Is our system for regulating health practitioners working?

Can we be confident that health practitioners are being regulated appropriately? If Tasmania is any indication the answer is a resounding ‘no’ and the regulators need to be acting quickly to fix this.

Tasmania is proving a cautionary tale showing the weaknesses in our national systems for regulating health professions such as doctors and nurses. Primary health practitioners and their employers need to be fully aware of the professional standards that apply. Practitioners need to be supported by their employers to meet their mandatory obligation to report any proscribed misconduct that they witness. Employers have their own separate reporting obligations.

The Australian Health Practitioner Regulation Agency (AHPRA), in partnership with its 15-national profession-specific Boards, oversee the scheme of regulation ‘to protect the public’.  Clearly, if Tasmania is anything to go by, the national scheme of regulation is not working adequately. The Tasmanian public is not being fully protected.

As the Tasmanian Commission of Inquiry (COI) into child sex abuse in institutional settings gets underway we are continuing to see more staff within the health, education and other public sectors being stood down for allegations of historical abuse against children. This suggests that our regulatory and professional monitoring systems, at both the State and national levels, are ineffective in the timely removal of abusers from settings where children are exposed. Some suspected perpetrators in Tasmanian institutions may have been able to escape accountability for decades in some instances. It would be devastating if we come to learn that some of our practitioners actively covered up the crimes of their peers. No doubt the truth will come out in consequence of the COI and its investigations, and we should not pre-empt the findings of the commissioners.

However, a system of regulation that allowed an alleged and long-suspected paedophile to work on the Children’s Ward in Launceston for almost 18 years is abjectly failing in its objective to keep the public safe. While the exact circumstances that permitted this is a key focus of the COI, any objective analysis could reasonably conclude that there is likely to be multiple systemic failures at all levels. We look to the COI to identify systemic failures so they can be fixed going forward, but regulators shouldn’t expect the commissioners to do their job for them. Regulators have their own statutory responsibilities to fulfil.

Unfortunately, it is increasingly clear that this was not an isolated incident, and not confined just to hospitals, as shown by the 16 public servants who have been stood down since the Inquiry was announced late last year.  While hospitals have been the focus to date, primary healthcare settings need to be increasingly vigilant and PHNs should consider what role they may have in helping practitioners and employers to understand and act on their mandatory reporting obligations to AHPRA.

Importantly other recent Royal Commissions have scrutinised regulatory bodies and noted clear deficiencies in how they operate.  No doubt in the current COI, the actions of regulators will be a major focus of the commissioners, and this is vital.

Regulators may be tempted to wait for the release of the final report of the COI before acting. However, the COI may take years to complete its important work, and during this time no-one should feel fully satisfied that the current scheme is protecting the public adequately.  The ongoing stream of public servants being stood down suggests that this is just the tip of a potentially larger iceberg. We need to consider the discomforting possibility that some abusers may remain working in full view in some of our healthcare settings.

We should be fully expectant that AHPRA and its local Boards, and other regulators, will now be engaging deeply with the Tasmanian Department of Health to work out what actions are needed to make the Tasmanian public safer from practitioners who engage in misconduct endangering their patients. Tasmania cannot afford to wait for the outcome of the Inquiry and the regulators need to be on the front foot with this.

We can also expect salutary lessons for the other jurisdictions.