No More. It Ends Here.
Our goals: Redesigning the Medical Supervisory System
There will be no investigation of vexatious or illegal complaints. AHPRA’s current activities in this realm are equivalent to the compulsory assessment of rape victims with a view to obtaining a conviction of the rape victim for resisting. Conviction Guaranteed.
Reasonable and satisfactory evidence beyond reasonable doubt should be the standard applied.
Patients must lodge an investigation fee of $100 for all submitted complaints. If this is too much, I think we all need to remember that the average complaint triggers thousands of dollars of legal defence activity for the accused doctor. Expenses need to be shared amidst those generating them. $100 is a pittance in relation to the costs arising in the investigation and management of a complaint.
People must fully lodge their own complaint in writing. All verbal complaints may not be written by anyone- not a patient. The writing of a patient complaint by an OHO, AHPRA or official staff member, not the police, is to be an offence. Where the patient’s complaint is proven or provable to be false any staff member involved in the “generation” of a complaint becomes an accessory for any offence and is “equally” liable for any punishment under law.
Legal Breaches by Official Staff and Patients may be Chargeable.
Patients generating a complaint and official staff involved in the generation of a "vexatious" complaint can be charged separately and independently. As a doctor, it is not always in the community interest to charge every patient involved in bad behaviour but it is definitely in the community interest to charge every official person accessorising a complaint: by creating it, optimising it or adjusting it in any way to improve its impact. A complaint is a complaint. It should be the “complaint” and should not be altered for convenience or “impact’ by any third party.
Every accused has the right to face his/her accusers. Anonymous complaints (? generated by AHPRA) are not to be valid or actionable. I think this is one of the keystones of the "Western: legal system - forgotten by AHPRA and its minions.
The government to pay ¾ of medical indemnity insurance premiums for all doctors.
The removal of medical records assessments and medical records audits as a tool for AHPRA. It was never intended that the assessment of practice medical records in accreditation was to be used as a tool for coercive persuasion for doctors. If accreditation judges the practice satisfactory, AHPRA should not have the capacity to make its own findings.
The compensation of all doctors who have had a medical record judgement made against them. Amounts to be $30,000 refunded to doctors paying for assessments / audits or for doctors doing assessments non- gratis for their colleagues. Plus an amount of $30,000 as compensation to all doctors for their time and effort involved in these activities. Plus legal expenses / costs involved.
Refund to doctors of all legal expenses incurred in actions relating to medical records. Plus interest: using ATO reference interest rates for ATO penalties, Plus a component for damages: 50% of initial expenses, subject to interest penalties. Plus refund of all legal expenses where medical records was a component of the legal judgement.
Apology to all doctors with medical records or education assessment conditions where these “offences” have been published/ released by AHPRA to the public –the apologies to be published publicly on the AHPRA web site for five years - admitting the faults and inappropriate actions of AHPRA. Also required are Apologies in writing to all doctors, to all doctor’s supervisors and co-workers and these apologies to be published in newspapers.
Where Supervisors/ Mentors/ Auditors are appointed, AHPRA to appoint these, to pay for their wages in full through an external Agency such as RACGP, given oversight Powers / Rights for the process.
Payment to all doctors forced to resign / stop work for what AHPRA judges to be an offence- but which are offences which do not exist in the real world. Not wanting to undergo a process akin to Domestic Violence- is a reasonable choice for normal people, even if AHPRA in its self-righteousness feels otherwise.
Where an offence has occurred; AHPRA has only the power to refer the matter to a Tribunal or a Court. It loses the capacity to make adverse rulings itself.
Compensation as Wages to be paid to any doctor who claims he/she was forced to retire or forced to stop work.
Wages to be based on the highest earning year in the four years prior to the” compulsory” retirement. Age is age of retirement.
At 60 years of age or less: ten years based on full wage reducing at 10% per year, prime cost method.
At 65 years of age plus, seven years based on full wage reducing at 15% per year, prime cost method.
At 70 years of age plus, five years based on full wage reducing at 20% per year, prime cost method.
Full time wages disbursement for any Doctor AHPRA stops from working without a Tribunal determination of a civil offence - as applicable to normal citizens. No Medical Offences that don't exist in the real world - allowed.
Sacking of all AHPRA staff involved in any potentially illegal action and a ban for said staff for ten years on any employment for any government body or organisation or QANGO. A record against every staff name associated with any above category of “wrong doing” to be created and recorded on a criminal check registry. People accused of such offences are to be allowed to take the registered offences to an appeals court. Medical Agency oversight of government legal processes opposing appeals to ensure appropriate and reasonable action is taken by the government body to maintain judgements.
Criminal charges against all staff and the AHPRA Board involved in illegal or potentially illegal activities.
All official staff involved in any patient’s action where an offence has occurred are guilty of acting as an accessory.
Removal of Honours for all members of the AHPRA Board/ Boards.
