‘The attack is ever present in my thoughts.’

Ahpra has accepted all recommendations from a review into the safety of notifiers, which was launched after a GP’s violent attack on a pharmacist that saw him jailed for attempted murder

An independent review of Ahpra’s management of confidential and anonymous notifications has made 10 recommendations to strengthen the protection of notifiers from risks of harm.

It was launched following the guilty verdict against an Adelaide GP in November 2018 for the attempted murder of a Port Lincoln pharmacist.

In the months leading up to the attack, the pharmacist had notified Ahpra about the GP’s prescribing practices, having noticed he had written scripts for several different individuals for high quantities of diazepam, oxazepam and panadeine forte.

Court documents revealed the pharmacist authorised release of her name after being told by Ahpra that if she was prepared to do so, the referral would be expedited and “carry more weight”.

Her full name was included on the notification document provided to the GP, and later the name of one of the pharmacies she worked at was also provided to him.

The Supreme Court of South Australia heard that on 10 October 2017, the GP had gone to the pharmacy where she worked, lured her out from behind the counter with a bunch of flowers and then tried to stab her with a 15-centimetre fishing knife.

Thankfully the pharmacist survived the attack, however she sustained three lacerations, bruising and swelling to her left arm and hand.

The GP was sentenced to 15 years’ jail with a non-parole period of 10 years.

Following the trial, presiding judge Hon Justice Ann Vanstone wrote to Ahpra’s chief executive officer, expressing the view that the crime would not have taken place if the pharmacist’s name, and the name of the pharmacy at which she worked, were not disclosed to the GP.

She believed the notification was the motive for the crime, and while she acknowledged that Ahpra staff were no doubt acting in good faith, she said it was difficult to see a justification for releasing the pharmacist’s name to the GP, as the prescriptions spoke for themselves and the investigation would have not been advanced by disclosing her name.

Making sure that individuals feel safe to raise their concerns with us is vital.

AJP readers shared their thoughts about the event.

“How did he get her name? Why are pharmacists not protected when reporting prescribers?” asked one reader.

Another said: “Two friends of mine have been on the ‘other’ end of Ahpra reports in the last year. In both these circumstances APHRA did disclose who made the report… I don’t think anyone at Ahpra could have imagined this happening. But now that it has a review of procedures is necessary.”

Ahpra responded to concerns with a full statement, admitting that the “case has shocked and appalled the Medical and Pharmacy Boards of Australia and Ahpra”.

The agency asked the National Health Practitioner Ombudsman and Privacy Commissioner (NHPOPC) Richelle McCausland to conduct an independent review of the confidentiality safeguards in place for individuals making notifications about registered health practitioners.

A pharmacist’s story

The pharmacist at the centre of the legal case made a statement to the NHPOPC.

“In my 15 years as a pharmacist I had never before made a notification to Ahpra, so I was unsure of the process and of what to expect. I called Ahpra and assumed the phone conversation would result in Ahpra taking down the practitioner’s name and making its own inquiries before deciding on their course of action,” she said.

“I had no knowledge of Ahpra’s approach to privacy or the option of making a confidential or anonymous notification.

“During the first telephone conversation with Ahpra, I briefly described my concerns. The Ahpra staff member directed me to Ahpra’s website so I could make an online notification,” she said.

“The Ahpra staff member recommended that I release my name to the practitioner, as it demonstrates transparency, the allegations would carry more weight, and it makes the investigation of the notification more expedient.

“I was unaware of what was happening in the background at Ahpra regarding the investigation, but I now know that Ahpra disclosed my identity to [the GP] in the first letter he received. He was provided with a copy of the notification, which included my full name. The letter also contained the supporting documents I had provided to Ahpra, which included the name and address of the pharmacy where I worked and where I was subsequently attacked,” she said.

“The attack is ever present in my thoughts and is something I continue to deal with, both physically and mentally, on a daily basis. I feel the notifications process and Ahpra’s procedures are flawed, and this must be changed to protect future notifiers and prevent something like this occurring again.

“My notification should have been de-identified because my name was irrelevant to the allegations. I accept that my role as a pharmacist was relevant and it may have added weight to the allegations, but my actual identity was irrelevant to the notification and associated investigation.

“I would like the current process and policies to be changed so that future notifiers are safe and feel supported in their difficult decision to lodge a notification.”

A balancing act

Ms McCausland released the results of her review today (Wednesday 17 June), noting that Ahpra’s current approach was consistent with the practices of other regulators.

