Mandatory Reporting (Discussion)

Discussion in 'General Discussion' started by hpfanfiction, Nov 16, 2017.

  1. hpfanfiction

    hpfanfiction Paediatric Healer at St. Mungo's Hospital Magical Moderator

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    I'm surprised the topic of mandatory reporting of health practitioners who "placed the public at risk of substantial harm in the practitioner’s practice of the profession because the practitioner has an impairment" hasn't been brought up in this thread yet. Educational providers are also required to make mandatory notifications about students

    Medical Board of Australia - Guidelines for mandatory notifications

    Here are some real cases
    Medical Board of Australia - June 2017


    Mandatory reporting: is it killing doctors? - MJA InSight 15, 24 April 2017 | doctorportal
    This might not applicable to the OP or most health professionals/student health professionals with a medical condition , but is important to be aware of
     
    Last edited: Nov 16, 2017
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  2. hpfanfiction

    hpfanfiction Paediatric Healer at St. Mungo's Hospital Magical Moderator

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    I forgot that the exemption to the requirement for a treating health practitioner to make a mandatory notification about their health professional /student health professional patient is WA and sort of Queensland specific! (I'm from WA).

    ETA- If you're impaired by mental ill-health issues, the medical board will be very careful about letting you continue to practice (discrimination issues aside). Even if you think your medical records are confidential as a doctor/student , treating doctors (eg psychiatrist or a GP) outside of WA/sometimes Queensland are subject to these mandatory reporting requirements
     
    Last edited: Nov 16, 2017
  3. Benjamin

    Benjamin Resident (JCU MBBS) Administrar

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    This is a HUGE topic & deserves some attention. I think at the moment there is a bit of mis-information or at least a lack of clarity in this thread.

    In short (because the rest of this is a bit boring) as long as your depression is not potentially causing substantial harm then it should not have any impact from registration point of view. Medical schools & hospitals do not have a right to know your medical history & if your illness isn't significantly impacting your ability to be safe then they have no right to know about it.

    Anyway, onto my rant. chinaski I would love to hear your opinion on this.

    Mandatory reporting laws suck. Not because they're aren't appropriate but because a lot of people interpret them incorrectly & think that ANY mental health illness would need to be reported & would consequently preclude you from practicing as a doctor. This is not the case. Mental health is a spectrum of disease in terms of how it affects your functionality - for some people depression means they lose their independence entirely & require hospitalisation, for the majority though it doesn't get to this point. For medical practitioners the numbers suggest that the vast majority of notifications are dismissed early in the process - i.e. ~148 in 2016-17 alone but only THREE documented cases since 2010 of mental illness (excluding substance abuse) that required restrictions to be placed on their practice or required AHPRA to take action.

    The actual wording for the mandatory reporting is as follows (emphasis mine):
    Section 140 of the National Law defines ‘notifiable conduct’ as when a practitioner has:
      • practised the practitioner’s profession while intoxicated by alcohol or drugs; or
      • engaged in sexual misconduct in connection with the practice of the practitioner’s profession; or
      • placed the public at risk of substantial harm in the practitioner’s practice of the profession because the practitioner has an impairment; or
      • placed the public at risk of harm because the practitioner has practised the profession in a way that constitutes a significant departure from accepted professional standards

      • Education providers are also required, under section 143 of the National Law, to make mandatory notifications in relation to students, if the provider reasonably believes:
        1. 'a student enrolled with the provider has an impairment that, in the course of the student undertaking clinical training, may place the public at substantial risk of harm, or
        2. a student for whom the provider has arranged clinical training has an impairment that, in the course of the student undertaking the clinical training, may place the public at substantial risk of harm.’

    The important part (as I have emphasised) is that the impairment must be bad enough to potentially cause substantial harm. There are NO 'absolute' guidelines on what substantial harm is but a general way to consider it would be - "did their practice change or potentially be inappropriate or inadequate as a result of their impairment".
    • The clearest example of this is a cognitive impairment such as dementia or an acquired brain injury.
    • Having depression that requires you to take an anti-depressant but where you can still function on a day-to-day basis does not constitute notifiable conduct provided you are still functioning within your workplace.
    • Having depression where you are unable to concentrate or function normally at work & subsequently make mistakes that otherwise (if you were not depressed) you would not be expected to make DOES constitute notifiable conduct. However, even this would rarely be reported unless it was severe as it's hard to pick up.
    The key part is that it not only needs to impair your functioning (as with any mental health diagnosis) but also impair it in the workplace to the point where the public is placed at risk. If you have a generalised anxiety disorder that means you have panic attacks when faced with "____trigger not present in workplace___" then that's fine, but if your generalized anxiety disorder causes panic attacks & directly causes the public to be at risk then that's not okay.

