Now that we have covered some basic grounds of mandatory notification, let’s go ahead and factor in some more concepts to get the hang of the topic.
There are two very important key factors to consider
Although you can report anything to AHPRA, when it comes to the MANDATORY reporting TWO key factors come to play and have to be assessed before any decision is made as to whether mandatory reporting must be done. The first one is if the nature of the conduct can impose SIGNIFICANT RISK to the wellbeing and health of patients. With just this amount of info, you already can exclude so many manners and conducts off the table.
With this in mind, let’s take a look at some scenarios from PART1:
You are an intern in a surgery ward and you have noticed a surgeon has a bad temper and behaves poorly and rude with patients and staff.
Assess the presence of SUBSTANTIAL RISK:
Although the way he is behaving is unacceptable, against social norms, and ruse, he still might be the best surgeon with brilliant clinical outcomes. Just by having a short wire or bad temper patients are not at SUBSTANTIAL RISK, not at least to the best your knowledge. So, mandatory reporting is unlikely to be the best option. Look at other options.
You are a registrar in a hospital, and you notice a year-4 medical student seems lost and depressed.
Assess the presence of SUBSTANTIAL RISK:
He seems lost and depressed. Most medical students may seem lost and depressed at some point. I was myself ages ago 😉. It does not mean his patients are at risk, at least not to the best of your knowledge. He seems lost and depressed, but it does not mean he is placing the patients he is seeing at SUBSTANTIAL RISK. So, best options could be talk to him and express your concerns for him or talk to the person in charge of medical students.
You notice that one of the doctors in your clinic is peeking into patients’ files with whom he has no therapeutic relationship.
Assess the presence of SUBSTANTIAL RISK:
Although what he is doing is not the most ethical and professional deed, such action does not put the patient’s health and well-being at risk. It can be breach of confidentiality with ramifications, but as far as SUBSTANTIAL RISK is concerned it is not a notifiable conduct. You might want to speak to him about the wrongness of his action or to someone in a supervision or managerial position.
You notice your local pharmacist is not himself anymore and your patients are receiving misleading instructions on your prescriptions from him.
Assess the presence of SUBSTANTIAL RISK:
What do you think? What if a patient receives wrong medicine or wrong dose? There is absolutely SUBSTANTIAL RISK involved; so, MANDATORY REPROTING gets a green light. We might want to talk to other layers of supervision but regardless of the outcome you need to report to AHPRA unless you are sure someone else has done that. If you fail to report and his condition causes harm to a patient, that would be on you, and you would be held legally liable for not reporting. We will get back to this with more details later.
You see one of your fellow doctors takes morphine vials and puts them in his pocket. You do your digging and learn he is taking them out.
You notice a nurse gives half the prescribed dose of the oxycodone prescribed for a patient with a recent hip surgery and takes the rest with her.
Assess the presence of SUBSTANTIAL RISK:
These two scenarios might look similar at first glance but can be interpreted differently. In the first scenario a fellow registered doctor is in fact stealing morphine. Theft is a crime and punishable by law. But stealing morphine does not put patients at risk. Does it? Therefore, while his action is unacceptable, and he may go to prison for that as a criminal, there is no need for MANDATORY NOTIFICATION. I would turn a blind eye on it, talk to him in non-confrontational way, talk to one of the people in supervision or administration or even informing the law enforcement authorities. But AHPRA? I don’t think so.
In the second scenario, however, the nurse is cutting the patients’ share of painkiller and thereby putting them in pain and physical and mental discomfort. You might not want to consider pain a substantial risk, but it is. A patient in pain does not feel WELL so their WELL-BEING is affected substantially. Mandatory reporting to AHPRA comes to play.
Now let’s summarize the four broad categories that can potentially place patients’ wellbeing and health at risk and require mandatory reporting:
1- Impairment
2- Intoxication
3- Significant departure from accepted professional standards
4- Sexual misconduct
The first two ones are no brainers. If you have Alzheimer disease, or psychosis, or as a neurosurgeon you have tremors, you are putting patients at risk. As are you when you are drunk or stoned.
Numbers 3 and 4 need a bit of explanation. What does significant departure mean? Shouting and dancing in the ward while visiting patients in the ward is a deviation from professional standards. Aren’t they? But here we are talking treatment standards not ethical or manner standards. Significant departure from standards means that instead of prescribing antihypertensive medications for your patient, you advise that they pray to God three times a day on an empty stomach. Wow :)) that was too extreme but I think you got the concept. Or for example you prescribe OTC medicine for a patient with acute cholecystitis.
Of all the above, the thing AHPRA has a relentless scary extreme approach towards is sexual misconduct. Even if the patient has informedly consented to that or even she/he was the one who stepped forward, seduced, and proposed. Why is that? How could this affect the patient’s well-being as the most important key element of forming a notifiable conduct?
Well, we get to that as well as an in-depth digging of each the four categories, the second key element and a lot more in PART 3. Stay tuned and blessed.