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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.
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The AMA and each College including ACRRM and RACGP , and specialist colleges should demand representation on the AHPRA and any other body that regulates medical practitioners, and demand representation by the relevant college on each investigation.
A very timely article Georgie. My experience supports Sue Ieraci’s extremely important point that a good doctor, the subject of complaint, in addition to self-imposed recriminations suffers a loss of self esteem and confidence and becomes tentative and risk averse thus greatly increasing the potential for the unfortunate practitioner to further “harm the public”. The only viable course for AHPRA if they really believe their primary role is to protect “the public” is to adopt a strongly supportive and practitioner-oriented approach to complaint handling. The only alternatve would be to suspend the practitioner from practice pending resolution of the complaint. Given that AHPRA seems to consider itself immune from the law of unintended consequences they might just do this. I will follow the AHPRA review with great interest.
The issues raised in this article – especially the Queensland power to impose conditions or suspend a doctor – prove that the complaints process can be used vexatiously.
For example, when I was an intern at a Queensland Hospital, some of the consultants found me a bit demanding as a 37yo with three degrees. So a few of the consultants made a non-specific, vexatious complaint that was impossible to respond to. It was quite stressful because they alluded to poor patient care, without cases or examples or details.
The Qld Board immediately imposed conditions without any rationale, and then refused to investigate immediately as they are required to if they chose to act unilaterally. It transpired there was no case to answer, and the complaint was groundless and vexatious. I had to take the Board to the Medical Practitioners’ Tribunal and force them to lift the conditions. This took three years…
AHPRA and HCCC have an unrealistic expectation that doctors should be godlike in their perfect behavior. They do not examine the background,or,I suspect,the veracity of the complainant’s statement. They have no interest in what can be a perfectly obvious second agenda on the complainant’s part. They take very little notice of the doctor’s attempt to justify his/her behavior, and they prosecute relatively minor matters with great ferocity.
I have always wondered whether the prosecution of myself was seen by them initially as an “easy kill” to improve their statistics.
Thank you for this article. I have seen many people suffer the emotional consequences of long delays in complaint resolution – resulting in long periods of anxiety or depression. Paradoxically, the less serious complaints are held over the practitioners heads for longer periods because they are seen as lower priority from the patient’s point of view. I also have the impression that people outside the profession do not understand the self-recrimination that comes from making a genuine error – it is assumed that ”punishment” is the only consequence. IN my experience, both personally and professionally, almost every practitioner who has made a genuine error that harmed a patient is appalled by what has happened, and may become excessively cautious and risk averse, if not frankly avoidant. There is room for much more sophistication in this entire process.
There may be many well handled complaints that we don’t hear about, but there are too many cases that are publicised where the practitioner has been penalised without due process. The simplest way to decide whether there is a real case to answer is to have an independent, fair-minded expert review the evidence and recommend the appropriate course of action, as is usually the case in matters handled by malpractice insurers. AHPRA can be very heavy handed, and in one case, without even ensuring that they had the correct identity.