Mandatory reporting: cure worse than illness?

LET me tell you a story.

Once upon a time, in the state of New South Wales, there lived a nurse called SJ. She loved her job. She was proud of being a nurse and helping others through her work.

SJ had recently been separated from her husband. The separation was messy and SJ felt trapped in her situation. She became increasingly depressed and sought help from several doctors and psychologists, but always felt limited by her poor financial situation. Her depression worsened and she became suicidal. SJ made plans to end her life.

She stopped working as a nurse as she became increasingly desperate in her suicidality. A close friend discovered her suicide plan and convinced her to be assessed in hospital.

SJ was admitted to hospital and, while there, tried to hang herself. After this, she became an involuntary patient and the treating psychiatrist told her he was obliged to notify the Australian Health Practitioner Regulation Agency (AHPRA).

This distressed her immensely and she pleaded that the notification was unnecessary as she had voluntarily stopped her nursing work and had no plans to work in future until she felt better.

• Related: MJA -- Reporting of health practitioners by their treating practitioner under Australia’s national mandatory reporting law
• Related: MJA InSight -- Don’t go it alone

It must be reinforced here that Australian national mandatory reporting law does not specifically require all involuntary admissions of health practitioners to be reported.

This is a real story and obviously the identity of SJ is deliberately hidden. On further investigation, it appears this issue is unique to NSW and has been an area of debate ever since national reporting laws were introduced in 2010. In recent research published in the MJA, Marie Bismark and colleagues describe the issues of mandatory reporting and challenges of preserving the treating doctor–patient therapeutic relationship.

Certainly, SJ found it very difficult to trust future treating doctors when trying to report her suicidal feelings and thoughts, as there was constant threat of being reported again to AHPRA. In fact, on seeking a second opinion from a psychiatrist, it was once again reinforced to her that another admission to hospital with suicidality would trigger another mandatory report.

Clearly the law is intended to provide protection to the public from impaired health practitioners, as well as direct treatment and health care for the practitioner, but the tragedy is that it engenders lack of trust in treating professionals.

It should always be at the discretion of the treating professional as to when to report an impaired health practitioner to the national authority and when exemptions can be judiciously applied.

For example, voluntary removal from work is reasonable grounds to not require a notification. Why NSW law is interpreted as requiring mandatory notification of all involuntary hospital admissions of nurses and doctors to their respective councils and to AHPRA, while the rest of Australia does not require this, is a matter of concern for all health practitioners.

The NSW Nursing and Midwifery Council website has no specific details of such a mandatory requirement, but SJ’s case has shown me that the same interpretation for nurses is being applied in that state.

As a medical practitioner in Queensland, if I treat another doctor or a nurse for a depressive illness with acute suicidality, I am not automatically required to report them to AHPRA, even if I enact involuntary assessment legislation under the Queensland Mental Health Act.

Psychiatrists in Queensland can admit and treat involuntary patients who are health practitioners, and it is up to their discretion to report impairment to AHPRA. The relevant Queensland Health Ombudsman information sheet on the issue is clearly different to the NSW interpretation.

• Related: MJA InSight -- Malcolm Forbes and Margaret Kay: Mandatory dangers
• Related: MJA InSight -- Mary Langcake: Support or report?

In Western Australia, the National Law was amended on its introduction in 2010 to include an exemption to mandatory reporting if a health professional is treating another health professional. A reasonable belief of impairment must exist for a reporting trigger to be reached. This was deliberately included to ensure that health professionals are not discouraged from seeking appropriate care, for fear of being reported. The Honourable Nick Goiran and colleagues argued this case well.

SJ has not been deregistered and can still work as a nurse in NSW. She has had to undertake a health assessment and appear before a review panel. The stress and trauma of this entire process has made for an incredibly difficult recovery from her depression and she continues to lack trust in NSW health professionals, given the system of reporting there.

Sure, lets protect the public, but let’s not make the cure worse than the illness.

Dr Minh Le Cong works for the Royal Flying Doctor Service in Queensland and is the chief editor of the PHARM (Prehospital and Retrieval Medicine) blog site and podcast, the FOAM4GP blog site and the Ketamine Leadership Academy blog site.