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Health Bulletin April 2023

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Ahpra Culturally Safe Regulations

A new culturally safe health regulation process is set to be implemented by Australian Health Practitioner Regulation Agency (Ahpra). This process will provide for the addition of at least two Indigenous representatives working alongside practitioners from each relevant profession and community members to assist with decision making in a culturally safe health care and racism in accordance with the legislation governing health practitioners in Australia. This will particularly include decisions regarding any notification involving Aboriginal and/or Torres Strait Islander Peoples.

The new additions to the decision making panel have been developed following Ahpra, the National Boards and the Aboriginal and Torres Strait Islander Health Strategy Group’s commitment to enshrine cultural safety as a guiding principle and objective for the National Scheme, adopted as legislative amendments to the Health practitioner Regulation National Law in 2022.

The National Health Leadership Forum also welcomes and supports Ahpra’s work, Chair Ms Fiona Cornforth commenting on how important it is in “address[ing] the discriminatory policies and practices that exist” to achieve their shared visions.

Ahpra and the National Boards will continue to implement their five-year strategy (the National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025) alongside Indigenous health leaders. Ahpra also delivers cultural safety training to their staff members while actively looking to increase the Aboriginal and/or Torres Strait Islanders on National Boards and committees.

To read the full article click here.

The final tribunal matter concerning the disproportionally high perinatal death rate at the Bacchus Marsh Hospital has been decided

Warning: some readers may find this article distressing

During the period between 2009 and 2015, a higher-than-average number of babies were delivered stillborn or died shortly after birth at Bacchus March Hospital (formerly operated by Djerriwarrh Health Services).

One independent investigation ordered by the Victorian government found that seven of the babies’ deaths between 2013 and 2014 could have been avoided.

Dr Lee Gruner, now retired, was the medical director at Bacchus March Hospital during that time.

On 17 March 2023, the Victorian Civil and Administrative Tribunal (VCAT) found that Dr Gruner had engaged in professional misconduct. The proven allegations of misconduct arose from her failure to ensure the safe delivery of clinical services at Bacchus Marsh Hospital.

VCAT found Dr Gruner failed to ensure safe delivery of clinical services because she did not:

  • undertake appropriate performance reviews of Medical Officers;
  • ensure that Medical Officers’ record keeping was appropriate;
  • ensure that Medical Officers were appropriately credentialed and were working within the limits of their defined scope of practice; and
  • address the identified risks of medical staffing in the obstetric unit.

Dr Gruner has now been barred from practicing medicine and reapplying for medical registration for 10 years. While Dr Gruner was already retired when VCAT handed down their decision, the ban was necessary to prevent Dr Gruner from coming out of retirement and recommence practicing.

Dr Anne Tonkin, Chair of the Medical Board of Australia, commenting on VCATs final verdict has strongly warned:

‘There’s no excuse for those in clinical leadership roles not knowing what is expected of them. The buck stops with them. We should not need to go through these tragedies to learn these lessons.’

While the disqualification of Dr Gruner will not shorten her career, VCAT found that the disciplinary action was appropriate to deter similar behaviour from others in positions of power.

A background on the investigation and tribunal matters relating to these incidents can be found here. Link to the full VCAT decision can be found here.

Culture of medical training in the spotlight in 2022 Medical Training Survey

The 2022 annual Medical Training Survey (MTS) was published in February this year. The Medical Board of Australia is of the opinion that the survey presents small but concerning changes from previous years about the culture and pressures in medical training.

The MTS is a survey for medical trainees conducted by the Medical Board of Australia. Its purpose is to track feedback about the quality of medical training, with over half of Australia’s trainee doctors taking part in the survey.

This year’s results show that the medical training sector is in desperate need of attention. The results showed that 55% of Aboriginal and Torres Strait Islander trainees have experienced and/or witnessed bullying, harassment, discrimination and racism and a total of 34% of all trainees experienced and/or witnessed this behaviour.

The survey found that trainees are concerned about the repercussions of reporting inappropriate behaviour. The results showed that 70% of people subject to bullying, harassment, discrimination and/or racism did not report it. Over half of this group were concerned about the potential consequences of their complaint and believed that nothing would come from making a report.

A positive change from the 2022 survey was an increase in trainees being paid for their overtime.

The MTS is considered to be a sufficient tool to monitor change among trainee doctors. The Medical Board of Australia intends to use these results to observe issues within the system and implement changes to improve the culture of medical training in Australia.

To read more, please click here.

NMBA getting nurses and midwives ready to work quicker

The Nursing and Midwifery Board of Australia (NMBA) is introducing measures to prepare nurses and midwives to enter the workforce and ease the strain on the sector.

One of the measures will allow former registered nurses and midwives who have been out of the industry for 10-15 years to be considered for provisional or general registration with conditions. A six month re-entry program will be introduced for eligible candidates.

The NMBA will review and simplify its policies around re-entry into practice for nurses and midwives, and boost the number of Objective Structures Clinical Examinations (OSCE) to eliminate exam wait times for overseas qualified nurses looking to become registered in Australia.

NMBA Board Chair, Adjunct Professor Veronica Casey acknowledged “the immense stress and pressure our nurses and midwives are experiencing”. Professor Casey stated that this has resulted in the new measures, to “take steps to simplify the pathways to registration while maintaining a high standard of care for the public”.

The NMBA is looking for further opportunities to increase its examination infrastructure to support the continued rise of international applications in 2023, with almost 500 applicants recently sitting the exam over a two-week period.

The examination process will also be made more accessible and affordable via an online Registered Nurse OSCE preparatory course which will support overseas applicants to understand critical information on the Australian healthcare system.

