AMA Victoria to seek royal commission from AHPRA

THE Victorian branch of the Australian Medical Association (AMA) will present a motion at the AMA National Conference later this month calling for a Royal Commission on the Australian Health Practitioners Regulatory Agency (AHPRA ).

Dr. Mukesh Haikerwal, former President of the Federal AMA and member of the AMA Victoria Council, said Preview+ the motion had been filed with the federal AMA and would be on the agenda for the conference which will take place from July 29 to 31.

The move comes after AHPRA’s decision to impose restrictions on Western Australian GP Dr David Berger due to his alleged conduct on Twitter. Some prominent doctors using social media fear that free speech is at risk.

Dr. Berger has been a vocal, direct, and sometimes sarcastic critic of governments, health directors, and health authorities for lack of action and alleged ignorance of evidence regarding the current COVID-19 pandemic.

Dr. Berger must undertake training “regarding professional and courteous behavior towards colleagues and other practitioners, including when using social media in accordance with Good medical practice: a code of conduct for doctors in Australia“, according to AHPRA. Dr. Berger was reportedly the subject of an anonymous complainant who objected to his way of speaking.

Dr Haikerwal said Preview+ the call for a royal commission follows the 2011 “inept” Senate investigation into AHPRA.

The motion from the AMA’s Victorian State Council reads:

“The following are some of the areas of concern that need to be addressed by the terms of reference of the Royal Commission:-

  1. There must be a presumption of innocence in the investigation of all practitioners.

  2. The objectives of the National Registration and Accreditation Program under national law should be amended to require AHPRA to have a duty of care to the registrant and in particular to minimize mental health impacts and financial effects about the health care practitioner under investigation.

  3. The identities of healthcare practitioners under investigation should be protected to minimize potential loss of reputation and opportunity.

  4. AHPRA and the Medical Board of Australia must offer confidential support by an independent mental health professional to any medical professional under investigation.

  5. A requirement that all investigations must be completed within 6 months, except in exceptional circumstances.

  6. Treating practitioners should be exempted from mandatory reporting requirements, in accordance with Western Australian law, to ensure that intoxicated practitioners can seek appropriate medical care without fear of compulsory reporting.

  7. AHPRA staff need and should receive training to understand the forensic environment and, in particular, in addiction medicine and toxicology.

  8. The sensitivity of urine and hair drug testing needs to be aligned with that of other professions to avoid false positives and therefore potential unintended consequences.

  9. All investigations should include specialist health professionals with relevant expertise in the area under investigation.

  10. In the interest of quality assurance, AHPRA be mandated to conduct an annual survey of health care practitioners and that these results be made public.

  11. A healthcare practitioner whose medical registration has been revoked, and that period has now been served, will have their registration reinstated no later than 3 months after that date.

  12. All reprimands issued by AHPRA will be reviewed after 5 years.

  13. All inquiries made to and by Healthcare Practitioner Compliance or Investigation Officers are acknowledged and responded to within 7 days.

  14. Physicians undergoing mandatory urine and hair drug testing protocols should have their testing process clinically reviewed after 4 months.

  15. Any notification deemed vexatious by the Holder, must be examined urgently by the Review Committee and if it is deemed as such, then the Complainant formally sanctioned.

  16. At all examinations by a doctor, the practitioner should have the right to be personally present and to be legally represented. They, or their legal representative, must have the full and absolute right to support their cause. The review decision must then be communicated to the attending physician within 14 days.

Health personalities, including the editor-in-chief of the Australian Medical JournalProfessor Nick Talley AC, have asked AHPRA for more clarity on the conduct of doctors on social media.

Speaking on the ABC PM program last tuesdayProfessor Talley said:

“Obviously, there are examples of behavior that would be totally unacceptable. On the other hand, there are also gray areas. The concern is that sometimes these gray areas are interpreted in a way that might not be appropriate, that might stifle the conversations that really need to take place, that might stifle an important debate about public health, because practitioners have too afraid to commit. There is no doubt that [David Berger case] has sent chills to all who engage on social media.

