December 2020 Newsletter

Message from the President 

Paramedics have been on the frontline of providing healthcare throughout 2020, dealing with the challenges of the COVID-19 pandemic. This has included changes to practice incorporating risk assessment, infection control, more extensive use of personal protective equipment and considerations relating to aerosol generating procedures. These changes to practice have all related to safeguarding the wellbeing of patients, paramedics and other colleagues in health and/or emergency services. On behalf of the Council, I would like to thank all paramedics for your service to the community during this time and your commitment to keeping the community safe.

The Council has of course adjusted its approach in response to the COVID-19 pandemic. The main change has involved holding meetings and panels online. This has been effective in supporting engagement with practitioners, Council members and our Health Professional Councils Authority (HPCA) colleagues, with the online technology allowing our activities to proceed smoothly. In this newsletter we are focusing on the ways in which the health pathway operates regarding complaints about a paramedic. I hope you find this informative and allays any concerns you might have. The purpose of the Council is not to punish practitioners, but rather ensure the safety of the public. The health pathway facilitates Council achieving the purpose of public safety while simultaneously creating an environment for the practitioner to practise safely while managing their health condition. 

In the lead up to Christmas, I would like to thank the HPCA team for their support to Council throughout the year. They are a highly professional and compassionate team who work tirelessly with the Council to ensure the safety of the public. On behalf of the Council I wish you a Merry Christmas and Happy New Year. To those who will be working over this period of family celebration, we extend our very special thanks.

Alan Morrison

President 

The role of the Paramedicine Council of NSW

The Council is a statutory body established under the Health Practitioner Regulation National Law (NSW). The Council is made up of six members, including four paramedics, a community member and a legal member who are nominated by the NSW Minister for Health and appointed by the NSW Governor. The Council is entirely independent of any employer and has its own procedures for managing complaints and mandatory notifications about registered paramedic practitioners and students in NSW. The Council’s focus is on safe professional practice, maintaining public safety and minimising risk. The Council can act to prevent unsafe practice and has legal powers to enable it to do so.

 Who are the Council?

• Mr Alan Morrison – President, Paramedic
• Mr Peter Lang – Deputy President, Paramedic
• Ms Cassandra McKenzie – Paramedic
• Mr Brian Parsell – Paramedic
• Ms Margo Gill – Community member
• Dr Ruth Townsend – Australian lawyer

The term of the four practitioner members and community member expires on 30 June 2021. Recently expressions of interest were invited from practitioners and the community with an interest in applying for appointment to Council for three years commencing July 2021. Applications closed on the 20th November and the assessment of applications, managed by the HPCA has commenced. Current Council members are not involved in the selection process.

For general enquiries you can contact the Council via email at HPCA-ParamedicineCouncil@health.nsw.gov.au or phone 1300 197 177. The Council is supported by staff employed by the HPCA.

Council activity

The HPCA 2019/20 annual report was tabled in Parliament last week. The full report will be available on the Paramedicine website in the coming weeks. Some key statistics from the report include:

Complaints data:

• Complaints received = 63
• Mandatory notifications = 27
• Student notification = 1
• Complaints closed = 56

Immediate Action:

• Boundary violations = 2
• Health impairments = 7
• Offences = 2

Assessments and hearings concluded:

• Health assessment = 15
• Impaired Registrants Panel = 5
• Counselling/interviews = 9

Number of active monitoring cases by stream:

• Conduct pathway = 3
• Health = 11

How does the Council manage complaints?

In the last newsletter we explained the ways in which the Council works with the Health Care Complaints Commission (HCCC) to manage complaints in NSW. Regardless of whether a complaint is lodged to the HCCC, the Australian Health Practitioner Regulation Agency (Ahpra) or the Council, information is shared between us.

In this newsletter we provide an example of how we deal with a complaint concerning the health of a practitioner. The focus of the health pathway is to ensure the safety of the public while simultaneously creating an environment for the paramedic to practise safely and manage their health condition.

A complaint is received

The HCCC and the Council consult to determine the next step in managing the complaint as outlined in the past newsletter 

If it is agreed Council is best placed to handle the matter within the health pathway, we may direct a practitioner to attend an independent health assessment with a Council Directed Health Assessor (CDHA). This involves meeting with the CDHA who will undertake an assessment in the areas relating to the practitioner's health. This will help us to determine:

• the practitioner's current health status
• if the practitioner has an impairment under the Health Practitioner Regulation National Law (NSW)
• any further action we need to take to ensure the safety of the public.

