New RANZCP guideline 11: Developing reports and conducting independent medical examinations in medico-legal settings

December 9, 2020

This document has been developed by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) to guide members who are preparing reports in medico-legal and/or forensic contexts. This includes reports based on independent medical examinations, and reports which are prepared for both civil and criminal matters. This guideline establishes a basic standard of practice and outlines the role of the psychiatrist when responding to a referral request for a report, along with best practice in conducting independent medical examinations, report writing and adherence to appropriate professional standards.

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NSW workers’ compensation scheme in disarray

January 12, 2020

Deteriorating performance of the NSW workers’ compensation scheme.

A review of the Nominal Insurer (NI) was commissioned in February 2019 to determine the reasons for deterioration in the NI performance. The final report was released in December 2019.

A report in the Australian Financial Review in September 2019 highlighted the problems.

The sustainability of the NSW workers compensation Nominal Insurer, which insures 3.6 million employees and collects over $2 billion in premiums a year, is in jeopardy according to Peter McCarthy the former workers compensation principal actuarial adviser to the State Insurance Regulatory Authority (SIRA).”I have been advising or working in personal injuries schemes like icare around Australia and overseas for nearly 35 years and I have never seen a scheme deteriorate as much in such a short time frame,” Mr McCarthy told The Australian Financial Review.

In Mr McCarthy’s view, if the scheme went into deficit, employer premiums would have to increase by between 45 and 60 per cent.

In addition to workers compensation, the $36 billion icare also insures builders and homeowners, provides treatment and care to those severely injured on NSW roads and protects over $193 billion of NSW Government assets.  Workers compensation accounts for about 50 to 60 per cent of what icare does.

The company’s chief executive John Nagle rejected that the scheme was falling into disrepair.

However Mr McCarthy pointed to icare’s 2018 financial year results, which showed a blowout in the number of impaired premiums.

Impaired premiums increased by over $50 million from the 2017 to 2018 financial year, up from $35 million to $87 million. Further, as of the 2018 financial year there were $226 million in overdue premiums sitting on icare’s books, an increase from $39 million in 2015.

NSW Treasurer Dominic Perrottet said the Labor government had left the state’s workers compensation scheme facing a $4 billion deficit. “We have done the hard yards to repair their damage and provide financial stability, and icare’s board and management have been instrumental in this.”

Concerns over rising costs

Observers concerned with the health of the scheme also point to rising costs. According to a libaility valuation commissioned by icare in 2018 had a $1.3 billion surplus for the scheme. However, two years prior at June 30, 2016, a liability valuation by PwC estimated assets of $17.9 billion and liabilities of $14.6 billion, a surplus of $3.4 billion.

Medical costs for icare had risen by 40 per cent combined over the past four years. Mr Nagle said “we don’t control some medical costs as they are regulated.”

Data from the regulator showed that icare’s medical costs between the 2016 and 2018 financial years increased significantly more than those for specialised and self-insurers, and the Treasury Managed Fund.

icare’s return to work rate, which points to the speed at which injured workers get healthy and back to work, has fallen according to both SIRA data and icare data, although the degree varies. A major problem is that the definition of return to work differs between SIRA and icare.

SIRA has had concerns about whether injured workers were getting the right level of early support to assist in recovery, and whether premiums were being administered in a compliant, transparent and consistent way.

An overview of the executive summary

 

In 2015 NSW WorkCover was replaced by:

1. State Insurance Regulatory Authority (SIRA) –a new independent regulator of NSW insurance schemes (worker compensation, home building compensation and compulsory third party). SIRA was to oversee the Notional Insurer.
2. b) Insurance & Care NSW (icare) –an insurance and care service Icare is the responsible entity for the NI.
3. c) SafeWork NSW –an independent workplace safety regulator.

 

SIRA has had limited ability to enforce guidelines and standards or direct icare.

Icare  implemented an ambitious model based on principles of triage, injured worker empowerment and straight through processing in January 2018. There is now one insurance agent for all new claims (EML).

 

The ambition of the model was matched by the ambition of the timeframe for implementation and the control by icare over EML. This has caused substantial confusion within the market and employers in particular, have complained about the lack of involvement in return to work (RTW) plans and claims verification. The new claims model has led to a significant deterioration in the performance of the NI, through poorer return to work rates, underwriting losses, no competition and therefore, concentration of risk.

 

The primary driver for the decline is the implementation and operation of the new claims model implemented by icare. icare has implemented a number of improvements to improve the performance of the NI. They have not reversed the decline.

 

The reviewer noted that an icare Board report shows that 46% of the NI’s claims are non-compliant with the legislation, and that icare considers this non-compliance as a lower order risk. This approach to compliance seems to indicate an absence of concern with regulatory matters.

Concerns were expressed in the submissions about lack of information about premiums, including reasons for marked increases, delayed or no response to queries and a call centre dealing with initial claims contributing to further delays, lack of proactive case management, inconsistent approach and errors, as well as lost paperwork. The outcome of this approach is seen as promoting reactive case management, poor communications and a lack of accountability.

Concerns were expressed about relevant case manager experience and skill levels,as well as a lack of understanding of workers compensation legislation/operations. Inappropriate hiring, inexperience and high staff turnover were all raised as issues. Positive comments were made about the motivations and attitudes of some individual staff

High caseload volume and inadequate resourcing were mentioned as adversely effecting the operation of the scheme. These issues were often connected with other issues of claims model design, communication, delays and RTW outcomes.

