In 1990, seismic improvements in the regulation and accountability of health professionals in NSW resulted from the Report of the Royal Commission into Deep Sleep Therapy. But these gains are now at risk under plans being developed for national registration and accreditation of health professionals.
In a move that has not attracted the scrutiny that it deserves, a sub-committee reporting to Australian health ministers has recommended that health professional boards should self-manage complaints and investigations.
In NSW this would be a return to the system before the deep sleep inquiry and no one wants that. Not the consumers of NSW — The Public Interest Advocacy Centre and other consumer groups have made submissions opposing any watering down of the NSW system for complaint management — and not the health professions, who have seen the benefits of separating complaint management.
The Health Care Complaints Commission (HCCC) in NSW was established as an independent statutory body responsible to Parliament as a result of the deep sleep inquiry. The NSW Medical Practice Act was also extensively revised.
The Brett Walker Inquiry into Campbelltown and Camden Hospitals in 2004 confirmed the role and functions of the HCCC and extended its powers. Further recent amendments to the NSW Medical Practice Act require doctors to report certain types of misconduct to the Medical Board. These helpful changes make the NSW regulatory system the strongest in the country.
Early this year the Council of Australian Governments (COAG) agreed to build a single national registration and accreditation system for health professions including medical practitioners. This is necessary and will lessen the likelihood of unprofessional clinicians moving around undetected and make it easier for health professionals to practise across borders. But standardisation should not be at the expense of existing and effective models of complaint handling. The lowest common denominator should not drive reform — the higher standards should prevail.
A medical board, even with the best will in the world, is not appropriate to carry sole responsibility for complaints. Public trust requires complaints to be investigated by a skilful and accountable organisation such as an independent HCCC.
The perception that doctors will look after doctors is real, in part stemming from the tendency of doctors to identify with colleagues rather than patients. We would not accept police investigating police.
Most health registration boards are in various stages of transition from a “club type” organisation to being more open and transparent.
With colleagues in Queensland, Victoria and South Australia, I am currently researching struck-off doctors to ascertain if there are any common characteristics that might influence medical school selection. The only state where one can go to a website and obtain the names and the decisions on all the doctors is NSW.
There is also no requirement on doctors outside NSW to report unethical or unsafe practitioners.
Unfortunately many boards are the product of the competing interests of their colleges, associations, defense organisations and government. If we were designing for good regulation, we would start with patient expectations of health professionals — appropriate knowledge, skill and behaviour — and provide the infrastructure that best achieves these outcomes.
NSW, with some pain, has a sound infrastructure for managing complaints and investigations. We should be looking to implement the strengths of the NSW system nationally, rather than putting our hard-won gains at risk.
Merrilyn Walton is Associate Professor of Medical Education and Director of Patient Safety at the University of Sydney, and was the Commissioner of the NSW Health Care Complaints Commission from 1993-2000
Dr Dabner’s comments highlight the inherent contradiction of suggesting that “ehtical standards” are purely a matter of ‘personal taste’, the fall back position of the liberal establishment, particularly those debasing medicine by attacking innocent human life and dressing that up as ‘therapeutic”, but then insisting that there are norms of ethical practice that must be “policed’. If its purely a matter of personal taste, why should my preference for ‘vanilla’ trump your preference for ‘chocolate’.
Of course, the relativism of the ‘Dr Dabners’, sadly all too prevalent, isnt coherent. Thats why formulations like the Hippocratic oath are so valuable. They represent the true meaning of ethical practice because they rest on a true measure of the human person, not my personal whim.
Sadly, the vulnerable suffer when those with power over them are left to exercise their whims.
With the passage of recent legislation in Victoria compelling doctors and hospitals to be complicit in the killing of unborn children and with the Catholic Archbishop of Melbourne making it clear that Catholic hospitals, which supply a third of maternity beds in the state, will defy this assault on innocent human life, I note that the Medical Board of Victoria has stated that it is ‘commited” to upholding this “law”. Aside from the infringement of the conscience of doctors upholding the Hippocratic oath, which proscribes the killing of the unborn, one can hardly be inspired by the capacity of Medical Boards anywhere to understand the nature of ethical medical practice.
The Professor knows what she is talking about.
“NSW, with some pain, has a sound infrastructure for managing complaints and investigations. We should be looking to implement the strengths of the NSW system nationally, rather than putting our hard-won gains at risk.”
I can only say hear hear!!! to her comments.
I know as I have had a 40 year medical career without a single complaint from a patient against me and a fearless engagement with Medical Boards which rely on Dr’s shitting their pants when the ‘board finger’ (which can be criminally dysfunctional as can any finger in the universe) is pointed at them.
Although I agree with Prof Walton’s comments it’s worth mentioning that in some states (Tasmania for example) the police do in fact police themselves and there is no independant body to do so. Similarly numerous other professional groups (Lawyers and accountants spring to mind) govern themselves. I’m not saying this is desirable, just that doctors are not the only ones who function in this way. As Dr James has so conveniently demonstrated in his comment, the definition of what ‘ethical medical practice’ is often depends on one’s own perspective. I personally would not want someone with this particular set of biases sitting on a medical board against me… Personally I’d love to see reform as I think the current system is potentially unfair to the profession and certainly not the best thing for patients and the community.
I look forward to seeing the outcome of your research although I am unfortunately pessimistic about our ability to predict future behaviour in any prospective trainee even if we can identify general traits that may correlate with loss of registration.
I would like to agree with Professor Walton. CHOICE strongly supports national registration of health professionals – it has been far too long coming. It should be seen as an opportunity to design the best system to handle complaints about registered health professionals.
CHOICE deals with complaints handling schemes across a wide range of industries. We believe that they work best when there is the greatest possible amount of transparency and independence. In our experience, this increases public trust in the system. It will also protect the boards and professionals involved from any perception that they are protecting their colleagues.
This is not to say there is no role for the professional boards. They have a very important role in setting standards and evaluating professional behaviour. This can continue within a scheme that also delivers transparency and independence. However, their interests must be balanced with those of consumers.
As I understand them, the proposed arrangements would, in some instances, allow a professional board to decide to deal with a complaint itself, investigate the complaint, and appoint a panel to hear its prosecution of the complaint. The hearing could be conducted in private with no right for the complainant to be present or heard. Then if the complainant is not happy with the panel’s decision they have no right to seek a review. This may not leave consumers satisfied with the system and does little to overcome the perception of professions protecting their own.