Have you ever heard of the ISCRR, if not join the group. I have known about this group since its inception but keep forgetting the name. ISCRR stands for the Institute (there was a short break while I checked I had got the title right ) for Safety, Compensation and Recovery Research. I won’t bang on about this clunky title but for goodness sake. Even IRRSAC would be better (Insitute for Recovery Research, Safety and Compensation!
Anway this is a worthy veture, at last the workers’ compensation and transport accident authorities have put in some money to do some research on work and transport injury issues, OK some of the research is a blinding glimpe of the obvious but some seems useful.
On its homepage the ISCRR is described as the Institute for Safety, Compensation and Recovery Research (ISCRR) and is a joint initiative of WorkSafe Victoria (WorkSafe), the Transport Accident Commission (TAC) and Monash University. It was established in 2009 to facilitate research and best practice in injury prevention, rehabilitation and compensation. Funding and support is provided by the three partner organisations.
ISCRR has a collaborative research model. This relies on extensive and ongoing consultation and engagement with all stakeholders involved at every stage of a research endeavour: from setting the research agenda, through facilitating and conducting excellent research to translating the research findings into best practice in WorkSafe and TAC operations.
Go to their website at http://www.iscrr.com.au they produce a monthly update on the research they have been doing. I have posted one of their one page report summaries from the March update entitled EXPLORING PATIENT PERCEPTIONS OF BARRIERS AND FACILITATORS OF RECOVERY FOLLOWING TRAUMA.
It is worthwhile subscribing to their monthly update to see their range of research activities. You might even persuade them to get a name change!
The Age – 30 March 2013 SRC Act Review
Federal public servants seeking workers’ compensation payouts face the biggest crackdown in decades. – ComCare Review (link to the Review)
A federal government review of the $1.2 billion Comcare insurance scheme has urged sweeping reform to curb dubious claims for psychological injuries, payouts for dodgy therapies, doctor shopping and outright fraud.
The review has made more than 147 recommendations to re-write the legislation on Commonwealth public sector compensation claims, with the aim of getting injured workers back to work and ending their “passive” reliance on compensation.
The taxpayer-funded insurer lost more than half a billion dollars in the 2011-12 financial year as the number of claims for psychological injuries in the public sector – many based on accusations of bullying and harassment – increased.
According to the review’s two reports – by Melbourne barrister Peter Hanks, QC, and former Defence Department head Allan Hawke – some long-running claims under the Comcare scheme have exceeded $2 million.
The review, ordered in 2012 by Workplace Relations Minister Bill Shorten, cited a case of taxpayers paying nearly $30,000 for massage therapy that had “no curative effect” and another of a Brisbane-based bureaucrat flown to a Buddhist meditation retreat in Alice Springs to treat his anxiety disorder.
In other cases that have made recent headlines – not mentioned in the review – a Commonwealth public servant was compensated, after a court appeal, for injuries sustained during a “vigorous” sex session in a motel room on a work trip.
And an underperforming Canberra public servant was compensated after she claimed one-on-one counselling sessions constituted bullying.
The reports do not call for cuts to benefits for injured workers but urge a shift from a payout-oriented insurance scheme to one that emphasises rehabilitation and a return to work.
The report says claims for psychological injuries in the public service have increased by 30 per cent in the past three years and is four times higher in the federal public service than for other employers.
Mr Hanks says compensation for these claims should not be paid for more than three months without a diagnosis by a properly qualified medical practitioner.
He also wants to see an end to payouts for mental stress caused by imaginary factors.
“It is an unfair burden on employers to make them liable to pay compensation for a psychological injury that is caused by an employee’s fantasising rather than by any aspect of employment,” he wrote.
Among the key recommendations is a no-fault, provisional liability that would cover injured workers for a three-month rehabilitation period and a shift in jurisdictions for workplace dispute resolution from the Administrative Appeals Tribunal to Fair Work Australia.
Mr Hanks wrote that Comcare’s legislative framework was supposed to be beneficial to workers but the insurer had a duty to spend taxpayers’ money wisely.
He also urged greater vigilance on doctors who signed off on compensation payouts and “that health practitioners are held accountable for their conduct, and that they do not exploit what is, in effect, a publicly funded scheme by overcharging, overservicing or providing services that do not meet basic professional standards”.
Mr Shorten said he would now consult ”stakeholders” on the reports by Dr Hawke and Mr Hanks.
“It is vital that the Comcare scheme is focused on early and effective intervention to promote recovery of injured workers,” he said.
“It is also critical that employers and Comcare are pro-active in supporting injured workers from the point of injury, during rehabilitation and when they return to work.”
The issue of confidentiality is problematic for civil forensic psychiatrists. Most of us err on the side of caution and have claimants sign a document acknowledging that the information they provide will be incorporated into a report. The information is otherwise kept confidential by me. I have no control over what happens to the report however.
We assume that because people arrive they have given implicit consent to release of information. I was involved in a recent matter before the Medical Board of Australia where the issue in question was that the “practitioner prepared and provided a report to try and company which included a possible diagnosis, without having met performed a clinical assessment of the complainant.”
in brief a complainant had arrived for a medicolegal assessment by a psychiatrist with regard to his workers compensation claim. He refused to sign the full disclosure document and was told the interview could not proceed. In the interim the psychiatrist overheard him dealing with office staff and thought he was aggressive and angry. Documentation provided to the psychiatrist indicated that he had been described as a difficult employee and “paranoid”. The psychiatrist wrote a briefing note to the insurance company stating why he had not been able to complete the examination. The psychiatrist went further. The psychiatrist wrote that he was concerned about the complainant’s behaviour and thought there was a “possibility that he does have a significant psychiatric illness” and “may have a paranoid disorder”. The psychiatrist urged the insurance company to warn future assessors that the complainant may be difficult and may make complaints about them although there was no indication of any physical threat.
This letter was used by the insurance company to deny the claim and, somewhat unwisely, the psychiatrist agreed to the release of this letter to support their decision. This led to the complainant making a complaint to the Medical Board of Australia.
Another experienced psychiatrist formed the view that he had breached confidentiality. My opinion was that behaviour had been observed in a public place ie the waiting room and that confidentiality did not apply. See definitions below.
Definitions of Medical Confidentiality
Psychiatry: The ethical principle that a physician may not reveal any information disclosed in the course of medical care.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.
A substantive rule in bioethics saying that the information a patient reveals to a health care provider is private and has limits on how and when it can be disclosed to a third party; usually the provider must obtain permission from the patient to make such a disclosure.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.
confidentiality /con·fi·den·ti·al·i·ty/ (kon″fĭ-den″she-al´ĭ-te) the principle in medical ethics that the information a patient reveals to a health care provider is private and has limits on how and when it can be disclosed to a third party.
Dorland’s Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.
The second issue was whether he was entitled to report on the behaviour he had observed and overheard. In my view he was. The third issue was whether this constituted a psychiatric report. In my view it did not. I understand a psychiatric report to be amassing considerable amount of data, doing a mental status examination and using that information to form an opinion. This did not appear to be the situation. I thought the critical matter was whether or not the psychiatrist had been fully frank in stating what informed his concerns. I believed he had done so.
This matter raises the further issue of the experience of many civil forensic psychiatrists that if claimants are not happy with the report they make a formal complaint about the psychiatrist.
I would be interested in your views on this matter. By the way the psychiatrist on the matter referred to above was found to have no charges to answer.
I have provided for your interest a link to a consent form to release claimant’ s information.