The single issue raised most commonly across claims submissions related to communication. The quality, frequency and clarity of communication from the NI and its agents was consistently seen by all stakeholders as an issue to be addressed. These communication issues were viewed as leading to delays, confusion, worse outcomes and increased frustration between participants.

Submissions specifically mentioned experiencing delays in obtaining approval and delaying required or agreed treatment.

The 2019 NI RTW rate has deteriorated to 84% from 93% in 2018 and 96% in 2016.This rate measures the percentage of injured workers who report having returned to work at any time.

The current NI RTW rate measured by a survey has reduced to 73% 83% in the 2018 NI RTWSurvey.

Many complained about the shift to the single scheme agent and the loss of choice and competition within the scheme. This had caused a deterioration in claims management as well as a depletion of the broader pool of experience of claims managers in the NSW workers compensation system.

The Medical Support Panel was thought to be completely unnecessary, creating more delays… The MSP process required multiple levels of internal review at EML, unacceptable MSP responses and further delays which effected the worker’s recovery and the employer’s premium.’

The review did not cover matters around medical treatment in any detail because the pre-eminent concerns raised were about delays to treatment caused by poor claims management. There were some concerns expressed about lack of choice and independent medical examiners, but this was regarded as a result of poor execution rather than an inherent problem with the new claims model.

 

 

 

 

 

Posted in news, Review of schemes, written by Michael Epstein | No Comments »

How do we psychiatrists stand re demographics and ‘offending’ Medical Board of Australia Report December 2019

December 28, 2019

i have been perusing the Annual Report of the Medical Board of Australia. The data in the report is worth mining. for comparison I have attached similar data regarding psychologists.

• There are 119,926 medical practitioners registered in Australia of whom 4,027 are psychiatrists.
• The psychiatrist/ population ratio varies between South Australia 1:5650 to Northern territory 1:9107 and the Australia wide ratio is 1:6298.
• The gender ration is female to male 41.1 – 58.9.

Notifications of medical practitioners to the Medical Board of Australia

 

• 6,970 notifications 2018/2019 = 5.9% of the workforce, 4801 notifications closed, no further action 73.8% (3,543) leaving 1,258 about which action was taken.

 

Medical Board of Australia – Registrant data
Medical practitioners made up 16% of all health practitioners registered nationally (118,996 individual registered (2018/2019) medical practitioners in 2018/19; up from 115,113 in 2017/18).   Reporting period: 01 July 2019 to 30 September 2019
Table 1.1 Medical practitioners – registration type by state or territory Registration types Registration subtypes ACT NSW NT QLD SA TAS VIC WA No PPP Total General 802 12,966 596 8,560 2,754 769 10,008 4,195 914 41,564 General (Teaching and Assessing) 10 12 1 3 11 2 39 General (Teaching and Assessing) and Specialist 1 1 General and Specialist 1,034 18,035 544 10,863 4,329 1,221 14,699 4,954 780 56,459 Specialist 200 2,273 131 2,580 635 249 2,214 1,584 552 10,418 Provisional 123 1,541 91 1,333 448 108 1,407 768 89 5,908 Limited Area of need 4 53 18 79 27 24 213 70 2 490 Postgraduate training or supervised practice 35 703 21 275 182 96 495 199 38 2,044 Public interest 0 Teaching or research 11 5 2 10 4 3 35 Non-practising 30 759 9 306 157 52 554 201 900 2,968 Total 2,228 36,352 1,410 24,013 8,535 2,522 29,611 11,977 3,278 119,926
Table 3.2 Medical practitioners – by age group
Table 4.2 Medical practitioners – percentage by gender Gender ACT NSW NT QLD SA TAS VIC WA No PPP Total Female 47.2% 43.5% 50.7% 42.1% 42.8% 43.5% 44.2% 44.4% 40.3% 43.5% Male 52.8% 56.5% 49.3% 57.9% 57.2% 56.5% 55.8% 55.6% 59.7% 56.5% Not stated or Intersex or Indeterminate <0.1% <0.1% <0.1%
Table 4.3 Medical practitioners – by area of specialist practice by gender Speciality name Female Male Not stated or Intersex or Indeterminate Addiction medicine 27.3% 72.7% Anaesthesia 32.0% 68.0% Dermatology 47.3% 52.7% Emergency medicine 36.0% 64.0% General practice 43.2% 56.8% Intensive care medicine 20.3% 79.7% Medical administration 33.7% 66.0% 0.3% Obstetrics and gynaecology 49.4% 50.6% Occupational and environmental medicine 20.5% 79.5% Ophthalmology 23.0% 77.0% Paediatrics and child health 52.7% 47.3% Pain medicine 25.7% 74.3% Palliative medicine 59.8% 40.2% Pathology 44.3% 55.7% Physician 32.1% 67.9% Psychiatry 41.1% 58.9% Public health medicine 42.2% 57.8% Radiation Oncology 43.1% 56.9% Radiology 27.3% 72.7% Rehabilitation medicine 48.6% 51.4% Sexual health medicine 57.6% 42.4% Sport and exercise medicine 23.0% 77.0% Surgery 12.2% 87.8% Grand Total 37.0% 63.0% 0.0%   Level of compliance with standards 96.8% compliant: fully compliant with the registration standards 0.9% compliant (education): compliant through education in one or more standards 0.2% non-compliant: non-compliant with one or more standards 2.2% no audit action required: during the audit period, practitioners changed their registration type to non-practising, elected to surrender their registration or failed to renew their registration

