Subscribe
×

Preference: Law

558

Christmas message from AMA President

It has been a very busy and very successful year for the Federal AMA. Your elected representatives and the hardworking staff in the Secretariat in Canberra have delivered significant achievements in policy, advocacy, political influence, professional standards, doctors’ health, media profile, and public relations.

We have worked tirelessly to ensure that health policy and bureaucratic processes are shaped to provide the best possible professional working environments for Australian doctors and the highest quality care for our patients.

Our priority at all times is to provide value for your membership of the AMA.

As 2017 draws to a close, I would like to provide you with a summary of the work we have undertaken on behalf of you, our valued members.

General Practice and Workplace Policy

  • Our strong advocacy led to a decision to lift the freeze on Medicare patient rebates.
  • AMA coordination of Doctors’ Health Services around the country, with funding support from the Medical Board of Australia.
  • Launched the AMA Safe Hours Audit Report, giving added focus to the issue of doctors’ health and wellbeing.
  • Maintained a strong focus on medical workforce and training places, with the National Medical Training Network significantly increasing its workforce modelling and projection work following sustained advocacy by the AMA.
  • Secured a number of concessions in the proposed redesign of the Practice Incentive Program (PIP), as well as a delay in the introduction of changes.
  • Lobbied at the highest level for a more durable solution to concerns over Pathology collection centre rents, focusing on effective compliance, and achieving a fair balance between the interests of GP members and pathologist members.
  • Led the Reforms to After-hours GP services provided through Medical Deputising Services (MDSs) to ensure that these services are better targeted and there is stronger communication between the MDS and a patient’s usual GP.
  • Successfully lobbied the ACCC to renew the AMA’s existing authorisation that permits GPs to engage in intra-practice price setting, potentially saving GPs thousands of dollars annually in legal and other compliance costs.
  • Ensured a proportionate response from the Government in response to concerns over the security of Medicare card numbers, avoiding more draconian proposals that would have added to the compliance burden on practices, and added a barrier to care for patients.

 

Medical Practice

  • Fundamentally altered the direction of the Medical Indemnity Insurance Review, discussing its importance to medical practice at the highest level, helping to ensure the review is not used as a blunt savings exercise, and saving doctors and their patients millions of dollars in increased premiums.
  • Led a nationally co-ordinated campaign with the State AMAs and other peak bodies to uphold the TGA’s decision to up-schedule Codeine.
  • Campaigned against an inadequate, poorly conceived, and ideological National Maternity Services Framework, which has now been scrapped.
  • Campaigned on the issue of Doctors’ Health and the need for COAG to change mandatory reporting laws, promoting the WA model.
  • Launched the AMA Public Hospital Report Card.
  • Pressed the case for vastly improved Private Health Insurance products through membership of the Private Health Ministerial Advisory Committee (PHMAC), my annual National Press Club Address, an appearance before a Senate Select Committee, and regular and ongoing media and advocacy.
  • Launched the AMA Private Health Insurance Report Card.
  • Successfully convinced the Government to address concerns with the MBS Skin items, and will continue to do so with the MBS Review more broadly.
  • Successfully lobbied for changes to the direction of the Anaesthesia Clinical Committee of the MBS Review.
  • Launched a new AMA Fees List with all the associated benefits of mobility and regular updates.
  • Saw a number of our Aged Care policy recommendations included in a number of Government reviews.
  • Lobbied against the ill-thought-out Revalidation proposal, which resulted in a vastly improved Professional Performance Framework based around enhanced continuing professional development.
  • Successfully held off the latest attempt to have a non-Medical Chair of the Medical Board of Australia appointed.

 