    I have spent the last hour going through the reports from AHPRAs Board that are published online here: Australian Health Practitioner Regulation Agency - Court and Tribunal Decisions & also here as a summary table: Australian Health Practitioner Regulation Agency - Panel Decisions. There are almost no cases against doctors for mental health issues excluding substance abuse (plenty of these). In total there are:
    • Ten cases of mental health illness being reviewed by AHPRA from 2010 - 2017
    • Three of these are for doctors. One was self-referred & resulted in no change to registration, another was coupled with substance abuse & resulted in conditions being applied, and the other was coupled with sexual misconduct & also resulted in conditions.
    • Six for nurses who had conditions imposed on their registration or forfeit their registration before the review
    • One for a chiropractor who lost registration
    I have found the following case summaries that relate to mental health illnesses (excluding substance abuse) in doctors. Unfortunately I can't find the third case:
    - Substance use & concurrent personality disorder: Medical Board of Australia - Medical practitioner registration suspended for professional misconduct after repeated drug use
    - Psychiatrist who lost registration initially because of sexual misconduct, found to have depression & bipolar, allowed to work again under conditions including regular psychiatric review & reporting to AHPRA: Sherman v Medical Board of Australia (Occupational and Business Regulation) [2012] VCAT 946 (4 July 2012)

    Interestingly this number does not in any way reflect the actual volume of reports that AHPRA gets. In 2016-17 alone "serious health impairment" made up 17.5% of mandatory complaints or 148 complaints in total. I only have details about case matters for those that require action & subsequently need to go to AHPRA's panel or tribunal. There are a number of steps that can occur from report submission - dismissal
    • Immediately dismissed
    • Further investigation & information
    • Health assessments or performance assessments
    • Action required, reviewed by panel / tribunal
    For students there are also more numbers published in the AHPRA annual report on page 51 of the .pdf: http://www.ahpra.gov.au/documents/default.aspx?record=WD17/24009&dbid=AP&chksum=1y+EzMMIk59bKaFGykGADA==
    • Two students were reported to AHPRA, 7 to HPCA (another organisation for health care practitioners)
    • In 2016/17 the outcome of previously pending reported students was 21 cases dismissed by AHPRA, 16 by HPCA / 19 in total had conditions applied following panel hearing / 4 were cautioned / 1 had registration cancelled.
    The upshot of this huge rant is that while mandatory laws are scary & sound like AHPRA is going to take away your registration if you start taking anti-depressants this clearly isn't the case. A very small percentage of health care practitioners are reported, an even smaller percentage require further assessment & an even smaller (THREE since 2010) require action in the form of altering registration.
     
    Last edited: Nov 17, 2017
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  4. Kat92

    Kat92 Student (BDemCare, BBeSt). Hopeful for JMP 2020

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    I agree with Benjamin Medical schools & hospitals do not have a right to know your medical history & if your illness isn't significantly impacting your ability to be safe then they have no right to know about it. Although, if you do disclose support mechanisms could be put in place through disability support units.

    When I have done placements for AHA, AIN and MedASST I have always disclosed any medical conditions anyway just in case anything happens so that we can all work on the best treatment to manage the scenario- plus I wear my medical alert necklace.

    As for AHPRA they do prefer if you advise them of any medical conditions in case there any future legal ramifications. Plus, they are quite understanding when you talk to them about those things as I rang them at one point and asked the question to know whether med was off the book as a future pathway for me or not. Also, in saying that one of my friends who is an RN has severe type1 diabetes needs regular breaks and insulin has not had a problem with reg or employment. So having a disability or medical condition certainly does not disclude you at all from a career in health/med.
     
  5. biom

    biom Regular Member

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    A few questions....

    "Practitioners should be aware that if they make notifications that are frivolous, vexatious or not in good faith, they may be subject to conduct action."

    1. In real-life is this much of an issue? Are there many notifications made where the notifier is disgruntled because of (perceived) poor treatment in the work place or personal grievances?

    2. Conversely are issues overlooked because of friendships or a desire not to make waves?

    "Medical schools & hospitals do not have a right to know your medical history & if your illness isn't significantly impacting your ability to be safe then they have no right to know about it."

    3. Is the individual in the best position to make this assessment? For example, if i have a serious mental or emotional issue, I may be unable to make an objective assessment. Alternatively, something that I might perceive is insignificant might not be considered insignificant by others.

    4. Has there ever been any consideration given to some sort of mandatory health check so that an objective and periodic assessment of a pratcitioner's satisfactory health is always available?
     
  6. Benjamin

    Benjamin Resident (JCU MBBS) Administrar

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    I doubt it, but I don't have numbers or evidence to support this. I do not think the report can be done anonymously, I think you HAVE to disclose your identity when reporting & as such that in itself would be a deterrent to this kind of behaviour.

    In saying that, it's clear from the numbers I posted above that the majority of reports result in no action.

    Yes, and there have been a number of cases where this has results in the college reprimanding people for NOT reporting someone they knew about. In saying that, almost all those cases were related to sexual misconduct or drug use rather than mental illness. An example I remember reading last night was the GP running a practice was reprimanded for not reporting one of other GP's working at his practice when he knew of the complaints made about sexual assault.

    No, the individual isn't always in the best position to make that assessment. In saying that, at a junior level at least your performance is constantly monitored in terms of feedback from supervisors about how well you performed to expected standards. Given we would ONLY care about impairment if it impacted your performance / ability to function at work deteriorating then I think this is a reasonable system - i.e. retrospective rather than prospective. This seems scary until you realise how many checks & balances occur in the hospital system on a day-to-day basis: it is difficult to consistently provide sub-standard care & not have it realised by those around you. Unfortunately this doesn't work so well in rural areas or where practitioners are isolated.

    I don't think so & I think it would be received incredibly poorly if it were proposed. There are a few requirements in place already - vaccinations, TB screening, blood-borne virus notification - but adding more or adding a "general" screen would be a nightmare. Once again it comes back to whether the condition is impacting your work sufficiently to put the public at substantial risk & I think there are relatively few illnesses that are both severe & hidden enough to not be in plain sight while also resulting in substantial risk to the public.
     
  7. biom

    biom Regular Member

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    Thanks for the detailed response.
    Any thoughts on why this might be?
     

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