By my count there were:
2 psychiatrists
1 psychologist
1 GP
1 mental health nurse
1 carer rep
1 consumer rep
4 mental health bodies
6 bureaucrats
At the meeting, this diverse range of stakeholders raised a multitude of views and concerns, particularly the lack of mental health consumer and carer input into private health network.
| Adjunct Assoc. Prof. Kim Ryan | CEO, Australian College of Mental Health Nurses |
| Professor Malcolm Hopwood | President, RANZCP |
| Professor Lyn Littlefield | Executive Director, Australian Psychological Society |
| Professor Morton Rawlin | Vice President, Royal Australian College of General Practitioners |
| Dr Bill Pring | Private Mental Health Alliance (PMHA), AMA Observer |
| Mr Frank Quinlan | CEO, Mental Health Australia |
| Ms Georgie Harman | CEO, Beyondblue |
| Ms Sue Murray | CEO, Suicide Prevention Australia |
| Ms Marita Cowie | CEO, Australian College of Rural & Remote Medicine |
| Mr David Meldrum | Executive Director, Mental Illness Fellowship of Australia |
| Mr David Butt | CEO, National Mental Health Commission |
| Ms Janet Meagher | Consumer representative National Mental Health Consumer and Carer Forum |
| Ms Eileen McDonald | Carer representative National Mental Health Consumer and Carer Forum |
| Mr Stephen Brand | Senior Manager, Policy & Advocacy Australian Association of Social Workers |
| Professor Tom Calma | Advisor Australian Government Department of Health |
| Ms Natasha Cole (Chair) | First Assistant Secretary, Health Services Division Australian Government Department of Health |
| Ms Colleen Krestensen | Assistant Secretary, Mental Health Reform Taskforce Australian Government Department of Health |
| Dr Anthony Millgate | Assistant Secretary, Mental Health Services Branch Australian Government Department of Health |
| Ms Emma Gleeson | Acting Assistant Secretary, Mental Health Early Intervention Branch Australian Government Department of Health |
AMA Psychiatry Newsletter April 2016; AMA Qld submission to the Office of the Health Ombudsman
The Office of the Health Ombudsman (OHO) was established by the Queensland Government in 2013 to strengthen the health complaints management system. It replaced the Health Quality and Complaints Commission (HQCC), an organisation that had been criticised for fundamental deficiencies in the way it handled complaints, as well as unjustified delays in dealing with complaints against medical practitioners. Plus ca change plus la meme chose!
Highlights:
I have written previously about the problems forensic psychiatrists have had with vexatious notifications to the Medical Board. Two of our colleagues had had four notifications each, three of them had been shown to have no merit but it appeared that four notifications required action and so the two psychiatrist had a practice visit from two other psychiatrist over a period of a day. I thought this was questionable with regard to ethical practice in particular the psychiatrist roared through all the medical records not just those to do with the notifications and apparently sat in on one or two interviews.
Complaints were made to the Medical Board of Victoria by our representatives and as you will see there has been dialogue with the AMA. Some information about this was provided in the April newsletter of the Medical Board of Australia. (See below)
Improving the notification process
Continuing our work on a fair and timely process
Senior leaders from the Board, AHPRA and the AMA met in February 2016 to look at ways in which doctors’ experience can be improved when a notification is made about them. This was the second workshop with the AMA about this. The first workshop was held 12 months ago.
There was positive feedback about changes we have made in the last 12 months to improve the experience of doctors involved in the regulatory process. Improvements include:
The workshop also explored what we are doing to support good regulatory decision-making including:
The Board and AHPRA agreed to explore how we can most usefully ask practitioners for feedback about their experience of the regulatory process when a notification has been made about them, so we can improve our processes.
There was also good discussion about how the experience of the National Scheme1 can better support the profession to deal with practitioners whose performance is not satisfactory.
The Board and AHPRA appreciate the AMA’s commitment to continuing to work constructively with us to improve the process for practitioners, in a fair way, with clear information.
The AMA has also published information about the workshop at A refined way to complain.
For more information about notifications, AHPRA has published guides for practitioners on the notifications process (performance assessments).
Western Australia is pressing ahead with its 2013 plan to replace the State Workers’ Compensation and Injury Management Act 1981 with a new statute, WorkCover WA has confirmed.
“The drafting of the Bill is a significant undertaking and is at a preliminary drafting stage with Parliamentary Counsel’s Office,” a spokesperson said yesterday.
The State Government has been quiet on the proposed laws since approving the drafting process in October 2014 .
The spokesperson confirmed that the new statute will be based on recommendations from WorkCover’s June 2014 report on the old Act, and the Government will consult broadly on the Bill before introducing it to Parliament.
“I cannot confirm when it will be introduced to Parliament at this stage,” he said.
WorkCover’s 171 recommendations included: replacing the “complex and highly prescriptive” 1981 Act with a new Act; redefining “worker” as “an ’employee’ for the purpose of assessment for Pay As You Go (PAYG) withholding” under Commonwealth taxation laws; enforcing whole person impairment thresholds for common law claims; and significantly increasing death benefits
The Workplace Injury Rehabilitation and Compensation Act (the WIRC Act) recasts the Accident Compensation Act 1985 ( the ACA Act) and the Accident Compensation (WorkCover Insurance) Act 1983 (ACWI Act) into a single Act that is simpler and easier to use.
This link gives you a table that indicates where the provisions of the Accident Compensation Act 1985 can be found in the Workplace Injury Rehabilitation and Compensation Act 2013 that became operational on 1 July 2014.