Public Health

  • Launched the AMA Indigenous Health Report Card, which this year focused on ear health, and specifically chronic otitis media, in conjunction with the Minister for Indigenous Health, The Hon Ken Wyatt AM.
  • Led the medical community by being the first to release a Position Statement on Marriage Equality, and advocated for the legislative change that eventuated in late 2017.
  • Released the updated AMA Position Statement on Obesity, following a policy session at the AMA National Conference, which brought together representatives from the medical profession, sports sector, food industry, and health economists.
  • Launched the AMA Position Statement on an Australian Centre for Disease Control (CDC), which was welcomed by experts in communicable diseases.
  • Released the AMA Position Statement on Female Genital Mutilation, which provided a platform for the AMA to engage in advocacy on preventing this practice.
  • Released the AMA Position Statement on Infant Feeding and Maternal Health.
  • Released the progressive and widely-supported AMA Position Statement on Harmful substance use, dependence, and behavioural addiction (Addiction).
  • Successfully lobbied against the proposal to drug test welfare recipients, including a strongly worded submission to a Parliamentary Inquiry on the proposal, which resulted in defeat of the proposed measure in the Parliament.
  • Released the AMA Position Statement on Firearms, generating considerable media coverage and interest, in Australia and overseas. Most importantly, it is a factor in Australia maintaining its tough approach to gun control.
  • Released the AMA Position Statement on Blood Borne Viruses (BBVs), which called for needle and syringe programs (NSPs) to be introduced in prisons and other custodial settings to reduce the spread of BBVs. This policy has been promoted by other health organisations and saw the AMA create strong ties within the sector.
  • Ongoing and prominent advocacy for the health and wellbeing of Asylum Seekers and Refugees, including a meeting with the Minister for Immigration and Border Protection, The Hon Peter Dutton MP, and lobbying on behalf of individual patients behind the scenes.
  • AMA lobbying of manufacturers saw a change to the sale of sugar-sweetened beverages in some remote Aboriginal communities, which will improve health outcomes.
  • Promoted the benefits of Immunisation to individuals and the broader community. Our advocacy has contributed to an increase in child and adult vaccination rates.
  • Provided strong advocacy on climate change and health.
  • Consistently advocated for better women’s health services.
  • Lobbied for the establishment of a No-Fault Compensation Scheme for people adversely affected by vaccines.

 We promoted our carefully-constructed Position Statement on Euthanasia and Physician Assisted Suicide during consideration of legislation in Tasmania, Victoria, NSW, and WA.

I would like to thank Dr David Gillespie for his contribution to the Rural Health portfolio, and hope that his legacy will be seen in the success of the new Rural Health Commissioner, a position the AMA lobbied for and supports.

In the New Year, we will release new Position Statements on Mental Health, Road Safety, Nutrition, Organ Donation and Transplantation, and Rural Workforce.

As your President, I have had face-to-face meetings with Prime Minister Malcolm Turnbull, Opposition Leader Bill Shorten, Health Minister Greg Hunt, Shadow Health Minister Catherine King, Greens Leader Dr Richard Di Natale, and a host of Ministers and Shadow Ministers.

We also organised lunch briefings with backbenchers from all Parties to promote AMA policies.

In July, our advocacy was publicly recognised when the Governance Institute rated the AMA as the most ethical and successful lobby group in Australia.

I have met regularly with stakeholders across the health sector, including the Colleges, Associations, and Societies, other health professional groups, and consumer groups.

As your President, I have been active on the international stage, representing Australia’s doctors at meetings in Zambia, Britain, Japan, and the United States.

The highlight of the international calendar was the annual General Assembly of the World Medical Association. Outcomes from that meeting included high level discussions on End-of-life care, numerous ethical issues, Doctors’ health, and an editorial revision of the Declaration of Geneva.

But our focus remains at home, and your AMA has been very active in promoting our Mission: Leading Australia’s Doctors – Promoting Australia’s Health.

We have had great successes. We have earned and maintained the respect of our politicians, the bureaucracy, and the health sector. We have won the support of the public as we have fought for a better health system for all Australians.

We have worked hard to add even greater value to your AMA membership.

May I take this opportunity to wish you, your families, and loved ones a safe, happy, and joyous Christmas, and a relaxing and rewarding holiday season. I hope you all get some quality private and leisure time – you deserve it.

Dr Michael Gannon
Federal AMA President

Unacceptable kidney transplant rate for Indigenous Australians

AMA President Dr Michael Gannon has called for urgent attention in addressing the gap between Indigenous and non-Indigenous Australians accessing kidney transplants.

Figures just released show that Indigenous patients are 10 times less likely than non-Indigenous patients to be added to the waiting list for a kidney donation transplant.

About 13 per cent of patients receiving dialysis treatment in Australia are Indigenous. Only 241 of 10,551 patients with a functioning kidney transplant are Indigenous.

Some renal experts have pointed to a racially-based bias, suggesting some non-Indigenous doctors favour non-Indigenous dialysis patients.

Other specialists in the field insist the gap is not fuelled by racism.

