Our Health Program
The Council's Health Program is relatively small, representing less than 5 per cent of referrals to the Council. However it is an important aspect of our work and in keeping with our main priority, which is to ensure the protection of the public while ensuring doctors are fit to practise and able to deliver care safely.
Medical practitioners are not immune to physical illness which may impact on their fitness to practise. They may also have mental health issues such as severe depression or addiction to alcohol or other drugs. Apart from the general risk factors they share with the rest of the community, doctors are also exposed to particular risks as a result of the stresses and responsibilities of professional life; access to prescription drugs and the temptation to treat themselves.
The Health Program is designed to support doctors whose health is impaired through supervision and guidance, with the ultimate goal they return to full health
This example below (Dr X) illustrates how we manage notifications about impaired doctors and medical students and how we work with them while protecting the public.
What is an impaired medical practitioner or student?
'Impairment' is a term defined in the National Law.
A medical practitioner is considered to have an impairment if he or she has a condition that may detrimentally affect the capacity to practise medicine.
A medical student whose capacity to undertake clinical training is detrimentally affected by his or her health may also be considered impaired.
An impaired medical practitioner or medical student is usually the concern of the Council’s Health Program.
The Council's approach to an impaired practitioner will depend on the nature of the illness, the degree of insight displayed, any existing treatment program, and most importantly, any perceived risk to patients and others if the doctor continues to practise.
Similar considerations apply to students who may have contact with the public in the course of their clinical training.
How does our Health Program work?
How does the Council address an impairment in doctors?
Sometimes the Council receives a complaint or notification about a doctor which indicates there may be a risk that the doctor is impaired in a way that could impact their capacity to practise. This article explains the role of a Council appointed practitioner (CAP) assessment when impairment is considered a potential concern.
Who can attend a CAP assessment? Is this a disciplinary process?
Practitioners can be asked to see a Council appointed practitioner (CAP) when the nature of a complaint or notification suggests there is a risk of impairment. For example, a complaint or notification may indicate a doctor’s lack of awareness that they are making clinical errors or repeatedly confusing patients which raises questions of possible cognitive impairment. A medical practitioner is considered to have an impairment under the law if they have a condition that may detrimentally affect their capacity to practise medicine.
Practitioners asked to attend a CAP assessment are not being punished and this is not a disciplinary process. Instead, the focus is on obtaining more information about the doctor, their health and their ability to work safely.
Who are CAPs?
A CAP is an independent health practitioner who on behalf of the Medical Council makes an assessment of the existence, extent, and nature of an impairment. A CAP has comprehensive understanding of the Council’s programs. The CAP is not a treating practitioner for the doctor. All CAPs are specialists in their fields such as neuropsychologists, addiction psychiatrists and specialist psychiatrists, neurologists etc.
The role of the CAP is to determine whether a doctor has:
- a medical disorder, such as major Depression; Substance Abuse Disorder; Bipolar Disorder etc
- any deficits in their cognitive performance
- insight into these issues
- appropriate supports in place, such as treating practitioners, and
- whether the type of work they perform has been modified to compensate for these deficits.
These assessments are completed and compared with norms that reflect practitioners of similar age and training. The CAP will provide a report to the Medical Council with their findings and recommendations for the Council to consider. An example of this would be where the CAP recommends the practitioner find their own treating practitioner where they do not already have one, for example, a treating psychologist. Another example is where the CAP determines the doctor is impaired and should have conditions placed on their medical registration, ie to attend for Urine Drug screening (UDS) thrice weekly.
What happens next? Can the Medical Council disagree with the CAP’s recommendation?
The CAP will provide a report to the Council advising whether the practitioner is impaired under the definition of the National Law. It is important to note the CAP does not make a decision to impose conditions. This is the role of the Council’s delegates who also look at all the information available to them regarding a practitioner.
Where the CAP determines there is no impairment, the Council then considers whether any or no further action is taken.
Where the CAP determines the practitioner to be impaired, the CAP may recommend the Council places conditions on the practitioner’s registration with the intention of allowing them to practise safely such as private health conditions which may include the practitioner attending treating practitioners to assist them manage their own health.
Following objective testing, if an impairment is determined to be such that it is not currently safe for the practitioner to continue working (this may be temporary or ongoing) then the CAP will advise this finding for the Council to consider whether any further action is taken.
Conditions recommended by a CAP are frequently accepted by the Council who will then refer the doctor to an Impaired Registrants Panel Inquiry (IRP).
