With changes to mandatory notifications to take effect soon, we look at case studies of what constitutes impairment as AHPRA encourages registered practitioners to seek help for their own health
In February this year amendments to the Health Practitioner Regulation National Law were passed by the Queensland Parliament, and to prepare for their commencement early next year, AHPRA has released new materials to inform health practitioners.
The amendments, which will apply in all states and territories except Western Australia, have raised the threshold for what should lead to mandatory notification by treating practitioners for three of the four types of conduct—impairment, intoxication and practice outside of professional standards.
This threshold will now be “substantial risk of harm” which AHPRA describes as “a very high threshold for reporting risk of harm to the public”.
“In context of mandatory notifications, we want to hear from practitioners and employers only where there is a concern of substantial risk to patients,” CEO of AHPRA Martin Fletcher says as the regulatory agency rolls out new resources this week to explain the changes.
“We know that many health practitioners have crippling fears about what we will do if we receive a mandatory report about health impairment,” says Mr Fletcher.
“We hear very distressing stories about health practitioners who are too afraid to seek help because they’re worried about being deregistered.
“These are the unintended consequences of mandatory reporting. And this is a challenge for all of us, because all of us want to make sure that health practitioners feel safe to get the care they need when they need it.
Many health professionals have misunderstood their obligations in relation to mandatory reporting and this has resulted in health professionals, including pharmacists, being reluctant to seek treatment for health issues.—Kay Dunkley, PSS
“It’s important they seek help without fear of having a mandatory notification made about them,” says Mr Fletcher.
“Healthy practitioners are good for patient safety. We want all registered practitioners to know what the changes mean for them and to seek advice and support for their own health and wellbeing, without fear of an unnecessary mandatory notification.”
Meanwhile under the new legislation, any concerns about sexual misconduct—the fourth type of conduct—should continue to be the subject of a mandatory notification, with treating practitioners required to report past, present and future concerns as well.
What constitutes an impairment that poses ‘substantial harm’?
Providing guidance on behalf of AHPRA, psychiatrist Dr Kym Jenkins explains that fear of mandatory reporting should not be a barrier for health professionals seeking help.
“Illness is not impairment—feeling stressed and wanting to do something about it is not a condition for mandatory reporting,” explains Dr Jenkins.
“Being on treatment for a mental illness is not a condition for mandatory reporting. Seeking treatment for it, having a mental illness in the past or taking time off work are not conditions for mandatory reporting,” she says.
However she adds that “sometimes it can be difficult to decide about mandatory reporting … sometimes it’s not so clear cut.”
Dr Jenkins provides three examples of patients she’s seen to make clearer when a mandatory report is or isn’t required (see the full video here).
|CASE STUDY 1|
The first example is a doctor that I saw recently. He felt that all his career he’d been a fraud, that he was a fake, and had a bit of difficulty in concentrating at work. He’d already taken a couple of days off because he couldn’t face going into work.
He did not put any patients at risk. He’d already had a couple of days off. And we were able to sit and talk about what was the best treatment plan for him.
He started on some antidepressant medication and embarked on a course of psychotherapy and had a few more weeks off work in order to get better. There was no question at all about putting in a mandatory report for this doctor.
Outcome: no ✗ mandatory notification
|CASE STUDY 2|
My second example is a nurse that I saw a couple of years ago. She had a psychotic illness and she believed that the doctors on the ward that she was working on were poisoning the patients, that the medications were contaminated.
And therefore [believed] it was her responsibility, her duty, to tell all the patients not to take their medication.
Now she was clearly putting patients at risk of substantial harm and she actually did trigger mandatory reporting.
Outcome: yes ✓ mandatory notification
|CASE STUDY 3|
I also had a referral about a patient who was another doctor and this referral came from a neuropsychologist. And the neuropsychologist had actually seen this doctor and done full assessment on him, because he had a neurological problem and some cognitive slowing had showed up.
I actually had to talk to the doctor himself and found out what work he was doing, he wasn’t actually seeing patients, he wasn’t working in an acute setting where he might have been putting patients at risk, he was involved in medical administration and writing reports.
By all accounts his work was very accurate, very precise, it just took him a long time to do it. So he was not putting anyone at risk, so even though he did technically have an impairment, he was actually able to do his job absolutely fine.
Outcome: no ✗ mandatory notification
Dr Jenkins encourages health practitioners to get help as soon as they can, noting the mandatory notifications are rare.
“I see many many practitioners who have mental health problems and substance use problems. People can avoid seeking help for treatment for things like mental health issues, burnout or stress when they really need it,” she says.
“There are actually many things that delay us getting help for ourselves and prevent us from getting help, like workload pressures and other responsibilities. But fear of mandatory reporting should not be one of the factors, because mandatory reporting is actually incredibly rare,” she says.
Kay Dunkley, Executive Officer at the Pharmacists’ Support Service (PSS) says the organisation welcomes the new resources regarding mandatory notifications issued by AHPRA.
“They provide more detail and clarify when mandatory reporting is required by registered health professionals. The resources include clear advice and also useful case examples about mandatory notification,” she says.
“Many health professionals have misunderstood their obligations in relation to mandatory reporting and this has resulted in health professionals, including pharmacists, being reluctant to seek treatment for health issues.
“This reluctance to seek help has been counterproductive in relation to ensuring that as health professionals we are fit and well and able to adequately provide care to members of the community.
“We encourage all pharmacists, interns and students to seek help for health issues and if necessary take time off while they recover,” says Ms Dunkley.
“If any health professional is seeking help then mandatory notification is not required, provided they follow the treatment and advice of their treating practitioner in regard to their practice.”
Any pharmacist, intern or student who is concerned about their health and wellbeing can phone PSS to discuss their situation. Callers can remain anonymous and calls are confidential. PSS is available every day of the year between 8am and 11pm AEDST on 1300244910.