Dr. Andrew Miller (@drajm), an anesthesiologist and former president of the WA branch of the Australian Medical Association, said Preview+ that doctors were “obligated” by regulators, AHPRA and the Medical Board of Australia to advocate for their patients and public health.

“Sections 7.3 and 7.4 of the Good medical practice: a code of conduct for doctors in Australia says we are obligated to champion, protect and advance the health and well-being of patients, communities and populations,” said Dr. Miller.

Section 7.3 Health Advocacy

There are significant disparities in the health status of different groups in the Australian community. These disparities result from social, economic, historical, geographical and other factors. In particular, Aboriginal and Torres Strait Islander peoples bear the burden of gross social and health inequalities.

Good medical practice is about using your expertise and influence to identify and address inequalities in health care and to protect and advance the health and well-being of patients, communities and populations.

Section 7.4 Public Health

Physicians have a responsibility to promote the health of the community through disease prevention and control, education, and screening. Good medical practice involves:

  • 7.4.1 Understand the principles of public health, including health education, health promotion, disease prevention and control, and screening.

  • 7.4.2 Participate in community health promotion efforts and be aware of your obligations with respect to disease prevention, screening and reporting of reportable diseases.

“Sometimes you have to do it in a way that grabs attention,” Dr. Miller said.

“Sometimes you have to enter the fray and offend certain people to change the status quo – or it’s not effective advocacy. Everything else is an abrogation of our responsibilities.

Dr. Tim Senior (@timsenior), a general practitioner with the Tharawal Aboriginal Medical Service, said Preview+ that he hoped he could defend his social media presence if ever questioned by AHPRA.

“I’d like to think I could say, based on their own social media guidelines, that I’ve always put my patients first,” he said.

“It is completely legitimate to argue and discuss a health policy that is contested. It is only fitting that doctors be involved in these discussions because of our expertise, because we are citizens and because we see the effects of health policy directly on our patients.

“It’s one of our duties to advocate for vulnerable patients, and sometimes that’s going to lead to conflict.”

Last week, Victoria’s Minister of Health, Mary-Ann Thomas confirmed she would not take advice from acting state health director Ben Cowie who recommended that masks be made mandatory in pre-school and retail settings.

According AusDocAHPRA said Dr. Berger was guilty of undermining confidence in “public health messaging” relating to COVID-19.

“Dr. Berger has made comments in disagreement with politicians, government agencies and public health organizations, pharmaceutical companies and other medical professionals. He did so using emotional and pejorative language,” AHPRA said.

Dr. Miller questioned AHPRA’s strategy.

“If AHPRA hopes to maintain faith in health authorities, then shutting down these kinds of debates on social media will have the opposite effect,” he said. Preview+.

“To say that we cannot criticize health authorities or public health institutions could logically, in my opinion, damage public trust,” he said. “Does this compliance mandate also extend to non-pandemic health policies?

“There is no information available on who complained about Dr. Berger’s tweets. This cloak of anonymity is necessary for vulnerable complainants, not for those with power and agency in the debate, who may arming the AHPRA as part of a tactical political response, as far as we know.

“If AHPRA is simply acting as another arm of political administration picking and choosing which medical advice to follow and then trying to silence dissent, then that is not fair and, in my view, could amount to bullying.

“It really matters how they decide who to investigate and who to exonerate, and whether they are consistent and fair – is it only the outspoken critics of government policy that need to be re-educated? Are the government’s prominent medical apologists immune?

Other prominent doctors on Twitter were more circumspect about AHPRA’s action.

Dr Eric Levi (@DrEricLevi), a pediatric and adult otolaryngologist from Naarm Melbourne, has almost 48,000 Twitter followers and is an advocate for his patients and good medical practice.

“I am on Twitter to learn, engage, dialogue and educate people through the accessible platform of social media,” Dr. Levi said. Preview+.

“As doctors, we have the right to express our opinions, just like everyone else. I also believe that we have a responsibility to disseminate public health information through social media, which is a very powerful tool.

“But how that opinion and information is conveyed is important.

“It has always been true that physicians are held to a higher standard,” Dr. Levi said. “Yes, we can express our opinions, but we must do so in a respectful way.

“We’ve worked hard to earn that respect, and we’re privileged because of it.”

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