Impairment is defined under the National Law (NSW) as:

impairment, in relation to a person, means the person has a physical or mental impairment, disability, condition or disorder (including substance abuse or dependence) that detrimentally affects or is likely to detrimentally affect—

(a)  for a registered health practitioner or an applicant for registration in a health profession, the person’s capacity to practise the profession; or

(b)  for a student, the student’s capacity to undertake clinical training—

(i)  as part of the approved program of study in which the student is enrolled; or

(ii)  arranged by an education provider.

If the CDHA's assessment finds that the practitioner is impaired as defined under the National Law (NSW), we then refer the practitioner to meet with an Impaired Registrants Panel to agree on the ongoing action needed to protect the public. Most commonly, the panel and the practitioner may recommend that the practitioner’s practice is limited in some way, through conditions on their registration. Occasionally, we may suspend the practitioner for a fixed period, while they return to good health and until they are able to practise safely.

Practice-related conditions placed on a practitioner's registration by the Council are also notified to Ahpra and made available on the Register of practitioner's. Health and treatment conditions are not published on the Register of practitioners for privacy reasons. Conditions placed on registration apply nationally. 

We monitor these conditions, which are tailored to the health concern being managed. Common conditions may include ensuring the impaired practitioner engages in treatment, random drug and/or alcohol testing, and regular reviews and assessments with the CDHA. We expect practitioners in the health pathway to comply with all the conditions on their registration to ensure that they do not pose a risk to the public. As the practitioner returns to good health through rehabilitation and recovery, the conditions on their registration are gradually eased.

While the health pathway aims to return practitioners with impairment to unrestricted practice, this may not always be possible. Some practitioners, for example those with recurring psychiatric illness, may remain on the program indefinitely, potentially with low level, occasional review by us.

If you are a practitioner who is involved in our health pathway, we will give you the necessary information about what to expect at different stages in our process.

Further information is available on our website:

• How we manage complaints
• A complaint has been made about you
• What do you need to know about our processes

Case study

This is an example of how the health pathway might work following receipt of complaint by Council. It is entirely fictional and bears no relationship to any current practitioner.

Rodney came to the attention of the Council after a complaint was received from his employer. The complaint alleged that he had an unusually high rate of medication breakages, exceeded the normal rate of medication administration to patients and had a high level of short sick leave absences. Colleagues had noticed mood swings. A complaint from a patient had been received by Rodney’s employer alleging rude and inappropriate behaviour. When enquiries about the complaint were made by Rodney’s employer, he became angry and overly defensive. After the meeting, Rodney went home on sick leave.

After coming to the attention of the Council, Rodney was referred for a health assessment with a Council Directed Health Assessment (CDHA). Rodney explained that he had become depressed after suffering from intermittent neck pain, having suffered an injury some time ago. Over the last few years he had been prescribed pain medication, had been weaned off those, had been to a pain clinic, lost weight, undertaken exercise, and at times needed medication. Recently, he said his neck had been playing up and that was why he was getting frustrated and cranky at work. In the course of the assessment, Rodney denied taking any medications and denied misappropriating or misdirecting medications from work. When Rodney was directed to undergo a hair test as part of the assessment, he disclosed a problem with pain medication and admitted he was guilty of taking leftover medication. 

Rodney's story

Rodney had let his chronic injury overwhelm him and did not engage with his treating health practitioners to manage his pain properly. He decided to manage it himself and when he could no longer bare the pain, he started using medication wherever he could obtain it. He also admitted he had started experimenting with illicit drugs he had obtained from a friend.

The CDHA assessing Rodney was left with some concerns about his insight, due to his ongoing denial and delay in acknowledging the extent of his problems with the medication. The CDHA gave Rodney very clear advice that he needed to take responsibility for what had happened and for his health, and that he would be required to demonstrate to the Council that he is managing his health with appropriate strategies, such as engagement in treatment which could result in a stable recovery. 

What happens next?