Specialty	ACT	NSW	NT	QLD	SA	TAS	VIC	WA	AUST
Psychiatrists	74	1174	27	803	310	76	1106	368	4027
Population	426,700	8,089.500	245,900	5,095,100	1,751,700	534,300	6,594,800	2,621,700	25,364,000
Ratio	1:5766	1:6890	1:9107	1:6245	1:5650	1:7030	1:5962	1:7124	1:6298

Ratio of Psychiatrist to Population by State and Territory

Medical Practitioner notifications

• 5,359 notifications lodged with AHPRA
  • 10 notifications were made about students
• Australia-wide, including Health Professional Councils Authority (HPCA) in NSW and Office of the Health Ombudsman (OHO) in Queensland data, 6,970 registered medical practitioners – or 5.9% – had notifications made about them
• 4,801 notifications were closed
  • 5.8% had conditions imposed on registration or an undertaking accepted
  • 3.6% received a caution or reprimand
  • 0.5% registration suspended or cancelled
  • 0.1% fined
  • 16.1% referred to another body or retained by a health complaints entity (HCE)
  • 73.8% no further action taken
• Immediate action taken 170 times
• 339 mandatory notifications received
  • 234 about professional standards
• 895 medical practitioners monitored for health, performance and/or conduct during the year
• 1,043 cases were being monitored at 30 June
  • 104 on the grounds of conduct
  • 182 for health reasons
  • 207 for performance
  • 77 prohibited practitioner/student
  • 473 for suitability/eligibility for registration
• 160 criminal offence complaints were made and 143 closed
  • 83 new matters related to title protection
  • 3 to directing or inciting unprofessional conduct or professional misconduct
  • 68 to advertising breaches
  • 6 to other offences
• Matters decided by a tribunal: 55
• Matters decided by a panel: 22
• Decisions appealed: 30

Most common type of complaint

 

Clinical care	Medication	Communication	Behaviour	Documentation	Other
56.2%	10.2%	6.1%	5.2%	4.8%	17.6%

 

Sources of Notifications

 

Patient, relative or member of the public	Health complaints entity HCE(see below)	Other practitioner	Board’s initiative	Employer	Other
60.5%	20.7%	7.7%	2.0%	1.8%	7.3%

 

From the AHPRA website

 

Under the National Law, AHPRA works with health complaints organisations in each state and territory, to decide which organisation should take responsibility for and manage the concern raised about a registered health practitioner. See: www.ahpra.gov.au/Notifications/Further-information/Health-complaints-organisations.aspx

 

What is a ‘Mandatory Notification’?

According to the Medical Board of Australia website

 

Mandatory Notification

All registered health practitioners have a professional and ethical obligation to protect and promote public health and safe healthcare.

 Health practitioners and their employers, as well as education providers, also have mandatory reporting responsibilities under the National Law.

Education providers, registered health practitioners and their employers must tell us if they have formed a reasonable belief that a registered health practitioner has behaved in a way that constitutes notifiable conduct.

Notifiable conduct by registered health practitioners is defined as:

• practising while intoxicated by alcohol or drugs 
• sexual misconduct in the practice of the profession 
• placing the public at risk of substantial harm because of an impairment (health issue), or 
• placing the public at risk because of a significant departure from accepted professional standards.

The threshold for a person or organisation to make a mandatory notification is high. This means they need to have a reasonable belief that a practitioner has behaved in a way that constitutes notifiable conduct and that their belief is based on reasonable grounds.

Mandatory reporting exceptions for health practitioners

There are specific exceptions to mandatory reporting for all practitioners in Australia that relate to the circumstances in which the ‘reasonable belief’ is formed, for example in the medico-legal context.

In Western Australia, there is no legal obligation for treating health practitioners to make mandatory notifications (raise concerns) about patients (or clients) who are also health practitioners in one of the regulated health professions.

 

 

Comparing this data with that for Psychologists

Psychology board 2018/2019

• 37,783 psychologists
• Up 3.9% from 2017/18
• 5.1% of all registered health practitioners
• 0.6% identified as Aboriginal and/or Torres Strait Islander
• 80.0% female; 20.0% male
• 535 notifications lodged with AHPRA1
• Australia-wide, including Health Professional Councils Authority (HPCA) in NSW and Office of the Health Ombudsman (OHO) in Queensland data, 741 registered psychologists – or 2.0% – had notifications made about them
• 518 notifications closed
  • 10.0% had conditions imposed on registration or an undertaking accepted
  • 10.8% received a caution or reprimand
  • 1.2% registration suspended or cancelled
  • 8.5% referred to another body or retained by a health complaints entity (HCE)
  • 0.2% surrendered registration
  • 69.3% no further action taken
• Immediate action taken 20 times
• 69 mandatory notifications received
  • 50 about professional standards
• 142 psychologists monitored for health, performance and/or conduct during the year
• 144 cases were being monitored at 30 June
  • 28 on grounds of conduct
  • 16 for health reasons
  • 31 for performance
  • 18 prohibited practitioner/student
  • 51 for suitability/eligibility for registration
• 123 criminal offence complaints were made and 109 closed
  • 105 new matters related to title protection
  • 3 to practice protection
  • 13 to advertising breaches
  • 2 to other offences
• Matters decided by a tribunal: 13
• Matters decided by a panel: 3
• Decisions appealed: 5

Most common types of complaints

Clinical care	Documentation	Confidentiality	Communication	Behaviour	Other
24.7%	12.7%	11.0%	10.7%	10.3%	30.7%

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How much ‘offending’ Medical Board of Australia Report December 2019

