Characteristics and predictors of regulatory immediate action imposed on registered health practitioners in Australia: a retrospective cohort study
Owen M. Bradfield![https://orcid.org/0000-0002-8955-7432](/media/client/orcid_16x16.png)
A Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Vic. 3010, Australia. Email: mbismark@unimelb.edu.au; m.spittal@unimelb.edu.au
B Stanford Law School and Stanford Medical School, Stanford University, 117 Encina Commons, Stanford, CA 94305, USA. Email: studdert@stanford.edu
C Corresponding author. Email: owenmb@student.unimelb.edu.au
Australian Health Review 44(5) 784-790 https://doi.org/10.1071/AH19293
Submitted: 20 January 2020 Accepted: 17 April 2020 Published: 28 August 2020
Journal Compilation © AHHA 2020 Open Access CC BY-NC-ND
Abstract
Objective Immediate action is an emergency power available to Australian health practitioner regulatory boards to protect the public. The aim of this study was to better understand the frequency, determinants and characteristics of immediate action use in Australia.
Methods This was a retrospective cohort study of 11 200 health practitioners named in notifications to the Australian Health Practitioner Regulation Agency (AHPRA) between January 2011 and December 2013. All cases were followed until December 2016 to determine their final outcome.
Results Of 13 939 finalised notifications, 3.7% involved immediate action and 9.7% resulted in restrictive final action. Among notifications where restrictive final action was taken, 79% did not involve prior immediate action. Among notifications where immediate action was taken, 48% did not result in restrictive final action. Compared with notifications from the public, the odds of immediate action were higher for notifications lodged by employers (mandatory notifications OR = 21.3, 95% CI 13.7–33.2; non-mandatory notifications OR = 10.9, 95% CI 6.7–17.8) and by other health practitioners (mandatory notifications OR = 11.6, 95% CI 7.6–17.8). Odds of immediate action were also higher if the notification was regulator-initiated (OR = 11.6, 95% CI 7.6–17.8), lodged by an external agency such as the police (OR = 11.8, 95% CI 7.7–18.1) or was a self-notification by the health practitioner themselves (OR = 9.4, 95% CI 5.5–16.0). The odds of immediate action were higher for notifications about substance abuse (OR = 9.9, 95% CI 6.9–14.2) and sexual misconduct (OR = 5.3, 95% CI 3.5–8.3) than for notifications about communication and clinical care.
Conclusions Health practitioner regulatory boards in Australia rarely used immediate action as a regulatory tool, but were more likely to do so in response to mandatory notifications or notifications pertaining to substance abuse or sexual misconduct.
What is known about this topic Health practitioner regulatory boards protect the public from harm and maintain quality and standards of health care. Where the perceived risk to public safety is high, boards may suspend or restrict the practice of health practitioners before an investigation has concluded.
What does this paper add? This paper is the first study in Australia, and the largest internationally, to examine the frequency, characteristics and predictors of the use of immediate action by health regulatory boards. Although immediate action is rarely used, it is most commonly employed in response to mandatory notifications or notifications pertaining to substance abuse or sexual misconduct.
What are the implications for practitioners? Immediate action is a vital regulatory tool. Failing to immediately sanction a health practitioner may expose the public to preventable harm, whereas imposing immediate action where allegations are unfounded can irreparably damage a health practitioner’s career. We hope that this study will assist boards to balance the interests of the public with those of health practitioners.
References
[1] Health Practitioner Regulation National Law Act 2009 (Qld), ss 156–158.[2] Furness G. Review of processes undertaken by the Medical Council of NSW pursuant to Part 8 of the Health Practitioner National Law (NSW) with respect to Dr Emil Gayed. 2018. Available at: https://www.mcnsw.org.au/sites/default/files/full_deidentifed_medical_council_-_7_january_2019.pdf [verified 9 August 2020].
[3] Boseley S. Shipman struck off GMC doctors’ register for ‘undermining trust’. The Guardian. London: Guardian Media Group; 2000.
[4] Smith J. The Shipman Inquiry Fifth Report–Safeguarding Patients: Lessons from the Past–Proposals for the Future. London: The Stationery Office; 2004.
[5] Lam L. Both sides appeal in case of doctor acquitted of raping patient but convicted of sexual assault, Channel News Asia, 26 March 2020. Available at: https://www.channelnewsasia.com/news/singapore/doctor-wee-teong-boo-sexual-assault-12579566 [verified 4 August 2020].
[6] Singapore Medical Council v Dr Lee Siew Boon Winston [2018] SMCDT 4.
[7] Carville O. Predatory health professionals still practising. Herald on Sunday. Auckland: New Zealand Media and Entertainment; 2016.
[8] Carville O. Dodgy doctors continue to practise. The New Zealand Herald. Auckland: New Zealand Media and Entertainment; 2016.
[9] Feeley MM. The process is the punishment: handling cases in a lower criminal court. New York: Russell Sage Foundation; 1979.