During an interview with the ABC, Dr Gannon said these figures were unacceptable and more needed to be done to ensure Indigenous Australians received transplants when needed.

“I’m shocked by those figures. A ten-fold gap is entirely unacceptable,” Dr Gannon said.

“The topic of racism in our health system is an uncomfortable one for doctors, nurses, but it has to be one of the possible reasons for this kind of disparity.

“If there’s reasons why Aboriginal and Torres Strait Islanders are not being transplant-listed, they need to be investigated, but the problems need to be fixed.”

Dr Paul Lawton, a specialist at the Menzies School of Health Research, told the ABC that while Australian kidney specialists were well meaning, there was a “structural racism” that had led to low transplant rates for Indigenous patients.

“Currently, our system is structured so that us non-Indigenous, often male, middle-aged white kidney specialists offer kidney transplants to people like ourselves,” Dr Lawton said.

“It both makes me sad and angry that in Australia in the 21st century, we see such great disparities in access to good quality care.”

Indigenous Health Minister Ken Wyatt said he was disheartened with the figures and wanted to focus on building a heightened awareness of the issue over the next year.

According to Kidney Health Australia, about 30 of 800 kidney transplants performed each year are received by Indigenous Australians.

This under-representation can be attributed to a variety of reasons such as comorbidities, delays in listing and significant tissue matching issues. Importantly, the outcomes from transplantation are considerable poorer than among non-indigenous people.

To improve access to transplantation by Aboriginal and Torres Strait Islander renal patients, there needs to be a better understanding of how to address the barriers. There also needs to be improved support services for patients.

Kidneys for transplantation are largely from deceased donors. There are very few living kidney donors in Aboriginal and Torres Strait Islander communities, due to burden of disease and likelihood of comorbidities evident. Increasing live donations or listing more people on the waiting list is very unlikely to see improvements, given the burden of disease experienced and current barriers in the system.

The reasons for poor access to transplantation experienced by Aboriginal and Torres Strait Islander Australians are complex and can be attributed to:

• The greater burden of comorbid illness amongst Aboriginal and Torres Strait Islander dialysis patients leading to fewer patients being judge medically suitable;

• The shortage of living and deceased donors from within Aboriginal and Torres Strait Islander communities;

• The length of time on the waiting list and matching system;

• The challenges in delivering appropriate health services to people living in remote areas who might also have low health literacy and not speak English as a first language;

• The dislocation that follows from moving to transplant centres in distant capital cities; and

• The high complication rate, particularly in terms of early infectious complications leading to poor transplant outcomes, including substantially higher death and graft loss rates.

The poorer outcomes among those who receive transplants are due to higher rates of rejection, less well-matched kidneys, higher rates of infection and infection-related deaths. There are downsides to transplantation.

Prior to transplantation, these include a requirement for significant work up tests and assessments which require visits to major centres. After transplantation there is the prospect of a post-operative stay and side effects away from home and supports. The number of medications usually increases, and there is an increased risk of infections and cancers

CHRIS JOHNSON AND LUKE TOY

 

[Perspectives] Hospital histories

We never quite know what goes on behind closed doors. Hospitals are incubators for the most vital and vivid of human interactions. Much of these are secret and enclosed, sealed against the outside world. We are stripped down, as patients, wheeled on a trolley for surgery, our flawed and faulty bodies all we are left with. We become reliant on others to fulfil our basic bodily functions. Often dependant and frightened, patients are ministered to by staff, who also come with their own needs, anxieties, and dysfunctions.

OPINION – Can safer surgery be legislated?

BY DR PETER SUBRAMANIAM

 In June, a Royal Australasian College of Surgeons Queensland Audit of Surgical Mortality report sparked Queensland government action that may trigger new federal and state laws for public reporting of patient safety data across public and private hospitals. By August, Queensland had released a discussion paper and its push for such standards nationally was supported by federal and state health ministers at COAG Health Council. The Council tasked the Australian Commission on Safety and Quality in Health Care to work with ‘interested jurisdictions’ on such standards and to incorporate the work into national performance and reporting frameworks.

Compliance with audits of surgical mortality like the Queensland report is a mandated professional practice requirement for all surgeons while all public hospitals and almost all private hospitals already participate in the audits. So, the question doesn’t appear to be hospitals’ compliance with public reporting of performance data on patients admitted to hospital under a surgeon. The relevant questions seem to be what constitutes metrics of patient safety-oriented surgical performance and whether legislation can protect patients’ safety.