The Medical Board of Australia statistics for the last quarter of 2019 make for interesting reading.  In particular workforce distribution, overall ratio psychiatrists vs general population is 1: 5635

The lowest ratio is the ACT with 1:5000, the highest ration is in the Northern Territory 1:8562. The other interesting data is about notifications.  Out of a total medical workforce of 119,926 there were 5359 (4.5%) notifications in 2018/2019, of which 27% lead to

 

Medical Board of Australia – Registrant data

Reporting period: 01 July 2019 to 30 September 2019

Table 1.1 Medical practitioners – registration type by state or territory Registration types Registration subtypes ACT NSW NT QLD SA TAS VIC WA No PPP Total General 802 12,966 596 8,560 2,754 769 10,008 4,195 914 41,564 General (Teaching and Assessing) 10 12 1 3 11 2 39 General (Teaching and Assessing) and Specialist 1 1 General and Specialist 1,034 18,035 544 10,863 4,329 1,221 14,699 4,954 780 56,459 Specialist 200 2,273 131 2,580 635 249 2,214 1,584 552 10,418 Provisional 123 1,541 91 1,333 448 108 1,407 768 89 5,908 Limited Area of need 4 53 18 79 27 24 213 70 2 490 Postgraduate training or supervised practice 35 703 21 275 182 96 495 199 38 2,044 Public interest 0 Teaching or research 11 5 2 10 4 3 35 Non-practising 30 759 9 306 157 52 554 201 900 2,968 Total 2,228 36,352 1,410 24,013 8,535 2,522 29,611 11,977 3,278 119,926

Speciality name

Field of specialty practice

ACT

NSW

NT

QLD

SA

TAS

VIC

WA

No PPP

Total

Psychiatry

74

1,174

27

803

310

76

1,106

368

89

4,027

Population Ratio psychiatrists vs population

366,900 1:5000

7,317,500 1:6,232

231,200 1:8562

4,599,400 1:5728

1.658.800 1:5,351

511,000 1:6724

5,640,900 1:5100

2.366.900 1:6431

22,692,600 1:5635

Medical Practitioner notifications

• 5359 notifications 2018/2019 = 4.5% of the workforce
• 27% of notifications lead to further regulatory action = 1446 or 1.2% of the workforce
• Of this cohort of 1446, there was no action taken in 73.8% i.e. 1067

 

Amongst the 5359 notifications

 

339 were mandatory notifications

234 were notifications re professional standards

169 were complaints against medical practitioners re criminal offences, almost 95% related to title and practice protection

 

What is a ‘Mandatory Notification’?

According to the Medical Board of Australia website

 

Mandatory Notification

All registered health practitioners have a professional and ethical obligation to protect and promote public health and safe healthcare.

 Health practitioners and their employers, as well as education providers, also have mandatory reporting responsibilities under the National Law.

Education providers, registered health practitioners and their employers must tell us if they have formed a reasonable belief that a registered health practitioner has behaved in a way that constitutes notifiable conduct.

Notifiable conduct by registered health practitioners is defined as:

• practising while intoxicated by alcohol or drugs 
• sexual misconduct in the practice of the profession 
• placing the public at risk of substantial harm because of an impairment (health issue), or 
• placing the public at risk because of a significant departure from accepted professional standards.

The threshold for a person or organisation to make a mandatory notification is high. This means they need to have a reasonable belief that a practitioner has behaved in a way that constitutes notifiable conduct and that their belief is based on reasonable grounds.

Mandatory reporting exceptions for health practitioners

There are specific exceptions to mandatory reporting for all practitioners in Australia that relate to the circumstances in which the ‘reasonable belief’ is formed, for example in the medico-legal context.

In Western Australia, there is no legal obligation for treating health practitioners to make mandatory notifications (raise concerns) about patients (or clients) who are also health practitioners in one of the regulated health professions.

 

 

On 170 occasions immediate action was taken by the Medical Board to restrict or suspend the registration of a medical practitioner as an interim measure.

 

Of the 1446, 5.8% conditions on registration        = 84

3.6% caution or reprimand                                          = 52

0.5% cancellation or suspension of registration   =   7 (0.005% of all medical practitioners)

 

Comparing this data with that for Psychologists

Speciality name	Field of specialty practice	ACT	NSW	NT	QLD	SA	TAS	VIC	WA	No PPP	Total
PSYCHIATRY		74	1174	27	803	310	76	1106	368	89	4027

Psychology board 2018/2019 statistics

• 37,783 psychologists
• Up 3.9% from 2017/18
• 5.1% of all registered health practitioners
• 0.6% identified as Aboriginal and/or Torres Strait Islander
• 80.0% female; 20.0% male
• 535 notifications lodged with AHPRA1
• Australia-wide, including Health Professional Councils Authority (HPCA) in NSW and Office of the Health Ombudsman (OHO) in Queensland data, 741 registered psychologists – or 2.0% – had notifications made about them
• 518 notifications closed
  • 10.0% had conditions imposed on registration or an undertaking accepted
  • 10.8% received a caution or reprimand
  • 1.2% registration suspended or cancelled
  • 8.5% referred to another body or retained by a health complaints entity (HCE)
  • 0.2% surrendered registration
  • 69.3% no further action taken
• Immediate action taken 20 times
• 69 mandatory notifications received
  • 50 about professional standards
• 142 psychologists monitored for health, performance and/or conduct during the year
• 144 cases were being monitored at 30 June
  • 28 on grounds of conduct
  • 16 for health reasons
  • 31 for performance
  • 18 prohibited practitioner/student
  • 51 for suitability/eligibility for registration
• 123 criminal offence complaints were made and 109 closed
  • 105 new matters related to title protection
  • 3 to practice protection
  • 13 to advertising breaches
  • 2 to other offences
• Matters decided by a tribunal: 13
• Matters decided by a panel: 3
• Decisions appealed: 5

Most common types of complaints

Clinical care	Documentation	Confidentiality	Communication	Behaviour	Other
24.7%	12.7%	11.0%	10.7%	10.3%	30.7%

 

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Workshop in late August re Family Court Reports

May 26, 2019

Bob Adler, a very experienced child psychiatrist is running a 2 day workshop in late August for those interested in learning more about Family Court work including writing reports.  He will be assisted by Professor Mushin, a retired Family Court judge.  This will be a very valuable training experience.

