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UPDATED: 3.33pm Monday 18 July 2022.
THE Victorian Branch of the Australian Medical Association (AMA) will put forward a motion at the AMA’s National Conference at the end of this month, calling for a Royal Commission into the Australian Health Practitioner Regulation Agency (AHPRA).
Dr Mukesh Haikerwal, former President of the Federal AMA, and a member of the AMA Victoria Council, told InSight+ the motion had been tabled with the Federal AMA, and would be on the agenda of the conference which runs 29-31 July.
The move comes in the wake of AHPRA’s decision to impose restrictions on West Australian GP Dr David Berger because of his alleged conduct on Twitter. There has been concern among leading doctors using social media that freedom of speech is in danger.
Dr Berger has been a vocal, blunt, and sometimes sarcastic critic of governments, Chief Health Officers and health authorities for lack of action and alleged ignoring of evidence about the current COVID-19 pandemic.
Dr Berger must undertake education “in relation to behaving professionally and courteously to colleagues and other practitioners including when using social media in accordance with Good medical practice: a code of conduct for doctors in Australia”, according to AHPRA. Dr Berger was allegedly the subject of an anonymous complainant who objected to his manner of expression.
Dr Haikerwal told InSight+ the AMA Victoria decision to call for a Royal Commission was made well before news of Dr Berger’s run-in with AHPRA came to light, was a response to long-term concerns about the regulator’s “over-reach”, and follows on from the “inept” 2011 Senate inquiry into AHPRA.
The motion from the AMA Victorian State Council reads:
“The following are some of the areas of concern that must be addressed by the Terms of Reference of the Royal Commission:-
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There be a presumption of innocence in investigation of all practitioners.
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The objectives of the National Registration and Accreditation Scheme under the National Law be amended to mandate that AHPRA has a duty of care to the Registrant and in particular to minimize the mental health impacts and financial effects on the health practitioner under investigation.
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The identity of health practitioners under investigation be protected to minimize potential reputational and opportunity loss.
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AHPRA and the Medical Board of Australia must offer confidential support by an independent mental health professional to any health practitioner under investigation.
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A requirement that all investigations to be completed within 6 months, except in exceptional circumstances.
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Treating practitioners be exempt from Mandatory Reporting obligations, consistent with the Western Australian legislation, toensure that impaired practitioners can seek appropriate medical care without fear of mandatory reporting.
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AHPRA staff require and should receive training to understand the medico-legal environment and, in particular in addiction medicine and toxicology.
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The sensitivity of urine drug and hair screening be brought into line with other professions to avoid false positives and thus potential unintended consequences.
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All investigations must include specialist medical professionals with relevant expertise in the subject matter under consideration.
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In the interest of quality assurance, AHPRA be mandated to conduct an annual survey of health practitioners and that these results be made public.
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A health practitioner whose medical registration was cancelled, and that period has now been served, have their registration reinstated no later than 3 months after that time.
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All reprimands published by AHPRA be reviewed after 5 years.
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All inquiries to, and by Compliance or Investigation Officers of health practitioners are acknowledged and responded to within 7days.
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Medical practitioners undergoing mandatory urine drug and hair screening protocols should have their screening process clinicallyreviewed after 4 months.
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Any notification deemed vexatious by the Registrant, must be urgently examined by the Review Committee and if considered tobe so, then the Complainant formally sanctioned.
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At all and any reviews of a medical practitioner, the practitioner should have the right to be personally present and to be legallyrepresented. They, or their legal representative, must have the full and unfettered right to support their case. The review decision to then be informed to the medical practitioner within 14 days.”
Leading health figures, including Editor-in-Chief of the Medical Journal of Australia, Professor Nick Talley AC, have called for more clarity from AHPRA about doctors’ conduct on social media.
Speaking on the ABC’s PM program last Tuesday, Professor Talley said:
“Obviously there are examples of behaviours which would be completely unacceptable. On the other hand there are grey areas too. The worry is that sometimes those grey areas are being interpreted in ways that might not be appropriate, that might inhibit conversations that really need to happen, that might inhibit important public health debate, because practitioners are too frightened to engage. There’s no doubt the [David Berger case] has sent shivers throughout those who are engaging on social media.”