Of particular significance is section 91 (6) in the ACA Act that has been replaced with Section 64 (a) and (b) with regard to psychiatric impairment assessment.
There has been action on two fronts with regard to reviewing the current system of medical complaints. The Senate has established a wide ranging review (see below) and AHPRA has provided some insights into a KPMG independent review of that system and processes for managing notifications in Victoria. I reckon I could have written this in my coffee break. It includes such mind-boggling new ideas such as:
better risk assessment
Management of high-risk matters
greater transparency
culture
performance
You will notice that the item to do with “culture” refers to ” address perceptions of being pro-practitioner”. That has certainly not been our experience. Our experiences that you are guilty until proven innocent.
These are astonishing glimpses of the obvious. Go to the section below to read the full document.
On 2 February 2016, the Senate referred the following matter to the Senate Community Affairs References Committee for inquiry and report:
The medical complaints process in Australia.
The terms of reference are:
Submissions should be received by 13 May 2016. The reporting date is 23 June 2016.
Committee Secretary
Senate Standing Committees on Community Affairs
PO Box 6100
Parliament House
Canberra ACT 2600
Phone: +61 2 6277 3515
Fax: +61 2 6277 5829
community.affairs.sen@aph.gov.au
AHPRA has provided some insights into the findings of a KPMG independent review of its system and processes for managing notifications in Victoria.
The report recommends actions in five main areas, including a more systematic, data informed approach to risk assessing notifications:
I thought you might be interested to see 4 recently written papers
There have been a number of amendments to the Victorian Wrongs Act 1958 (Wrongs Act Amendment Act) that took effect on 2 December 2015. The major issue for us is with regard to psychiatric assessment. The threshold wording has been changed from “impairment of more than 10%” to “10% or more”. This applies to any climate to have been assessed before that date where the matter has not yet been finalised. Victorian forensic psychiatrists will be asked to submit a new certificate incorporating the changed wording. There are 5 changes in all of which the above is the only one relevant to us.
The NSW workers compensation guidelines for the evaluation of permanent impairment (4th edition) 1 April 2016 has just been released. It has been re-written to conform with the Safe Work Australia template. However there is no agreement by states using the GEPIC to use the PIRS and considering the disdain with which the PIRS and AMA6 are held together with the cost of training any such change is unlikely. The changes to the PIRS are as follows:
Psychiatric and Psychological disorders
Paragraph 11.4 from the 3rd edition, on the development of the PIRS has been removed to align to the Safe Work Australia national template guideline. The numbering therefore changes from 11.4 onwards (in comparison to the 3rd edition).
Clause Change
Introduction
Removed 3rd and 4th sentences that referenced s67 pain and suffering.
Removing the reference to s67 in this clause does not affect an exempt worker’s entitlement to claim for pain and suffering compensation. The reference to s67 in this clause was a case management tool which is now considered inappropriate in a medical guideline.
Co-morbidity
Removed the Alzheimer’s disease example. Replaced with a bi-polar disorder example.
11.10
Pre-existing impairment Minor change to second half of the paragraph for improved clarity, and to align with the wording in 1.28 in the Guidelines: Rephrased to:
The injured worker’s current level of WPI% is then assessed, and the pre-existing WPI% is subtracted from their current level, to obtain the percentage of permanent impairment directly attributable to the work-related injury. If the percentage of pre-existing impairment cannot be assessed, the deduction is 1/10th of the assessed WPI.
The recent NSW regulations, in particular 11(1)a has had an effect on the amount of work in NSW and increases the fee schedule for expert witnesses. I have included a commentary from McInnes Wilson Lawyers
(1) Costs are not to be included in an assessment or award of damages in respect of any expert witness giving evidence, or providing a report, on behalf of the claimant in relation to a claims assessment or in court proceedings under the Act, except for costs in respect of:
(a) one medical expert in any specialty (my emphasis) unless there is a substantial issue as to a matter referred to in section 58 (1) (d) of the Act
(1) This Part applies to a disagreement between a claimant and an insurer about any of the following matters (referred to in this Part as
“medical assessment matters” ):
(d) whether the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident is greater than 10%.
The Regulations retain the existing fee structure with respect to medical treatment and medico-legal services however, provide an increase on the maximum allowable fees.
With respect to medical treatment, Clause 19 states that an insurer is not required to pay beyond what is specified in the Australian Medical Association (‘AMA ’) List of Medical Services,
The maximum fees recoverable for medico-legal services are set out in Schedule 2. These are based on the Schedule of Suggested Fees for Medical xaminations and Reports which is determined by the Law society of NSW and the AMA. There is an increase in medico-legal fees to reflect current market rates. For example, a medico-legal report obtained from a specialist who has not previously treated the claimant and requires an examination has increased from $720 to $1,200. There is also an incentive for parties to obtain joint medico-legal reports by providing a higher recoverable fee (up to $1,600) in an attempt to reduce appointments for an injured claimant.
A further amendment contained within the Regulations is the inclusion of Clause 10(3) which states that the costs of obtaining an initial treating medical report cannot be claimed by an injured claimant’s practitioner if the insurer has already obtained a report and provided a copy to them. If, however, a request has been put in writing for a copy of the report, and the insurer has failed to provide same within a reasonable time, the cost of a second report can be claimed. This restriction does not extend to updated treating reports subsequent to the initial report.
Investigation Reports and Expert Witnesses
Clause 11 of the Regulations maintains the restriction on claiming costs related to expert witnesses and reports.
There is a presumption that only one medical expert in any specialty and two experts of any other kind can be included in an assessment or award of damages.