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Instructions on language from WorkSafe Victoria

May 21, 2018

In its most recent communication WorkSafe Victoria has advised IMEs about appropriate use of “gendered” language.   I make no commentary other than to note the threat if you do not comply.  Who would be an IME?.

The full document reads as follows.

Gendered language

WorkSafe has developed a guide for IMEs about the appropriate use of gendered language.

Binary male/female language expressed through gender specific terms, such as husband/wife, and gendered pronouns, such as he/she, do not always appropriately reflect our community diversity.

The Guide

This document provides Independent Medical Examiners (IMEs) with a guide to the appropriate use of gendered language.

Binary male/female language, expressed through the use of gender specific terms, such as husband/wife, and gendered pronouns, such as he/she, do not always appropriately reflect the diversity of our community.

What does it mean to misgender a person?

The Victorian Government’s Inclusive Language Guide defines misgendering as:

Using language to refer to a person that is not aligned with how that person identifies their own gender or body. Most but not all intersex and trans people who identify as male prefer to be referred to as ‘he’. Most but not all intersex and trans people who identify as female prefer to be referred to as ‘she’. Some people prefer to be described with their first name only or a non-binary pronoun such as ‘they’ rather than a gendered pronoun.

To avoid misgendering, the use of gender-neutral pronouns such as they, them or their may be more appropriate in some circumstances. Gender-neutral pronouns, such as ‘zie’ and ‘hir’, may also be used. Most importantly, pronouns used should align with those requested by the person and should be used consistently. If you are unsure, respectfully ask the person what their preferred pronoun is and ensure that you use this pronoun when communicating.

Misgendering of a person may amount to a breach of the IME Service Standards. Please refer to ‘Conduct during examination’ in the IME Service Standards for more information.

November 2017

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WorkSafe Victoria- dialogue with psychiatrists II – another bit of chicanery

March 13, 2018

During 2017 WorkSafe Victoria invited the Victorian committee of the College Faculty of Forensic Psychiatry to meet and discuss a number of issues including who should do IME work, documentation, questions asked, timing, security, and even fees. We had two meetings, I posted my thoughts at that time, they proved to be prescient! We were to have another meeting in July that did not proceed and we heard nothing further.

All IMEs then received a document  dated 31 January, 2018 that included several attachments.

Dear IMEs,
At WorkSafe we are looking for better ways to work with our IME’s.
It is important to us that you are kept up to date with relevant and useful information to support you in your roles as IME’s with WorkSafe.
Strategic Communications
Firstly, we are trying a different approach to the  way that we will communicate with you to keep you informed about important updates through our IME Insight.
In this issue:

• Mental Injury claims and the updated questions for Psych IME’s (see attachments)
  · Conflict of Interest: Have you got the processes in place to mitigate Conflict of Interest?
  · Recruitment Process (Update of the waves & dates)

We want to hear from you
Have ideas or feedback on how we can support you in your roles or to let us know if this type of update is useful, please contact independent_medical_examiner@worksafe.vic.gov.au
(See attached file: IME newsletter – issues one – jan 18.pdf)(See attached file: New Mental Injury IME Question Effective 18 December 2017.docx)(See attached file: New Mental Injury Questions A Guide for Practitioners V1 Dec 2017.docx)(See attached file: New-IME-Mental-Injury-Questions-IME-Coms V3 2018 (002).png)
Kind Regards
WorkSafe IME Provider Engagement Team

One attachment was the newsletter called ‘IME Insight’ dated 1 January 2018, a one-page document stating that there were new mental Mental injury questions

Another was “the New Mental Injury IME Questions” of which there are eight questions but so many sub- questions that in all there are a total 36 questions. There is also a guide to these questions, These questions in this guide were developed by the following:

Karen Chapman | Project Co-ordinator

Chris Lyons | Provider and Quality Co-ordinator

Dielle Felman  | Consultant Psychiatrist MBBS (Hons), MPM, FRANZCP

Dr Felman was placed in a difficult position.  She was asked to give advice about these questions but had no involvement with the Forensic faculty committee and was essentially speaking for herself.

The chair of the forensic faculty Victorian committee then contacted Lisa Boyd,who had been running the process and was told “We are looking for a very broad-based approach to liaising with psychiatry”; having the Forensic Faculty as the point of liaison does not seem to fit with this!

So much for consultation – Not happy Worksafe. It is consistent with my experiences with WorkSafe extending over 25 years.  I have been a member of the AMA VWA/TAC committee during much of this time and it is the same old story, bullshit consultation (to tick the box) and on they go doing what they intended doing all along.  I have decided to not re-apply to be an IME.