The NMBA expects the new measures will ease the current burden of Australia’s nurses and midwives.

For more information, click here.

Cosmetic surgery oversight group kicks off as MBA progresses reforms

The Cosmetic Surgery Oversight Group (Group), established by the Australian Health Practitioner Regulation Agency (AHPRA) Board and led by former Australia Competition and Consumer Commission Deputy Chair Delia Rickard, has begun work overseeing measures to improve safety in the cosmetic surgery sector.

The independently chaired Group was established following the release of the final report of the independent review of the regulation of medical practitioners who perform cosmetic surgery, which included 16 recommendations to improve patient safety in the sector. For more information on the report click here. The Group will aim to provide assurance to the community, governments, and industry stakeholders that AHPRA and the Medical Board of Australia (MBA) are implementing the recommendations.

The MBA has consulted with the public on three reforms that were recommended by the independent review. The following proposed reforms will be presented to the Health Ministers of each state and territory following the consultation process:

  • a registration standard to establish an endorsement pathway that will set expectations about minimum qualifications for medical practitioners wishing to perform cosmetic surgery;
  • stronger guidelines for medical practitioners who perform cosmetic surgery; and advertising guidelines for cosmetic surgery.
  • AHPRA is currently managing 254 notifications related to cosmetic surgery and cosmetic procedures regarding 86 practitioners. Through auditing 45 doctors and four business, the MBA has identified the most common breaches:
  • the use of photos that represent treatment outcomes without corresponding before photos for comparison;
  • reposting patients’ social media posts in breach of the ban on testimonials;
  • using terms that imply specialist registration by doctors who don’t hold specialist registration;
  • downplaying the risks and recovery period associated with surgery; and
  • claiming treatment outcomes that are not supported by evidence.

To read more, please click here. 

Concern over paracetamol access for Australians in pain

In February 2023, the Therapeutic Goods Administration (TGA) published an interim decision on proposed amendments to the Poisons Standard. The interim decision proposes to reduce packs for general sale from 20 tablets or capsules to 16, with packs for sale in pharmacies to be reduced from 100 to 32. Packs of 100 tablets or capsules would only be available with pharmacist supervision.

Every year, 225 people are hospitalised and 50 Australians die from paracetamol overdose, with intentional overdose most prevalent in teenagers and young adults.

The national pain advocacy body, Painaustralia, has made a submission to the TGA’s consultation on the interim decision expressing its disappointment in the proposal to reduce the size of paracetamol packs.

Painaustralia is concerned this will increase the per tablet cost of paracetamol, which is currently an affordable and accessible option for managing pain. This would be a disproportionate impact on low-income and rural communities.

One in five Australians over 25 live with chronic pain. Packs of 16 would last only two days for most of these consumers. In a survey conducted by Painaustralia, only 25% of respondents supported the proposal to limit pack sizes.

The TGA will make a final decision in April.

To read more please click here.

Russell Kennedy has previously published an insight regarding recent trends in paracetamol overdose. To read that insight, click here.

Consumers warned about Ozempic scams

The Therapeutic Goods Administration (TGA) has issued a warning about scams targeting consumers seeking semaglutide (trade name for Ozempic) during the current medicine shortage. Ozempic is a medication used to treat type 2 diabetes and has other ‘off-label’ uses which include weight loss.

The TGA is investigating a number of websites claiming to sell semaglutide products. The scams target GPs for distribution to their patients, promising that the purchased good will be delivered to the consumer’s home address, that the product is authentic and that the semaglutide can be compounded in the pharmacy if needed.

Advertising prescription medicines is prohibited, and any online advertisements for Ozempic can be a scam. Consumers are advised to only obtain Ozempic from an Australian pharmacy with a valid doctor's prescription.

To address the medicine shortage, the TGA has approved some overseas alternatives to Ozempic for temporary supply, which are listed on the section 19A approvals database on the TGA website. The TGA is also working with other regulators to combat these scams and take appropriate action against non-compliant advertising.

To access the media release, please click here.

Tribunal makes final decision on registered nurse who worked while under the influence of alcohol

On 14 May 2021, The Nursing and Midwifery Board of Australia (NMBA) suspended a Registered Nurse’s registration for a period of over 6 months and referred the Nurse to the Western Australia State Administrative Tribunal (Tribunal) due to events that took place on 14 January 2021 – 15 January 2021.

On 14 January 2021, the Nurse attended a social event and consumed alcohol. The Nurse then left the event to commence her nightshift at a hospital.

At 1.30 am (now 15 January 2021), the Nurse, after seeing 8 patients, finished her nightshift early due to feeling unwell. On her drive home, the Nurse was pulled over by local police.

The police conducted a random breath test, which revealed that the Nurse had a blood alcohol content of 0.104. the Nurse’s licence was immediately suspended following the breath test and she was charged with driving a motor vehicle with a blood alcohol content exceeding 0.08.

On 10 February 2023, the Tribunal found that the Nurse’s actions constituted professional misconduct and ordered that she:

  • be reprimanded; and
  • have conditions imposed on her registration, which include a requirement to complete an NMBA-approved program of education.

While many people enjoy alcohol as part of a healthy social life in Australian and New Zealand, consumption of any amount that results in an individual’s blood alcohol content to exceed 0.08 (about 1-2 standard drinks) before work is prohibited. The reason being that more than 1-2 standard drinks is considered to compromise performance at work and adversely affect the health and safety people, including persons receiving nursing and midwifery care and co-workers.

The Tribunal noted that the Nurse’s conduct was an isolated event, and she continues to learn and grow and is open to all feedback given. To read the AHPRA summary, please click here.

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