Georgie Haysom: Complaint consequences

THE recently reported case of a doctor found to have engaged in “infamous or improper conduct” for failing to stop and render assistance to the victims of a motor vehicle accident after her vehicle and another almost collided is newsworthy not only because of the facts of the case itself.

If you read the decision you will see the extraordinary length of time it took for the matter to come to a resolution in the state administrative tribunal.

The incident took place on 27 April 2002 but it was not until 11½ years later, on 14 November 2013, that the decision was handed down.

According to the decision, the doctor gave evidence in criminal proceedings in the District Court in 2005. Another 8 years went by with this doctor having a complaint hanging over her head.

This is an alarming example of the extended processes that doctors often have to endure to reach the conclusion of a complaints process.

At Avant we have seen many instances of complaints processes that have taken years to resolve, and while the impact on complainants awaiting the resolution of their complaint cannot be underestimated, the impact of complaints on the respondents is often forgotten. Even the most well-handled of complaints can cause great distress to practitioners struggling with a busy schedule.

Imagine a GP in a rural practice who receives a complaint that a patient waited too long to see them and that the receptionist had been rude. The rumour in the town is that the doctor wasn’t in the surgery but at home, when the reality was that they were delayed on duty at a local nursing home.

Even if this complaint was well handled, it could still take up to a year to resolve and would be distressing for the doctor and family.

In many of the cases Avant has been involved with, we have seen delays, administrative difficulties, lack of procedural fairness and lack of transparency create further anxiety and distress on the part of the practitioners we represent. The doctors we see are generally very upset by the thought that they have done something wrong in treating their patients — after all most went into medicine for altruistic reasons.

As Tessa Davis pointed out recently in MJA InSight, the complaints process can increase the frequency and severity of serious mental health issues.

Thankfully, cases with time frames of 11½ years are now rare and, generally speaking, the timeliness with which complaints bodies are dealing with complaints is improving. In Queensland, the new Health Ombudsman legislation, due to come into effect by July 2014, outlines tighter time frames for dealing with complaints.

However, although Health Ombudsman investigations must generally be completed within 1 year, 3-month extensions of time are allowed. Avant had submitted to the parliamentary committee reviewing the legislation that extensions should only be granted by a separate body, such as the Queensland Civil and Administrative Tribunal or the parliamentary committee, based on a careful review of the reasons given. We wait to see what the complaint handling times actually are under the new regime.

Research shows that being the subject of a current medicolegal matter is a risk for psychiatric morbidity, and that doctors with depression make more medication errors.

While some might say it is not the role of the regulator to ensure the health and wellbeing of those they are regulating, when this affects patient safety, it is incumbent upon the regulator to ensure the complaints handling process minimises the impact of that process on the person under scrutiny. Yet the power to take immediate action to suspend or impose conditions on a doctor’s registration (especially under the new regime in Queensland, where it can be done without notice) means that reputations and livelihoods can be lost instantly, followed by a drawn out process to get your “licence” back.

With the Australian Health Practitioner Regulation Agency (AHPRA) review of the national registration scheme due to start soon, it is time to step back and consider whether current complaints handling systems are achieving their stated aims, and doing so in a way that is fair to practitioners.

Do they strike the right balance between protection of the public and the rights of practitioners to a fair, transparent and efficient process? Will reducing the stress on the practitioner be factored into the operation of the complaints systems? Is there a better way to deal with some complaints, particularly those which have at their heart not protection of the public, but differences in clinical opinion? Are the colleges the best arbiters of adherence by clinicians to the standards they set, and what role should they play in the complaints handling process?

These are important questions, which we hope will feature in the terms of reference for the forthcoming AHPRA review.

The challenge for regulators and policymakers is ensuring that complaints handling processes do not constitute any threat to the very thing they are charged with protecting — patient safety.
 

Georgie Haysom is the head of advocacy at Avant.