Posted in Issues, news, written by Michael Epstein | No Comments »

Safe Work Australia – a useful guide to nationwide trends

October 12, 2017

I try to look at the website of Safe Work Australia because it is full of information about nationwide issues and issues in particular states. There is a comparison of the various workers compensation schemes in the different states and a plethora  of statistical information. It is well worth a look.

For example they are attempting to develop a nationwide system of impairment assessment (including the PIRS)

Permanent impairment

When someone sustains an injury it may result in a permanent impairment.

A prerequisite to determining the level of permanent impairment is the understanding that it shouldn’t be decided until the claimant has improved as much as is possible; that is when their impairment has become stable or isn’t likely to improve despite medical treatment.

• In addition to the assessment principles laid out in the AMA Guides, scheme legislation also provides substantial guidance on how to determine whether or not impairment is permanent.

In 2013, we made recommendations to the Ministerial Council on nationally consistent arrangements to assess permanent impairment, which were agreed to by the majority of jurisdictions in early-2014.

As a result we are now developing a national permanent impairment guide and a system for updating it, as well as developing a training package for medical practitioners who want to become permanent impairment assessors.

 

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Workers’ compensation statistics Australia 2014-2015

April 13, 2017

The most recent Worker’s compensation statistics were released by Safe Work Australia in early 2017. The three industries with the highest number of serious claims were labourers, community and personal service workers and machinery operators and drivers.
A serious claim is an accepted workers’ compensation claim for an incapacity that results in a total absence from work of one working week or more. Claims in receipt of common-law payments are also included. Claims arising from a journey to or from work or during a recess period are not compensable in all jurisdictions and are excluded.

Surprisingly there is no mention of claims for “stress” or mental injury recorded in the summary, buried within the document is the following;

Diseases led to 10 per cent of serious claims and the most common diseases were mental disorders (5.7 per cent).

A higher percentage of female employees’ serious claims arose from mental disorders (over 9 per cent for females versus just under 4 per cent for male employees).

Mental stress accounted for 5 750 claims, some 5.4% of the total number of claims. Mental stress as apercentage of total claims has been consistent for many years

Number of serious claims by nature of injury or disease, 2000–01 and 2009-10 to 2014–15p

Nature of injury or disease	2000-01	2009-10	2010-11	2011-12	2012-13	2013-14	% chg	2014-15p
Mental disorders	6 620	8 095	8 735	8 355	7 680	6 685	1%	6 130

 

Serious claims: median time lost (working weeks) and compensation paid by mechanism of injury or disease, 2000−01 and 2009–10 to 2013–14

Mechanism of injury or disease	2000-01	2009-10	2010-11	2011-12	2012-13	2013-14	% chg
Mental stress 11.4 15.2 16.6 16.6 16.5 16.0 40% Mechanism of injury or disease 2000-01 2009-10 2010-11 2011-12 2012-13 2013-14 % chg Median compensation ($) Mental stress $14 500 $24 200 $26 200 $26 600 $27 200 $26 400 82%

Summary of statistics
 Preliminary data show that there were 107 355 serious workers’ compensation claims in 2014–15, which equates to 6.5 serious claims per million hours worked.
 Between 2000–01 and 2013–14, the frequency rate of serious claims fell by 33 per cent from 9.5 serious claims per million hours worked to 6.3.
 In 2014–15, the frequency rate for male employees was 7.2 serious claims per million hours worked, while the frequency rate for female employees was 5.5.
 In 2014–15, the three occupations with the highest number of serious claims per million hours worked were Labourers (18.6), Community and personal serviceworkers (12.4), and Machinery operators and drivers (11.8).
 In 2014–15, the three industries with the highest number of serious claims per million hours worked were Agriculture, forestry and fishing (13.7),

Construction (9.8) and Manufacturing (9.3).
 In 2014-15, injury and musculoskeletal disorders led to 90 per cent of serious claims and the most common were Traumatic joint/ligament and muscle/tendon injuries (43.8 per cent). Diseases led to 10 per cent of serious claims and the most common were Mental disorders (5.7 per cent).
 Muscular stress while lifting or handling objects caused 32 per cent of serious claims in 2014–15, while Falls, trips and slips led to 23 per cent of serious claims.
 Between 2000–01 and 2013–14, the median time lost for a serious claim rose by 33 per cent from 4.2 working weeks to 5.6. In 2013–14, the median time lost for a serious claim was 5.4 working weeks for male employees and 6.0 working weeks for female employees.
 Between 2000–01 and 2013–14, the median compensation paid for a serious claim rose by 94 per cent from $5 200 to $10 100. In 2013–14, the

median compensation paid for a serious claim was $10 900 for male employees and $8 900 for female employees. When accounting for wage inflation, however, median compensation paid for serious claims increased by 23 per cent between 2000–01 and 2013–14, directly comparable with the increase in median time lost.
 In 2014–15, the bodily location most commonly affected by injuries and diseases that led to serious claims was the Back (21 per cent). Other common bodily locations were the Hand, fingers and thumb (13 per cent), Shoulder (11 per cent), and Knee (10 per cent).
 The rate of serious claims per 1000 employees is highest in metropolitan areas (10.6 claims per 1000 employees)
 Between 2009-10 and 2014-15, 69 per cent of serious claims in Agriculture, forestry and fishing occurred in regional areas, while 61 per cent of serious claims in Mining occurred in regional and remote areas. In the same period, 85 per cent of serious claims in Finance and insurance services occurred in metropolitan areas.
 Human agencies were the most common breakdown agency for serious claims in metropolitan (13 per cent of all claims) and regional areas (13 per cent), while Outdoor environment (16 per cent of claims) and Road transport (13 per cent) where the most common breakdown agencies in remote areas.