Dr Andrew Miller (@drajm), an anaesthetist and former President of the Australian Medical Association’s WA branch, told InSight+ that doctors were “obliged” by the regulators, AHPRA and the Medical Board of Australia to advocate for their patients and public health.
“Section 7.3 and 7.4 of Good medical practice: a code of conduct for doctors in Australia says we are required to advocate, protect and advance the health and wellbeing of patients, communities and populations,” Dr Miller said.
Section 7.3 Health advocacy
There are significant disparities in the health status of different groups in the Australian community. These disparities result from social, economic, historic, geographic and other factors. In particular, Aboriginal and Torres Strait Islander Peoples bear the burden of gross social and health inequity.
Good medical practice involves using your expertise and influence to identify and address healthcare inequity and protect and advance the health and wellbeing of individual patients, communities and populations.
Section 7.4 Public health
Doctors have a responsibility to promote the health of the community through disease prevention and control, education and screening. Good medical practice involves:
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7.4.1 Understanding the principles of public health, including health education, health promotion, disease prevention and control and screening.
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7.4.2 Participating in efforts to promote the health of the community and being aware of your obligations in disease prevention, screening and reporting notifiable diseases.
“Sometimes you have to do that in a way that gets attention,” said Dr Miller.
“Sometimes you have to step into the fray and offend some people to change the status quo — or it is not effective advocacy. Anything else is abrogating our responsibilities.”
Dr Tim Senior (@timsenior), a GP with the Tharawal Aboriginal Medical Service, told InSight+ that he hoped that he would be able to defend his social media presence if ever questioned by AHPRA.
“I would like to think I could argue, based on their own social media guidelines, that I have always put my patients first,” he said.
“It is absolutely legitimate to argue and discuss health policy that is contested. It is entirely appropriate that doctors are involved in these discussions because of our expertise, because we are citizens, and because we see the effects of health policy directly in our patients.
“It is one of our duties to advocate for vulnerable patients, and sometimes that’s going to result in some conflict.”
Last week, Victoria’s Health Minister Mary-Ann Thomas confirmed she would not adopt the advice of the state’s acting Chief Health Officer Ben Cowie who recommended that masks be made mandatory in early education and retail settings.
According to AusDoc, AHPRA said that Dr Berger was guilty of undermining confidence in “public health messaging” relating to COVID-19.
“Dr Berger has made comments that disagree with politicians, government bodies and public health organisations, pharmaceutical companies and other medical professionals. He has done so using emotive and pejorative language,” AHPRA was quoted as saying.
Dr Miller questioned AHPRA’s strategy.
“If AHPRA is hoping to maintain faith in health authorities then shutting down these kinds of debates on social media will have the opposite effect,” he told InSight+.
“To say we cannot criticise health authorities or public health settings could logically, in my opinion, damage public trust,” he said. “Does this compliance mandate also extend to non-pandemic health policies?”
“There is no information available about who complained about Dr Berger’s tweets. That cloak of anonymity is necessary for vulnerable complainants, not those who have power and agency in the debate, who may be weaponising AHPRA as part of a tactical political response, for all we know.
“Iif AHPRA is just acting as another arm of political administration that picks and chooses what medical advice to follow and then tries to silence dissent, then that’s not right, and in my opinion, could amount to bullying.
“It is really important to know how they decide who to investigate and who to exonerate, and whether they are being consistent and even handed – is it just vocal critics of government policy that have to be re-educated? Are prominent medical apologists for the government immune?”
Other doctors prominent on Twitter have been more circumspect about AHPRA’s action.
Dr Eric Levi (@DrEricLevi), a paediatric and adult otolaryngologist head and neck surgeon from Naarm Melbourne, has almost 48 000 followers on Twitter and is an advocate for his patients and good medical practice.
“I am on Twitter for learning, engagement, dialogue and to educate people through the accessible platform of social media,” Dr Levi told InSight+.
“As doctors, we have the right to express our opinions, just like everyone else. I also believe we have a responsibility to drive public health information through social media, which is a very powerful tool.
“But how that opinion and information is delivered is important.
“It has always been true that doctors are held to a higher standard,” said Dr Levi. “Yes, we can voice our opinions, but we must do it in a respectful way.