Impaired Registrants Panel Inquiry (IRP)
An Impaired Registrants Panel inquiry (IRP) is an informal inquiry where the practitioner meets with two to three Panel members to discuss the complaint/notification and the impairment. The inquiry is an opportunity for the practitioner to discuss the matter as well as any problems etc and generally takes three to five hours.
If the Panel agree the doctor has an impairment, the doctor will be requested to consider voluntarily agreeing to conditions on his registration. The Panel will then write a report for the Council.
If the Panel do not agree the doctor has an impairment, they will write a report for the Council to consider no further action or may recommend the Council refers the doctor to another stream, such as the performance stream.
What if I don’t agree to the conditions the CAP proposes?
Conditions proposed are not mandatory for practitioners to accept as the CAP assessment is not a disciplinary process. However, these conditions may be proposed (at an IRP) with the intention of keeping patients and the public safe as well as assisting the practitioner in taking care of their own health.
If an impaired practitioner lacks insight and does not acknowledge the need for some limitation on his or her practice, it may be necessary for the practitioner to attend a hearing convened under s150 of the National Law. At this hearing, the Council’s delegates will decide if it is necessary to take immediate action to protect the public, through the imposition of conditions or even suspension of the practitioner.
What type conditions may be placed on my registration?
The conditions placed on each practitioner are developed specifically for each individual situation, taking into account the concerns of Council and the type of work conducted by the doctor. However, broadly speaking, where a practitioner is experiencing a major depressive disorder, recommended private health conditions such as attending a treating GP and treating psychiatrist may be included. For practitioners with an addiction, they may have conditions requiring them to undergo periodic drug or alcohol screen testing as well as public practice conditions.
Are health conditions placed on practitioners shared with others or made public?
The Law requires the Council to notify Ahpra of any conditions placed on a practitioner’s registration. Health conditions are not published on Ahpra’s register due to privacy concerns. The Law also requires the Council to notify employers of all conditions imposed on a practitioner’s registration. However, health conditions are not made available to any other third party.
What is the best advice for practitioners facing a CAP assessment?
Council hearing members, program officers and doctors who have been through this process all recommend that practitioners who receive a complaint or notification contact their Medical Indemnity Insurer (MII) early for support. Doctors who undertake the process with the support of their MII frequently find it less stressful as they approach the assessment from a more informed position.
Guiding practitioners to recovery through monitoring
The Council’s Monitoring Team proactively monitors practitioners who are in the Health Program to ensure they are complying with their conditions. This may include drug testing, regular reviews or assessments. The practitioner is expected to comply fully with any conditions so as to assure the Council that they pose no risk to the public.
As the practitioner demonstrates evidence of progress in rehabilitation and recovery, the conditions on registration are gradually relaxed and/or removed. While a return to unconditional medical registration is a Health Program goal, a small number or practitioners, such as those with a recurring psychiatric illness, they may remain on the program indefinitely. They will be regularly reviewed by the Council Appointed Practitioner, the Impaired Registrants Panel and the Council.
What happens when a doctor breaches a Health Program condition?
If a doctor on the program who is wilfully and continually in breach of conditions, the Council may convene urgent section 150 proceedings which can result in a tightening of conditions or temporary suspension.
The Council may also refer the doctor to the Health Care Complaints Commission for investigation, which can lead to a prosecution in the NSW Civil and Administrative Tribunal. The Tribunal has the power to cancel a doctor’s medical registration.
Dr X - a Health Program case study
Dr X is a 60-year-old male GP who came to the attention of the Medical Council as a result of an investigation report by Pharmaceutical Services. The report indicated Dr X had written numerous prescriptions for pethidine in various patients’ names and that these prescriptions were for his own use.
In response, the Council initiated an urgent action to consider the need for immediate action under Section 150 of the National Health Regulation Law (NSW). As a result, the Council imposed a number of conditions on Dr X’s registration including that he be prohibited from prescribing, possessing and supplying any drug of addiction.
Dr X was also referred to an Impaired Registrants Panel which amended his conditions by requiring him to submit to urine drug screening and to attend for regular treatment of his drug dependency.
Thereafter Dr X joined the Health Program. Dr X engaged well with the program and remained compliant with his conditions over several years. Dr X reported that his involvement with the program allowed him to make major changes to his life and overcome his drug dependency.
Dr X reported that the support he received on the program was very helpful and the formal structure allowed him to keep working as a GP and doing what he loves. Dr X successfully exited the Council’s Health Program approximately three years after the initial notification.