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Senate Inquiry into complaints mechanism administered under the Health Practitioner Regulation National Law

January 16, 2017

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Victoria – TAC has developed a website for ‘health care providers”

December 9, 2016

The TAC has developed a useful website for ‘health care providers”.

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Doctor fights back against Internet Troll

September 29, 2016

We are familiar with various websites that rate those who do independent medical examinations. Some of these posts are incorrect and indeed defamatory.

Here is an example of comments from the workcovervictimsdiary Website.

Those IMEs who totally disregard honesty should be eliminated from the process. Consider having the state refer to an IME doctor rather than the insurer and the whole attitude towards fairness and honesty would likely improve

 Get rid of the (few) nutters doing most of the IMEs. If an IME doctor loses a certain amount of cases then don’t allow them to undertake more IME examinations. The reason these IMEs don’t succeed is because they are either wrong incompetent, dishonest or all three

Dr Alan Jager has sent us a post about a successful application to shut down such a website.  It makes interesting reading

Al Muderis v Duncan [2016] NSWSC 1363 saw the applicant, an orthopaedic surgeon, make an interlocutory application to to restrain the continued publication on the internet of material he alleges is defamatory of him. The defendant had not responded to correspondence and was not represented at the interlocutory hearing.

The application arose against the background of a complaint by a patient to the Health Care Complaints Commission, which was dismissed. A medical negligence claim was also made and dismissed.

Later the patient pleaded guilty to offences of intimidation and using a carriage service to harass, menace or offend. He was convicted and sentenced to four months imprisonment suspended on conditions. An apprehended violence order was made prohibiting the patient from assaulting, molesting, harassing or threatening the doctor, engaging in any other conduct that intimidates him, or stalking him. The AVO made specific reference to operation of a website.

The court made orders as requested by the medical practitioner, including an order directed to the website host registration entity. The website now appears to have been taken down.

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Victorian ombudsman damning of work safe agents and some IMEs

September 20, 2016

The Victorian Ombudsman has released a report regarding an “Investigation into the management of complex workers compensation claims and WorkSafe oversight”

 

This report is very critical of practices of WorkCover agent’s particularly with regard to doctor shopping and is unsparing in its criticism of certain IMEs in particular with regard to their bias and poor quality reports. The report is a damning with regard to actions taken by work safe about IME reports that are inadequate. Based on the reports the following recommendations relevant to psychiatrist were made. A copy of the full report is available in publications and a summary is also available.

 

Recommendation 14

Implement changes to the current IME system to:

1. prevent agents from selectively using ‘preferred IMEs’ or
2. provide injured workers a choice of the IME with the appropriate speciality, by whom they are examined.

Recommendation  15

Amend its IME complaint handling policy to provide scope for examination of complaints where a worker does not provide consent for the complaint to be provided to the IME, which may include the referral of the matters raised to the IME quality assurance division for intelligence gathering purposes.

 

Recommendation 16

Amend the IME quality assurance process to:

1. ensure IMEs subject to a high number of complaints are peer reviewed
2. document the process by which WorkSafe will review an individual claim file where significant deficiencies are identified in relation to an IME’s report, to ensure a worker’s entitlements have not been unreasonably rejected or terminated based on the

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The onerous provisions of the Victorian Transport Accident Act have been removed!

August 25, 2016

The Transport Accident Amendment Act 2016 was enacted in mid April 2016 (see effect of changes). The Act reverses the provisions enacted in the Transport Accident Amendment Act 2013 that limited the right of families of people who die or are severely injured in transport accidents to seek compensation for psychological injury.

The requirement that claimants with psychiatric injuries needed to seek treatment for three years before they can bring a serious injury claim has also been reversed. It did not recognise that many people suffering from mental illness find it difficult to reach out for assistance. Furthermore, it was especially difficult for claimants living in rural areas who may have limited access to mental health services.

This is a victory for common sense

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American Board of Independent Medical Examiners AMA 5 Training in Melbourne- Who cares

May 26, 2016

I was astonished to receive an invitation from eReports to attend a weekend workshop in Melbourne conducted by Prof Mohammed Ranavaya, president of the American Board of Independent Medical Examiners. The training will be on the transition from AMA 4 to AMA 5.

 

As far as i’m aware there are no plans In Victoria to change from AMA 4 to AMA 5 and furthermore I notice that the section with regard to psychiatric impairment rating is from 345 to 4:30 PM on 23 July, 2016, the Saturday of the week end of the course and last for 45 minutes. Considering that there is virtually no difference between AMA 4 and AMA 5 with regard to chapter 13 what is there to be said? Furthermore no jurisdictions in Australia, apart from in the Northern Territory, use chapter 13. In Victoria and South Australia the GEPIC is used and in other states the PIRS.

 

The cost, from what I could work out is US $595 for the Saturday, the two workshops on Sunday total US$750 and the fee for the examination from 5:30 PM to 9 PM is $995 and for the non-physical examination from 530 to 7 PM is $350. You we please today that if you sign up for everything you receive a $100 discount.

 

The problem of course is that AMA5has been used widely for years apart from in Victoria where no changes are planned to move to AMA 5. I have difficulty understanding why anybody would bother.

