Question Number: 16
PDR Number: 16
Date Submitted: 21/11/2022
Department or Body: Australian Health Practitioner Regulation Agency
Answer to Qs 2 and 3: Since appearing at senate estimates, Ahpra has published the Ahpra and National Boards Annual Report for 2021/22. The annual report has notifications data, including those related to Covid-19 – https://www.ahpra.gov.au/Publications/Annual-reports/Annual-Report2022/Notifications.aspx Ahpra confirms the evidence given by Mr Martin Fletcher at senate estimates. The data in the 2021/22 Annual Report says we received 1,303 notifications about 1,006 registered health practitioners. Out of the 1,303 notifications, 28 registered health practitioners (or 2% Page 2 of the number of notifications made) had restrictions imposed on their registration by immediate action because of conduct that posed a serious risk to the public or because it was otherwise in the public interest. The practitioners were from the professions of nursing, medicine, chiropractic, dental, pharmacy, paramedicine and psychology. 21 practitioners were suspended. 11 [of those 21] were suspended in relation to their conduct associated with spreading misinformation about Covid-19 or vaccination advice. These claims included that the Covid19 pandemic was fake, that the vaccination program was about government led mind control or in some instances representing that patients would develop cancer by having a vaccination administered.
10 [of those 21] were suspended for:
• failing to comply with public health orders when restrictions were in place to limit the spread of Covid-19 in the community
• serious, often fraudulent, behaviour involving issuing fake vaccination administration certificates or exemption certificates which thwarted the efficacy of the vaccination program
• prescribing unapproved treatment for management or prevention of Covid-19 7 [of the total 28] had immediate action conditions / undertakings requiring them to practise under supervision, and for some medical practitioners, limitations were placed on their practice relating to issuing of vaccination exemptions and prescribing.
Answer to Qs 5 and 6: Patients, members of the public, employers and other practitioners sometimes encounter a practitioner who they believe is not practising safely or acting professionally. Under the Health Practitioner Regulation National Law as in force in each state and territory (the National Law), anyone can make a notification if they think a practitioner is practising unsafely. They can also tell us if they think the practitioner has a health impairment that is affecting their ability to practise professionally and safely and that poses a substantial risk to the public.
Notifications help to identify:
• individual practitioners or students who need support or regulatory action to practise safely and professionally
• individual practitioners whose behaviour requires referral to a tribunal for disciplinary action
• barriers to safe professional practice that can be addressed by standards, codes and guidelines published by National Boards. Notifications range in seriousness and we have developed different strategies to deal with them. We focus on improving safety and professionalism in the delivery of healthcare. We work with practitioners, employers, health services and other regulators to ensure that all registered practitioners are providing care to patients that is safe and professional. There are times when it is necessary for the identity of a person who makes a notification to be protected or to enable regulators to accept anonymous complaints because they raise genuine concerns about unsafe practices or conduct that put the public at risk. Anonymity Page 3 and confidentiality provisions exist to ensure notifier safety. We can only protect the public when we are made aware of concerns about practitioners, and these provisions are crucial to ensure we can receive information that would not otherwise be provided. In 2018, Ahpra asked the National Health Practitioner Ombudsman (NHPO) to conduct an independent review of confidentiality safeguards for people making notifications about registered health practitioners. The report is published on the NHPO website: https://www.nhpo.gov.au/publications/safeguarding-confidentiality-review The NHPO found that our practice of accepting anonymous notifications is consistent with international health practitioner regulators and made 10 recommendations that we accepted and implemented. The driver for this review was the conviction of South Australian general practitioner Brian Holder for the attempted murder of a pharmacist, Kelly Akehurst. Ms Akehurst had made a notification about Dr Holder’s prescribing practices, and it was understood that the notification was the motive for this crime. While acts of violence against notifiers are rare, this experience shone a necessary light on whether our procedures for handling notifications adequately safeguarded the confidentiality of notifiers. On 14 September 2021, Brian Geoffrey Holder had his medical registration cancelled by the South Australian Civil and Administrative Tribunal and is banned from applying for registration or providing any health services for 25 years. This is the longest ban ever imposed on a registered practitioner by a tribunal on referral from a National Board. More information is available from our news item. A decision to protect the identity of a notifier requires us to exercise judgement and we have policies and procedures to guide this decision-making. If an anonymous notification does not include enough detail, it will not be accepted as a notification. Notifiers who seek to make anonymous notifications are told that anonymity may impede an assessment or investigation of their notification. We provide practitioners with a copy of the notification with the identifying details redacted or if that is not possible, we provide a summary of the notification. Ahpra staff speak regularly with practitioners: at an initial conversation, when giving updates, and in case discussions. This enables practitioners to ask questions to fully understand the concerns raised. Practitioners are provided with all relevant information that a board will consider. A board decision is never supported by information that has not first been provided to the practitioner. Practitioners are afforded multiple opportunities to respond to all relevant information. Also, the Australian Privacy Principles set out under the Privacy Act (Cth), as applied to the National Scheme, requires us to ensure individuals can use a pseudonym (ie maintain confidentiality) when they engage with us. Ultimately, National Boards will only take regulatory action where the board reasonably believes that, because of their health, performance or conduct, a practitioner presents a risk to the public or patients. This reasonable belief must be supported by proven objective circumstances. Page 4 Answer to Q 7: A vexatious notification is a notification without substance, made with an intent to cause distress, detriment or harassment to the practitioner named in the notification. We have given evidence in relation to vexatious notifications at previous Senate Inquiries and in response to questions from Senators on this matter. Ahpra developed a framework for identifying and managing vexatious notifications that was published in December 2020. The framework is accessible from Ahpra’s website: https://www.ahpra.gov.au/Notifications/How-we-manage-concerns/Vexatiousnotifications.aspx The National Health Practitioner Ombudsman is currently reviewing the implementation of this framework. Most of the notifications we receive result in no further regulatory action. This lends itself to a mistaken perception that most of those notifications lacked merit or that our processes are easily weaponised against practitioners. That is not correct. The evidence tells us that vexatious notifications are rare and there is greater risk that concerns will be under-reported rather than over-reported.
There are different reasons why a National Board might decide to take no further action:
• there is no ongoing risk to the public that it needs to manage, or
• because of the action already taken by the practitioner and/or their workplace there is no future risk to patients or the public.
Answer to Qs 8 and 9: Ahpra has checked our electronic record system and has found no correspondence to the Ahpra CEO from Pfizer about Covid-19 vaccines. Under the National Law, anyone can make a notification if they think a practitioner is practising unsafely. They can also tell us if they think the practitioner has a health impairment that is affecting their ability to practise professionally and safely and that poses a substantial risk to the public. Neither Ahpra nor the Medical Board can release information about specific matters, notifications or complaints that would identify notifiers and/or practitioners who are the subject of a notification. This is protected information under the Health Practitioner Regulation National Law as in force in each state and territory (the National Law). Ahpra has not received correspondence from pharmaceutical companies raising concerns about health professionals.