What are the metrics of patient safety-oriented surgical performance?

Patients admitted under a surgeon in a hospital are treated by a surgical team regulated by the hospital’s organisational framework that is part of a public or private hospital network. So, correctly, the metrics of patient safety-oriented surgical performance are metrics of the effectiveness of both surgical team performance and organisational performance of the hospital and its parent organisation. Only if both sets of metrics are reported will the public be fully informed about whether the hospital, public or private, is effective at protecting their safety.

This concept of patient safety-oriented surgical performance is backed by evidence. Patient safety depends on effective surgical team communication and adverse events by individual surgical team members are typically rooted in faulty systems and inadequate organisational structures. This evidence is reflected in local experience of more than 33,000 cases over eight years reported in the Australian and New Zealand Audit of Surgical Mortality National Report 2016. Its key points include that surgical team communication is a key element of good patient care and delayed inter-hospital transfers of patients with limited reserves can significantly affect surgical outcomes.

So, metrics of patient safety-oriented surgical performance must show effective surgical team communication as being timely decisions and actions to prevent, diagnose and treat surgical complications and deteriorating patients e.g. prompt resuscitation and surgery for postoperative bleeding. Likewise, such metrics must also show effective hospital and parent organisational systems enabling surgical teams’ decisions in a way that protects patient safety e.g. prompt inter-hospital transfers, timely ICU bed and OR access, safe working hours and staff levels.

Can legislation protect surgical patient safety?

The results of the Australian and New Zealand Audit of Surgical Mortality suggest surgical patient mortality represents a segment of Australia’s aging population who are at the extreme of life with co-morbidities that are a stronger predictor of death than the type of surgery. When an acute surgical condition supervenes, they have a rapidly shrinking window of opportunity with almost a quarter being irretrievable. They are prone to surgical complications which often leads to cardiac or respiratory failure with rapid deterioration and death. Nonetheless, surgical mortality in Queensland and nationally has been improving over the last eight years so it is difficult to envisage how new legislation will add much to improving surgical patient safety.

Is legislation necessary?

In 2016, a number of NSW private hospitals did not participate in the audit of surgical mortality despite compliance by all public and private hospitals in all other jurisdictions through the system funded by all State and Territory Governments. If legislation is to bring private hospitals in line with this public reporting system, it should be directed specifically for this reason. If it is to improve surgical patient safety or to inform patient choice, it is not clear how it will improve on the current public reporting system supported by governments. If a national performance and reporting framework is being developed, it should be directed at metrics of surgical team and organisational performance.

It remains to be seen if Government will be surgical in its approach to patient safety.

___________________________________________________________________________

Dr Peter Subramaniam MBBS MSurgEd FRACS is a cardiothoracic surgeon in Canberra who is currently pursuing a Juris Doctor law degree at the Australian National University. He established the Australian and New Zealand Cardiac and Thoracic Surgeons national cardiac surgery database in the ACT as well as the multidisciplinary ACT Cardiac Surgery Planning Group. He also has extensive experience in undergraduate and postgraduate surgical education.

Views expressed in the opinion article reflect those of the author and do not represent official policy of the AMA.

 

Federal Council communiqué – meeting of 17 and 18 November

Federal Council met in Canberra on 17/18 November. The meeting came in the midst of the political uncertainty arising from measures to deal with the citizenship status of federal politicians, the voluntary assisted dying debates in the parliaments of Victoria and NSW, and the strong majority poll in favour of same sex marriage reform announced during that week. 

The President reported on his activities over the past three months since the last meeting of Council in August. Among the highlights were his attendance at the meeting of Confederation of Medical Associations in Asia and Oceania (CMAAO) in Tokyo in September and the Council meeting and General Assembly of the World Medical Association (WMA) in Chicago in October. The WMA adopted a modernised version of the Declaration of Geneva which was also adopted by Federal Council at its November meeting.

The Secretary General’s report focused on the breadth of submissions, Parliamentary committee appearances, and inquiries to which the secretariat has responded in the last few months, continuing a trend observed throughout 2017.