“We have worked hard to earn that respect, and we are privileged because of it.”
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AHPRA has not been fit for purpose for many years
I have seen appalling interventions into the practice of highly competent docs., who, even after expert opinion vindicated their approach, were subject to conditions for a long time.
Have also seen their being disproportionately influenced by administrators, who may well themselves be conflicted.
Their value in dealing with the problematic docs whom I have encountered and often supported is zilch. I would be loath to take on the responsibility of joint supervision under AHPRA of a failing or problematic doctor, lest their suicide be on my conscience.
They are intensely bureaucratic, have PhD’s in arse protection and often show little insight into the needs of docs and patients at the coalface.
When dealing with the real problem – most notably recently the cosmetic “surgery” racket, they are either nowhere to be found or are on the scene rather late, usually saying “move along folks, nothing much to see here”
It needs root and branch reform
I feel APHRA or any other publicly funded regulatory bodies including elected members of the Government should be subjected to same rules and regulations and laws that apply to any member of the public as well as doctors. I am not sure Royal Commission is the answer because it is hugely expensive and funded by public money.
APHRA is huge publicly funded regulatory body resposible to administer licensing of health care professionals in Australia. They should be viewed both by the public and health care professionals as doing thier job competently and with compassion and accoutability to all parties.
Absolutely agree that Royal Commission into AHPRA is much needed. Unchecked powers in our democracy is dangerous. This is not Doctors against the politicians or regulators. CHO are Doctors, AHPRA board members, those with decision making authority are almost always Doctors. The lack of due process, diligence, systematic approach in the AHPRA decisions are appalling. Panels are formed by majority Doctors, minority legal practitioner(s)/community member(s). These panel members have often not read their briefs, lack subject matter expertise, off on their own tangent. As a result, they dish out punishment that does not fit the crime/is disproportionate to the crime. There is a lack of transparency or consistency in the decisions, casting doubts on integrity of AHPRA. The subject Doctor appearing in front of this ill prepared panel have their professional lives at stake. Many Doctors have given more to their profession & career than their family and all other aspects. Disastrously, in Doctors’ suicide there are multiple varied factors, but in my experience, AHPRA is almost always a commonality. The Royal Commission into AHPRA is long overdue. Thank you.
I am not a member of the AMA, but strongly support recommendations re investigations needing to be resolved in 6 months and need for relevant Specialist opinion (early). I have recently been affected adversely by above.
AHPRA and the Medical Boards have for generations been dangerous organizations and are severely damaging the health of the Australian population.
Any doctor practicing nutritional, environmental and Integrative medicine will attest to the bullying because they are different.
At least back in the 1980’s we were able to appeal to the Supreme Court and win. These days, the judicial system has been corrupted-COVID corrupted.
The publicly stated duty of AHPRA is to protect the health of the public from medical and other professionals, whose practice is sub-standard or dangerous. AHPRA has presented NO evidence of either in the case of Dr. David Berger.,
It has never been the duty of AHPRA to monitor the publicly stated opinions of medical practitioners about the opinions of other practitioners, officials or governments, unless they would lead to risks to the health of the public, e.g. advocating refusal to have Covid19 immunisations. Whether Dr. Berger expressed his opinions “courteously” or robustly, pricking the self-regard of others is not a matter that AHPRA should have any power over.
Remote communities are facing a crisis over lack of medical personnel. Withdrawal of Dr. Berger’s registration would make this worse for the community which he serves. Has AHPRA considered this?
AHPRA’s behaviour demands a public investigation of its decision and those responsible for it.
What like to see an investigation to ascertain whether there are any conflicts of interests related to APHRA board decision making and a clear policy on the protection of whistle blowers
I hope this is the beginning of the return of doctors to equal citizenship and responsibility as all other dwellers of our continent and islands.
There is a long established institution for reporting deviant behaviour of all kinds within our Westminster system, police forces state and federal and judicial systems both state and federal.
The laws and statutes established by our state and federal legislatures ONLY, none of this International Law and Human Rights nonsense to be used or even referenced.
If our deeds are considered to breach state or federal law, let it be reported to the police who have a well worn pathway of investigation to proceed to prosecution or not.
Abolition of the HCCC should follow as well.