[10] Mileikowsky G, Lee B. How to protect physician whistleblower—patient advocates—from retaliation to benefit patients: a legal analysis regarding summary suspension, retaliation, peer review and remedies. US-China Law Rev 2019; 16 21–33.
| How to protect physician whistleblower—patient advocates—from retaliation to benefit patients: a legal analysis regarding summary suspension, retaliation, peer review and remedies.Crossref | GoogleScholarGoogle Scholar |
[11] AHPRA. Intergovernmental agreement for national registration and accreditation scheme for the health professions. 2008. Available at: https://www.ahpra.gov.au/documents/default.aspx?record=WD10%2f36&dbid=AP&chksum=NwgooGtzxb6JjNBIEP9Lhg%3d%3d [verified 4 August 2020].
[12] Freckelton I. Under the one umbrella. Law Inst J 2010; 84 32
[13] Thomas L, Tibble H, Too L, Hopcraft M, Bismark M. Complaints about dental practitioners: an analysis of 6 years of complaints about dentists, dental prosthetists, oral health therapists, dental therapists and dental hygienists in Australia. Aust Dent J 2018; 63 285–93.
| Complaints about dental practitioners: an analysis of 6 years of complaints about dentists, dental prosthetists, oral health therapists, dental therapists and dental hygienists in Australia.Crossref | GoogleScholarGoogle Scholar |
[14] Spittal MJ, Studdert DM, Paterson R, Bismark MM. Outcomes of notifications to health practitioner boards: a retrospective cohort study. BMC Med 2016; 14 198
| Outcomes of notifications to health practitioner boards: a retrospective cohort study.Crossref | GoogleScholarGoogle Scholar | 27908294PubMed |
[15] Health Practitioner Regulation National Law Act 2009 (Qld), s 141.
[16] Health Practitioner Regulation National Law Act 2009 (Qld), s 142.
[17] Health Practitioner Regulation National Law Act 2009 (Qld), s 140.
[18] Health Practitioner Regulation National Law and Other Legislation Amendment Bill 2018 (Qld).
[19] Health Practitioner Regulation National Law Act 2009 (Qld), s 178.
[20] Health Practitioner Competence Assurance Act 2003 (NZ), s 69A.
[21] Health Practitioner Competence Assurance Act 2003 (NZ), s 39(2).
[22] Health Practitioner Competence Assurance Act 2003 (NZ), s 48(2).
[23] Health Practitioner Competence Assurance Act 2003 (NZ), s 69(2).
[24] Medical Council of New Zealand. 2012 Annual Report. 2012.
[25] Medical Council of New Zealand. 2013 Annual Report. 2013.
[26] TR v General Social Care Council [2010] UKFTT 75 (HESC).
[27] Bennett JB. The rights of licensed professionals to notice and hearing in agency enforcement actions. Tex Tech Admin LJ 2006; 7 205
[28] Moody M. When courts do not protect the public: how administrative agencies should suspend professionals’ licenses on an emergency basis. Fla Coastal L Rev 2008; 10 551
[29] Francis R. Report of the Mid Staffordshire NHS Foundation Trust public inquiry: executive summary. London: The Stationery Office; 2013.
[30] Unwin E, Woolf K, Wadlow C, Potts HW, Dacre J. Sex differences in medico-legal action against doctors: a systematic review and meta-analysis. BMC Med 2015; 13 172
| Sex differences in medico-legal action against doctors: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 26268807PubMed |
[31] Case P. Putting public confidence first: doctors, precautionary suspension, and the General Medical Council. Med Law Rev 2011; 19 339–71.
| Putting public confidence first: doctors, precautionary suspension, and the General Medical Council.Crossref | GoogleScholarGoogle Scholar | 21784783PubMed |
[32] Paterson R. Independent review of the use of chaperones to protect patients in Australia. 2017. Available at: AHPRA---Report---Independent-review-of-the-use-of-chaperones-to-protect-patients-in-Australia.PDF [verified 9 August 2020].
[33] Health Practitioner Regulation National Law Act 2009 (Qld), s 156(1)(e).
[34] Duckett S, Cuddihy M, Newnham H. Targeting zero: supporting the Victorian hospital system to eliminate avoidable harm and strengthen quality of care: report of the review of hospital safety and quality assurance in Victoria. Melbourne: Victorian Government; 2016.
[35] Snowball K. Independent review of the National Registration and Accreditation Scheme for health professions. Canberra: Australian Health Ministers’ Advisory Council; 2014.
[36] Health Practitioner Regulation National Law Act 2009 (Qld), s 156.
[37] Health Practitioner Regulation National Law Act 2009 (Qld), s 155.
[38] Health Practitioner Regulation National Law Act 2009 (Qld), ss 157 & 158.
[39] Health Practitioner Regulation National Law Act 2009 (Qld), section 3.
[40] WD v Medical Board of Australia [2013] QCAT 614 at [8]; Syme v Medical Board of Australia [2016] VCAT 2150; Ord v Nursing & Midwifery Board of Australia [2014] QCAT 68 at [8]; Chaudry v Medical Board of Australia (no.2) [2014] QCAT 288 at [16]; MLNO v MBA [2012] VCAT 1613.
[41] Health Practitioner Regulation National Law Act 2009 (Qld), s 159.
[42] Health Practitioner Regulation National Law Act 2009 (Qld), s 199.