She also highlighted that determining what information should be withheld from the practitioner when managing a confidential notification presents a challenging task for Ahpra.

“The issue of what information is disclosed to practitioners during the notifications process can be described as a balancing act between protecting the confidentiality of notifiers and ensuring procedural fairness for practitioners,” said Ms McCausland.

However she added there are circumstances in which it may not be appropriate or necessary to disclose a notifier’s identity to a practitioner.

“Relevant case law indicates it is not inconsistent with the principle of procedural fairness for a decision-maker to withhold the identity of the notifier for reasons of confidentiality, so long as the substance of the information is disclosed,” Ms McCausland concluded.

“There are sound reasons for accepting confidential and anonymous notifications.”

Ms McCausland made 10 recommendations for improvement, including that Ahpra:

  • introduces a new step in the notification process focused on proactively assessing whether it is necessary to disclose the notifier’s identity to the practitioner;
  • improves how confidential and anonymous notifications are managed and how information about privacy is communicated to notifiers;
  • seeks amendment to the Health Practitioner Regulation National Law to make it an offence to harm, threaten, intimidate, harass or coerce a notifier; and
  • develops and publishes a framework for identifying and managing vexatious notifications.

Ahpra accepted all recommendations from the report.

‘‘Information disclosed to us by notifiers is critical to our work as a regulator and keeping the public safe. So, it is vital that individuals feel safe to raise their concerns with us,” said Ahpra Chief Executive, Martin Fletcher.

‘‘We support strengthening the protection of notifiers from risks of harm and we will adopt all 10 recommendations, a number of which we are already progressing,” Mr Fletcher said.

The agency’s responses to the recommendations were as follows:

  • Ahpra says it will continue the practice of not naming a notifier when the notifier withholds consent to do so. It will also assess every notification on a case-by case basis to determine whether the release of the notifier’s name and/or category of notifier is necessary to enable a response.
  • Changes will be made allowing practitioners to request review of decisions to withhold a notifier’s name, and collection statement and Privacy Policy amended to make it clear that the name of the patient will be disclosed when the concern relates to care provided to a patient. The above policy will be developed by 31 July 2020 and in place by 30 September 2020.
  • Ahpra says it has begun a review of its Privacy Policy and statement on the collection and use of information, which will be published by 1 July 2020, and new resources are also being developed to guide staff on how and when to redact a notifier’s information and when Ahpra may be compelled to release information about the notifier to a practitioner.
  • Changes were made to Ahpra’s database in September 2019 address the consent requirements for notifier’s information to remain confidential or anonymous.
  • Ahpra says all its relevant communications are under review to ensure consistency and transparency in messaging to notifiers, to be completed by 31 December 2020. This includes consideration of information and pathways available to notifiers.
  • In September 2019, new guidance and training was implemented to ensure all notifications staff have the skills to structure conversations about consent, with knowledge of what information must be provided to the notifier.
  • Ahpra will publish a new guide for staff and consult with reference groups and professional indemnity providers on managing the risk of vexatious notifications.
  • Ahpra says it will develop guidance for staff on how to identify and flag potential harassment or intimidation of notifiers. It will also advise the government of a proposed amendment to the National Law to make it an offence for a registered health practitioner to harm, threaten, intimidate, harass or coerce a notifier.

The NHPOPC thanked Ahpra staff, acknowledging their “openness” and clear commitment to ensuring that the National Scheme operates in a fair manner for all involved.

She also acknowledged the pharmacist in her findings.

“Acting consistently with her professional obligation to make a notification resulted in what has no doubt been a frightening and highly distressing experience. It is appalling that [she] has suffered harm at the hands of a fellow health practitioner,” said Ms McCausland.

“The NHPOPC hopes this incident has thrown a spotlight on the importance of confidentiality safeguards for notifiers.”

The pharmacist told AJP: “I am pleased with the findings of the report and the fact Ahpra have agreed to implement all the recommendations. These will hopefully strengthen the protection of notifiers and reduce the risk of similar events occurring again.” 

Any readers who are distressed can call 1300 244 910 for anonymous and confidential support from a pharmacist colleague over the phone through the Pharmacists’ Support Service (PSS), available 8am to 11pm EST 365 days of the year.

For urgent assistance when PSS is not available, call Lifeline on 13 11 14.

For 24/7 confidential incident support for employee and owner pharmacists, members can call PDL on 1300 854 838 Australia wide.

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