To “ensure that impaired practitioners can seek appropriate medical care without fear of mandatory reporting” is a courtesy that won’t be extended to us until we extend it to other safety-critical workers (aircraft pilots, ship’s captains etc.)
The Hippocratic Oath should be restored to its proper place.
I’ve been getting harassed by AHPRA for 7 months and counting following an anonymous complaint. I wrote off my car after receiving one of their letters I was so stressed by it.
I’ve been suspended due to a complaint but 3 years have passed and no progress. Where is the fairness to me?
The presumption of innocence
when a person is reported to AHPRA is I would have a basic right . Naming somebody and putting it on public record for what may well be an entirely spurious unfounded complaint is simply unfair .
Practitioners who have been bullied by AHPRA see MyAhpra.com.au
Agree with everyone
Appallingly important decisions about doctors’ performance usually by a hand picked specialist, a lawyer and a member of the public.
If you mention vexatiousness by a colleague leading to an AHPRA notification, you’re accused of lacking insight
The people in power in AHPRA are appointees, sympathetic to blame, faceless and non contactable by their victims
Seriously psychologically damaging organisation lacking accountability, and we fund them!
Enormous impacts on our mental health and family with no insights here at all
Rigid and dinasourial thinking and processes
Bring on the Royal Commission asap and let’s get some serious media coverage in the meanwhile
It’s sad that many of us are too scared of AHPRA to put our name to our comments
I’m not sure a Royal Commission into AHPRA would actually achieve anything. I was reported to AHPRA in August 2020 for failing to get a disabled man’s toenails cut under GA despite 5 referrals to the local hospital! It was a kangaroo court and I was found guilty and had to do 6 months of education and mentorship! The damage it has done to my mental health is not fixable and as stated in my conclusion of the work “I am still learning to like my job”. AHPRA has no duty of care and should. This should never have been made an issue of.
I have been supported by my GP and Medical defence and a psychologist, all of whom say this was grossly unfair and should not have been taken any further.
I doubt I will enjoy my job again, and am looking to retire at the first available opportunity.!
AHPRA takes action against low hanging fruit such as individual doctors who have next to no choice but to accept a ruling by these non-elected bodies.
They are an utter failure when it comes to investigating serious issues such as the fiasco relating to the cosmetic surgical industry.
More to the point the individual persons who make these odious decisions are never identified.
It is always a “spokesperson “ who replies but the reply never addresses the question.
They hide behind slogans such as “we are merely protecting the public “.
A disgusting organisation which we as doctors fund.
AHPRA process related to registration caused me so much stress in 2019 I decided to quit being a doctor altogether. I live in a remote area and could have offered much needed services.
I think of some of the treatment I have experienced and witnessed of doctors to other doctors over my training and working life and that is never picked up by AHPRA. I imagine if Dr Berger witnessed inappropriate behaviour by a doctor, he would speak up about it. How can someone like him be reprimanded? It makes my skin crawl thinking of what some doctors (a great minority, but a minority that do a great deal of harm) do to their colleagues and AHPRA turns a blind eye. They cant say they don’t know about it as the AMA published their Breaking the Silence report and what has AHPRA done about that?? Are they saying sexual harassment (and worse) are ok but twitter comments are not?
I consider that AHPRA has long been “over reaching ” its indended role of ensuring standards and safety in the medical profession.
It is far too too expensive in its yearly fees
Because the decison-makers in both AHPRA and the Medical Board are not elected by the profession, they are beholden only to the actual or perceived dictats of the politicans that decide the appointments, nor may they be the best qualified and experienced persons for the complex decisions that may be required. There is also great latitude in the present arrangement for arbitrary and capricious decision-making without ready accessible rights of review, leaving only the risk of significant injury to potentially blameless victims.
For a whole number of reasons not just the one mentioned. Their processes are not seen as fair and cause undue stress and anxiety on members of the prfession for little gain. Moves underway in QLD to so call “name and shame” doctors being investigated has the effect of removing their entitlemnet to a presumption of innocence and also needs to be strongly fought.
What AHPRA should be doing instead is policing the promotion of regulated health services that happens everywhere on social media in complete violation of advertising rules. I suspect the regulator has just given up because of how commonplace it is.