–I think he wrote a peer review. If this brings nothing else,it should be a warning  to those who cheerfully agree to  write a judgmental report about someone. 

    There is a lot of sanctimonious behavior, and expectation of impossible god-like behavior. We are,I understand,all mere human beings. 

    AHPRA and the HCCC should be subjected to a shake-up. 

  3. Mary-Ellen Miller says:

    Queensland had the effective non adversarial Victorian model developed by and implemented by Dr Ian Siggins in both places. Ultimately successive legislative changes and policy changes since his retirement in 1997 has led to the situation today.

  4. Graham Row says:

    Hairy-chested politicians legislating their way into ethical matters singing the tiresome mantra, “I will stop this dreadful thing from ever happening again” are a curse. Professor McCaughey in the 1988 Mills Memorial Oration on medical ethics observed, “the law is too inflexible an instrument to deal with the immense variety and rapidly changing scene which is medical science and practice.  This limitation of law was seen centuries ago, by Plato and Aristotle, but is forgotten again and again.”  In the wake of the Ward 10B enquiry, the AMA in Queensland worked hard  to make the punitive Health Complaints Unit into a more even-handed and conciliatory body.  The hairy-chested politicians have progressively eroded this model to the present day shambles.  “RP” is simply one of its many victims.  It brings to mind the words of Morris West in his 1994 Veith lecture. “In the church, as in civil ilfe, bad law brings the principle of law into disrepute.  Dubious law puts the principle in doubt.  Law imposed upon the people without explanation, with its processes loaded against them ab initio, is of its very nature an injustice.  A law beyond effective appeal is a tyranny.” Goodbye doctors maintaining standards as an ethical obligation.  Hello hyper-regulated, demoralised “medical practitioners” reduced to fighting for tax deductibility for their mandatory CPD.

  5. Robyn Pogmore says:

    I have had much to do with this lately——-the outcome for me was catastrophic of course,but I think several aspects of the Board, AHPRA , and the HCCC’s practice are grossly unfair,and even,it seems to me,illegal.

    firstly,they do nothing to check the complainant’s story—-either for the truth,or for background agenda. They take the whole complaint,in every detail,climb on their high horses,and CHARGE at the doctor concerned. 

    They ask for one’s response,but take no notice whatsoever

    Also,they see themselves as the law,or a paralegal body—–how does the judiciary feel about this ?

    the HCCC people talk much about confidentiality,but betray their own hypocrisy by issuing press releases 

    there are also many vague,but indictable crimes——-unprofessional behavior,for a start. I was accused of arrogance,egotism,unprofessional behavior. 

    These bureaucracies need strict guidelines and SUPERVISION

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