For a case like Rodney's, where some acknowledgement has occurred, usually the practitioner will be referred to an Impaired Registrants Panel (IRP). A panel will recommend conditions to the practitioner. This will require voluntary acknowledgment and active participation by the practitioner to improve or manage their health condition. The Council therefore seeks agreement from the practitioner to the conditions recommended by the panel prior to imposing them. If a practitioner disagrees with the proposed conditions under the National Law (NSW), the matter must be referred to the Health Care Complaints Commission as a complaint for further consideration and action. The types of conditions recommended relate to monitoring health, engagement in treatment and practice restrictions. These conditions are placed on the practitioner’s registration so they can work when it is safe to do so. Sometimes it is appropriate that a practitioner takes time out from work to recover sufficiently to safely practise.

Examples of conditions and related policies for practitioners with conditions are on our website.

What happened to Rodney?

The CDHA advised Rodney that they would be recommending to the Council that some conditions be imposed upon his registration. Rodney attended immediate action (section 150) proceedings as there were concerns about immediate safety, both for him and for the public. The Council delegates of the proceedings noted that Rodney had been struggling with major life stressors and serious mental illness, factors which contributed to unacceptable professional conduct involving illegal drug behaviour. Immediate action conditions were placed on his registration. These will be reviewed by the Council following Rodney's meeting with the Impaired Registrants Panel, who will examine Rodney's progress and engagement in treatment and compliance with conditions. Since the complaint was received by the Council, Rodney has seen a psychiatrist for his depression and anxiety. Rodney is currently compliant with the conditions and isn’t working as a paramedic at this time, however, has a plan to support his return to practice. His conditions on registration will be monitored by the Council.

Lessons from Rodney's story

Rodney's story highlights the importance of the standards of practice and what can happen when a practitioner fails to comply with them. Some lessons we can learn from Rodney's story include:

1. Proactively managing our health with appropriate strategies (this is not self-diagnosis or self-medication) is always in our own best interests for maintaining good health and wellbeing. When we do this, it can prevent the possibility of health issues impacting upon our ability to safely and competently practise as a registered health practitioner.
    
2. Rather than hide depression or other mental health concerns, practitioners should seek treatment and support early. Any illness left untreated can become severe and affect critical thinking and other vital professional attributes to the degree that practice is unsafe.
    
3. If you’re concerned that you or someone you work with may be dealing with depression or drug and alcohol issues, help is available. It’s always ok to ask for help. Support your colleagues by encouraging them to seek treatment. 

It is also appropriate to discuss matters with your GP and notify your employer so that they can make appropriate adjustments to your work if necessary. This builds trust, maintains professional integrity and facilitates safe care. Note that:

1. Honesty is important as it increases trust. Professional integrity can be damaged when practitioners withhold information, are dishonest, or minimise the impact of their illness on their behaviour. This may also result in more restrictive conditions on practice or referral to investigation. 
    
2. Promoting health and wellbeing is one of the professional standards identified in the Codes of Conduct for paramedics. This standard refers to the health of both patients and practitioners. There are also mandatory notification requirements for reporting drug and alcohol issues and health issues when these issues are negatively impacting on practice.
    
3. Practitioners with chronic and relapsing health conditions may be monitored by the Council while being in ongoing treatment for some years. However they are still able to practice as long as they engage in treatment and maintain compliance with any conditions of registration placed on them.

Criminal offence

If you are charged with a criminal offence, you are obliged to notify AHPRA within 7 days. Read more about the Criminal History Registration Standard.

Self-notifying

The Council has an established pathway to manage complaints about health which is constructive and non-disciplinary. We encourage you to read more about how we manage health complaints on our website, there is also some information about self-notifying if you have a health problem.

Mandatory reporting

In the last newsletter we explored the mandatory notification requirements on Education providers, health practitioners and their employers if they have formed a reasonable belief that a practitioner has behaved in a way that constitutes notifiable conduct. Section 140 of the Health Practitioner Regulation National Law (NSW) defines notifiable conduct. The Paramedicine Board of Australia has published guidelines for mandatory notifications to provide direction to health practitioners, employers and education providers about the requirements for mandatory reporting.

Further information

If there are any topics you would like covered in forthcoming newsletters please email us at HPCA-ParamedicineCouncil@health.nsw.gov.au.