Request for medical professional bodies to disbar any members involved in illegal or potentially illegal activities for AHPRA. For example, if AHPRA’s action result death, suicide of or injury to medical practitioner, all people involved must be immediately be suspended without pay until a judicial review is undertaken. If AHPRA's action is contributory to the detriment of the practitioner, legal charges must be tendered.
No requirement for doctors to repay medical money where there has been no "financial benefit" to the doctor. If the HIC / PBS etcetera believe the tests should not have been funded publicly, they should be required to recover the money from the actual beneficiary - namely often the patient themselves.
Double Punishment to end. If a court punished a practitioner, this is not a reason for AHPRA to punish a practitioner as well. AHPRA’s role is to look after the safety of the public, not to act as a send line of enforcement. A punishment is a punishment, but "once" is what you have earned.
AHPRA to cease involvement in CPD / Education. No AHPRA representatives to sit on any panels with any other medical organisation and not to be recognised professionally in any negotiations with any other medical organisation.
Acceptance of some reasonable practice standards. NOTES are an aide memoire and must not take up more than 10% of a consultation time. For a standard GP consultation of ten minutes, the notes necessary are what can be reasonably recorded by an average practitioner in 60 seconds.
The purpose of a consultation is consulting, not note taking.
Other Organisations e.g. RACGP
Changes in accreditation standards need to be accepted by vote from the members- namely directed against the RACGP to stop bracket creep - the persistent escalation of standards and requirements to prove that the organisation and its employees are still needed.
Other Suggestions re Legal Revamp
And some suggestions for changing legislation from Dr Karmakar, who has had his own issues with the medical legal system include:
* Amend or invalidate section 106ZR so that all clinicians can have access to the standards set by the peers on the PSR panel. We can amend the legislation so that the privacy factor is maintained and yet doctors can have access to what the committee members are saying and finding to learn and make sure we are compliant with the expected standards.
* Allow proper legal representation so that individuals can choose to have their lawyers appear on their behalf, instead of medical professionals being forced to brush up on their cross-examination skills during a committee hearing.
Alternately, the government is not allowed to have legal representation as the doctors are not and no legal briefings or preparation is to be funded for government agencies acting against doctors. This is proposing a “level” playing field.
* Require full disclosure regarding who is giving advice to the Director of the PSR and what material this person is relying on to make decisions such as inappropriate billing in the early stages of the process.
* Review and amend the statistical processes taken during the initial identification process so things such as statistical profiling can be taken into consideration.
Statistical profiling needs to take into account the percentage of medical notes that are missed from being recorded by a doctor. (I have heard of studies in the past that show that approximately 20% of the events within a consultation, are not recorded by doctors- due to time and energy constraints.
Other Suggestions
* A restriction of 10% on the maximum amount of time in a consultation to be required to be devoted to the recording of consultation notes.
* Propose a better way of fining individuals, such as being charged to pay back only the amount you have actually earned and not the whole amount, including taxes and services fees that never hit your bank account. Amounts refunded must be “actually” earned, much in the same way that tax claims must have “real” or “actual” claims only that have actually been paid, to be deductible.
I would actually suggest that a co-payment being allowed for many items would take the pressure off the government for funding and return some of the oversight of medical bills to the patients involved themselves.
Amend the laws to ensure the process is more educational than punitive, so that doctors who are innately good will continue to do a good job, rather than be driven into clinical depression and, in some cases, leaving the job altogether.
New legislation will only appear if the government is forced to make new legislation. Public reviews or judicial enquiries can be quite happily ignored once the imminence of the crisis has faded somewhat.
* A compensation or support scheme for doctors affected psychologically or psychiatrically by investigations.
* Funding for Reasonable practicing medical doctors to oversight the appropriateness of actions undertaken against doctors and campaigns directed against doctors.
I have seen a few disasters swept under the rug by government over the decades. The campaign to restrict the use of Augmentin (Amoxycillin/Clavulate) resulted in a spike of community pneumonias that should have earned the originators of the Medicare/ HIC campaign, a prison sentence for deaths or grievous/ bodily harm engendered.
A campaign to reduce narcotic prescribing by threatening doctors with official action resulted in one doctor acquaintance’s patient developing an endocardiac golf ball sized vegetation that required 6 months of inpatient IV antibiotic treatment. (The patient had used IV drugs as a result of cessation of narcotic use enforced on the doctor.) Any savings on narcotic prescribing costs created by this program in Qld, would have disappeared in funding the treatment of this one patient. The HIC employees undertaking this action should not be allowed to pat themselves on the back for a jo0b well done and money saved. They actually increased medical costs to the system substantially, just not directly and visibly.
In Medicare/ HIC campaigns, legal charges aiming for a prison sentence for deaths or grievous/ bodily harm engendered are appropriate.
Consultation Legal Requirements Funded separately to Consultations.
Five minutes of funded consultation time to “comply” with official requirements in a consultation. Where there are restrictions on prescribing or ordering tests, there needs to be a specific quantum of time devoted to compliance, and the doctor to be paid for this.
AHPRA not to be involved in other activities : e.g. Education/ CPD.