These included a submission on the security of Medicare cards; several reviews of training funding arrangements and workforce distribution; improving Medicare compliance; secondary use of Medicare data; coordinated advocacy with State and Territory AMAs to change the requirements for mandatory reporting under the National Law; medical indemnity changes; codeine scheduling changes; and ongoing negotiations with Minister Hunt on several issues including the future funding of after hours GP services.

The AMA’s engagement with the MBS Review process and the Private Health Ministerial Advisory Committee continue. Federal Council noted the release by Minister Hunt during October of the first tranche of reforms to private health insurance. Key reform areas remain under review including the scope of benefit cover in the proposed gold, silver, bronze, and basic policies; insurance cover of private patients in public hospitals; and a process to improve transparency of medical fees and out of pocket costs. This latter subject was a focus for discussion by the Council in one of its two policy sessions.

In considering an approach to improved transparency of medical fees and out of pocket costs, Federal Council noted the Government’s proposal to establish an expert working group to consider the most effective way to communicate medical fees and out of pocket costs. Federal Council also noted that informed financial consent was key but not uniformly practiced. Federal Council reiterated its position statement in support of doctors charging an amount appropriate to the service and the patient, while condemning excessive charging. Federal Council agreed principles to guide AMA input into the expert working group.

Federal Council noted the array of AMA’s public health advocacy including an appearance before a parliamentary inquiry into e-cigarettes and consideration of the AMA’s broader tobacco advocacy. Federal Council approved two public health position statements, one dealing with nutrition and the other, road safety. The Council passed unanimously a motion calling on greater transparency of the conditions under which the asylum seekers and refugees on Manus Island are being held and offering an independent assessment by doctors of the health situation.

Continuing areas of public health policy attention include men’s health, sexual diversity and gender identity, and social determinants of health. A new working group was established to review the AMA position statement on drugs in sport.

Federal Council received a presentation from Scott McNaughton, General Manager of Participation Pathway Design with the National Disability Insurance Agency (NDIA) in the second policy session. Councillors were interested to learn about the role of medical practitioners in providing NDIS assessments; and the processes to access appropriate medical and psychosocial supports for people with mental illness. The presentation provided essential information and highlighted the steps underway by NDIA to fully implement the NDIS.

The Equity, Inclusion and Diversity Committee of Council reported that it proposes to publish an annual report on progress to achieve equity, inclusion, and diversity in the AMA.

Federal Council received a report on the successful forum in October on reducing the risk of suicide in the medical profession which was convened jointly by Federal AMA, AMA NSW and Doctors Health Services Pty Limited. The two key themes that came from the forum were the impact of culture and the need for compassion. A full report will be published in due course.

At the conclusion of the meeting the Secretary General reminded Federal Council that 2018 is an election year for positions on the Council, with a call for nominations to go out to all voting members in February. Federal Council draws its standing from its representative structure, with representation of members from across the country, and all specialties and stages of practice.

Dr Beverley Rowbotham
Chair Federal Council

[Articles] Attacks against health care in Syria, 2015–16: results from a real-time reporting tool

The data system used in this study addressed double-counting, reduced the effect of potentially biased self-reports, and produced credible data from anonymous information. The MVH tool could be feasibly deployed in many conflict areas. Reliable data are essential to show how far warring parties have strayed from international law protecting health care in conflict and to effectively harness legal mechanisms to discourage future perpetrators.

[Correspondence] Charlottesville: blatant racism, not grievances, on display

We recently published a paper1 on structural racism in a Lancet Series on equity and equality in health in the USA. Structural racism refers to the many ways in which racial subjugation is embedded in US society—not just in one individual, or groups of individuals, or one institution, but in all of our institutions—from culture to housing to employment to law enforcement, and beyond.1,2 Racism is supported by wealthy and working class whites alike.2,3 The ultimate weapon to maintain and reproduce this system is terror.

[Comment] Offline: Planetary health’s next frontier—biodiversity

Medicine’s inspiring power is the moral importance it attaches to human life. The commitment of health workers to the protection and strengthening of humanity is a bulwark against violence, repression, and abuse. It is in their defence of life and human flourishing that medicine and medical science find their political and social force. But the priority medicine gives to being human is also its great conceit—and flaw. What has become increasingly clear is that, as Emmett Duffy and his colleagues put it in Nature earlier this year, “Human well-being depends strongly on the interacting web of living species, so much so that we take this for granted.” If we are concerned about human health, we should also be concerned about the health of the biosphere that we inhabit.