Opinion
GP chaperones – is a review warranted?
30th Nov 2016
The need for chaperones for medical practitioners in private practice has received a lot of media attention in the past few weeks. With attention-grabbing titles such as “Chaperone ordered for Canberra GP accused of “grooming” female patient’[1], and ‘Darwin doctor banned from examining women without supervision’[2], one would be forgiven for believing there was an epidemic.
The Medical Board of Australia and Australian Health Practitioner Regulation Agency (AHPRA) recently stated that they are commissioning an independent review of the chaperone restrictions currently used, stating that their primary focus is one of patient and public safety.[3]
The Medical Board of Australia’s focus is to ensure that practitioners are “suitably trained to practise in a competent and ethical manner”.[4]
This article looks at the current protocol and whether the review of these restrictions is warranted.
Current Protocol
When allegations have been made against a practitioner and they are under investigation, chaperone restrictions can be placed on their registration. These restrictions can also be included in orders made by a panel, tribunal or court.[5]
When a practitioner requires a chaperone, the chaperone must be physically present and directly observe all contact with patients. ‘Contact’ has been defined by AHPRA to include:
- consultations;
- interviews;
- examinations;
- assessments;
- prescribing for;
- advising;
- treating; or
- otherwise seeing a patient whether in person or via communication device.
Under the protocol, there are requirements to be followed by the practitioner including, for example, notifying private health insurers of the restrictions and providing acknowledgements to AHPRA that Medicare can be contacted to monitor compliance with this restriction.[6] AHPRA can also carry out random practice inspections.
A chaperone log is required to be completed in ink, detailing every patient seen and what was observed which is required to be signed by the patient and the chaperone.
Notification setting out the requirements for the presence of the chaperone is required to be displayed in the practitioner’s waiting room.
AHPRA confirms that chaperones are required to be:
- a registered health practitioner without restrictions; and
- over the age of 18 years.
Further, that chaperones should not be:
- a relative;
- a friend;
- a direct employee; or
- a person in direct contractual or financial relationship with the practitioner.
Issues with the Current Protocol
The current protocol states that: ‘prior to any contact being made’ with the patients, the practitioner or a staff member should notify the patient of the chaperone restrictions.[7] If the practitioner makes contact with the patients without notifying them of their chaperone restrictions, they are immediately in breach of the restrictions imposed on them. Not notifying the patient of the reason for the chaperone potentially puts that patient at risk. If a patient is not aware of a risk they face, how can they protect themselves?
Further, a practitioner is not required to inform the patient why the chaperone must be present.
The present protocol therefore relies on the practitioner being an honest person who complies with all the reporting requirements as requested by AHPRA and t also involves the chaperone when required. If an allegation has been made against the practitioner and there is a need for a chaperone, is the practitioner’s honesty not already in doubt?
Patients place a lot of trust in their practitioners. The position of trust between patient and doctor is extremely important and influential. Patients tend to follow the instructions of their practitioners and are quite often in a vulnerable condition. They trust that the examination they are required to undergo is warranted, that the diagnosis is correctly established and that the advice given to them is correct.
Is a review warranted?
Presently in Australia, there are 47 practitioners who have chaperoning restrictions, approximately 0.04 per cent of registered practitioners.[8] Most of these cases are related to sexual assault, with a few related to drug use.
However, it appears from cases which have surfaced in the media, particularly in relation to sexual assault, that if a practitioner is likely to offend it is possible for them to do so even if a chaperone is present. Chaperones’ presence does not seem to prevent practitioners from acting unprofessionally.
In the past year, a neurologist is alleged to have sexually assaulted numerous patients over a period of time. It is alleged that some of these incidents occurred while a chaperone was present, behind the curtain in the consulting room.[9]
Conclusion
The current system favours the right of the practitioner to practise while not quite finding a balance on the protection of patients. The review appears, therefore, to be warranted, not just for the protection of patients but also for the protection of practitioners.
Joanne Baker graduated from USQ in April 2016 and is currently studying PLT at College of Law. Her legal career started as an Office Junior in a small law firm in her home town in England. She immigrated to Australia 15 years ago where she continued her legal career progressing, through from Secretary to Law Clerk in various areas of law. She is currently Graduate Lawyer in the Medical Negligence team at Slater & Gordon Lawyers. She has two children who keep her busy outside of work and a love for anything VW, particularly Kombies!
The views and opinions expressed in these articles are the authors' and do not necessarily represent the views and opinions of the Australian Lawyers Alliance (ALA).
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References
[1] Alexandra Back, ‘Chaperone ordered for Canberra GP accused of “grooming” female patient’, The Canberra Times, 24 August 2016, http://www.canberratimes.com.au/act-news/chaperone-ordered-for-canberra-gp-accused-of-grooming-female-patient-20160823-gqz3tr.html.
[2] Hayley Sorensen, ‘Darwin doctor banned from examining women without supervision’, NT News, 25 January 2016, http://www.ntnews.com.au/news/northern-territory/darwin-doctor-banned-from-examining-women-without-supervision/news-story/24a1019ea8f58179545b09ebdd402e96.
[3] Australian Health Practitioner Regulation Agency, Independent Review on Chaperoning, 10 August 2016, http://www.ahpra.gov.au/News/2016-08-10-Independent-review-on-chaperoning.aspx. AHPRA is a regulated body that assists the Medical Board of Australia.
[4] Australian Health Practitioner Regulation Agency, AHPHRA Chaperone Protocol, November 2015.
[5] Ibid.
[6] Ibid.
[7] Australian Health Practitioner Regulation Agency, AHPHRA Chaperone Protocol, November 2015.
[8] Australian Health Practitioner Regulation Agency, Independent Review on Chaperoning, 10 August 2016, http://www.ahpra.gov.au/News/2016-08-10-Independent-review-on-chaperoning.aspx.
[9] Julie Medew, Richard Baker, Nick McKenzie, ‘Patient plans to sue Andrew Churchyard’s estate over sexual misconduct’, The Age, 2 August 2016, www.theage.com.au/victoria/patient-to-sue-andrew-churchyards-estate-over-sexual-misconduct-20160802-gqj5vq.html.
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