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More action regarding complaints against medical practitioners

March 23, 2016

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:

1. the prevalence of bullying and harassment in Australia’s medical profession;
2. any barriers, whether real or perceived, to medical practitioners reporting bullying and harassment;
3. the roles of the Medical Board of Australia, the Australian Health Practitioners Regulation Agency and other relevant organisations in managing investigations into the professional conduct (including allegations of bullying and harassment), performance or health of a registered medical practitioner or student;
4. the operation of the Health Practitioners Regulation National Law Act 2009 (the National Law), particularly as it relates to the complaints handling process;
5. whether the National Registration and Accreditation Scheme, established under the National Law, results in better health outcomes for patients, and supports a world-class standard of medical care in Australia;
6. the benefits of ‘benchmarking’ complaints about complication rates of particular medical practitioners against complication rates for the same procedure against other similarly qualified and experienced medical practitioners when assessing complaints;
7. the desirability of requiring complainants to sign a declaration that their complaint is being made in good faith; and
8. any related matters.

Submissions should be received by 13 May 2016. The reporting date is 23 June 2016.

Committee Secretariat contact:

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:

1. Better risk assessment: need to embed a more systematic, data informed approach to risk assessing notifications not only taking account of the information which is outlined in the notification, but also factors such as a practitioner’s history of notifications, their practice context and who made the notification.
2. Management of high risk matters: more intensively apply resources to higher-risk notifications, so these cases are investigated thoroughly but quickly.
3. Greater transparency: interpret and use the National Law flexibly, not narrowly, to support information sharing in the public interest and promote greater understanding and transparency of what we do.
4. Culture: address perceptions of being pro-practitioner and shift this perception through cultural change, with a greater emphasis on service. We need to drive an open and transparent organisational culture with a clear balance between the interest of patients, public safety and the practitioner to ensure our service culture balances the rights and needs of all stakeholders.
5. Performance: continue to critically evaluate the causes of delays, especially for high risk and complex cases.

 

 

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Bits n’ Pieces

March 3, 2016

I thought you might be interested to see 4 recently written papers

• One is about the various compensation schemes in Victoria including the transport accident scheme, the worker’s compensation scheme and issues to do with civil liability
• One was written by a Queensland barrister about cross-examining expert witnesses, I thought it was rather lightweight but nevertheless useful.
• Work Safe Australia has a paper giving an overview of all the workers compensation schemes in Australia and New Zealand. Well worth a read.
• How many people go back to work after a claim? This is a research paper from Work Safe Australia Returned to Work Rate is the proportion of injured workers with 10 or more days off work who returned to work for any period of time at some stage since they had their first day off work.In 2013/14, 87% of Australian injured workers and 88% of New Zealand injured workers had returned to work at some time since their injury or illness.
• Within Australia, the Returned to Work Rate was higher than the national Rate for Comcare (92%); and Queensland and Western Australia (89% each). The Returned to Work Rate was lower than the national rate for Tasmania, the Northern Territory (86% each), Victoria (85%) and South  Australia (82%)

 

 

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Statistics from Work Safe Australia about Work and Mental Disorders

WORK SAFE AUSTRALIA 2015

WORK-RELATED MENTAL DISORDERS PROFILE

This is a brief overview of this interesting paper.  You can find the full document here.

Work-related mental disorders, each year on average:

• 7820 Australians are compensated
• 6% of workers’ compensation claims
• $480 million total claims payments
• $23 600: typical compensation payment per claim
• 14.8 weeks: typical time off work
• 90% of mental disorder claims are attributed to mental stress
• 39% of mental disorder claims are caused by harassment, bullying or exposure to violence
• 0.5 mental disorder claims awarded per 1 million hours worked
• 0.8 mental disorder claims awarded per 1000 workers
• Female workers 2.3 times the number of claims per million hours worked compared with male workers
• 65% of mental disorder claims awarded to workers aged 40 and over
• Compensated for a work-related mental condition:
  • 1 in 5 compensated defence force members, fire fighters or police officers
  • 1 in 5 compensated teachers
  • 1 in 10 compensated health and welfare support workers
• 64% of mental disorder claims arise from 4 out of 19 industry divisions:
  • Public administration and safety (21%)
  • Education and training (14%)
  • Health care and social assistance (21%)
  • Transport, postal and warehousing (8%)
• 46% of mental disorder claims from the transport, postal and warehousing industry are associated with a vehicle accident
• 17% mental disorder claims awarded to female workers were made by school teachers or health and welfare support workers
• Female defence force members, fire fighters, and police: 16 times higher than average claim rate
• Mental disorder claims involving a form of harassment or bullying:
  • 1 in 3 females
  • 1 in 5 males

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Expenditures on Psychiatric impairment by Victoria WorkSafe 1/11/2014 – 31/10/2015

December 7, 2015

We operate in a vacuum regarding the impact of our decisions financially. Some recent data from Victorian WorkSafe gives us some idea of the cost in Victoria.

GEPIC psychiatry examinations…………………1310
Cost GEPIC exams…………………………………..$1 325 000

Average cost per examination………………….$1 011.45
Psychiatric claims with entitlement paid…. 33
The total paid for the 33 claims………………$2 502 441.40.
Total cost……………………………………………….$3 827 441.40

 

 

 

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NSW Approved Medical Specialists appointments available

August 27, 2015

The New South Wales Workers Compensation Commission  is seeking applications from suitably qualified specialists wishing to be appointed as Approved Medical Specialists for the Commission to undertake assessments of general medical disputes and disputes about permanent impairment. Appointments to the panel of Approved Medical Specialists are made by the President of the Commission. Approved Medical Specialists are required throughout New South Wales, including regional and rural areas and in a range of specialties. An information package outlining the selection criteria and selection process is available on the Commission’s website at www.wcc.nsw.gov.au.  Applications close 9 September 2015.

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