Responses and recommendations
As this report highlights, the committee has received evidence of
considerable concern about the way in which medical complaints in Australia are
handled, including the use of notifications as a tool of bullying and
While the focus of the terms of reference for this inquiry was on the
medical complaints process, the committee is concerned by evidence that clearly
shows that bullying and harassment remain prevalent across the medical
profession, affecting patients and their families, medical practitioners,
students and trainees.
The committee notes that, in principle, the medical profession has a
'zero tolerance' approach to bullying and harassment. The committee is
encouraged by evidence it received from parts of the medical profession,
particularly some of the speciality colleges, outlining recent steps they have
taken to better address these issues.
However, as discussed in chapter 3, evidence to this committee
highlights that bullying and harassment is a widespread and significant
problem. The committee is concerned that despite assurances from witnesses
representing medical professionals, including speciality colleges, a sector‑wide
change to the way bullying and harassment is addressed and managed remains to
be seen. The committee was particularly concerned by evidence suggesting that
medical students and junior doctors continue to be among the most frequent
subjects of bullying and harassment.
The committee recognises that addressing bullying and harassment can
only be addressed with the cooperation of all sections of the medical
profession, including Commonwealth, state and territory governments, hospitals,
speciality colleges and universities. Without a coordinated, sector-wide
response to preventing such behaviour, it will continue to put patient safety
at risk, and see capable and dedicated people leave the sector, to the
detriment of the Australian health system.
The committee is particularly concerned by the number of individual
submissions it has received from medical practitioners, nurses and patients
sharing their experience with the complaints process. The committee recognises the
substantial impact that a notification investigation can have on both the
notifier and subject of the complaint. As outlined in chapter 2, the committee
has heard from multiple practitioners and members of the public about the
consequences of lodging a notification. Individuals have written to the
committee detailing the significant and ongoing effects they have suffered. The
calls for a Royal Commission from some submitters are just one illustration of
the level of community concern about the prevalence and impacts of bullying and
harassment in Australia's medical profession.
The committee agrees that these cases demonstrate possible systemic
problems with the medical complaints process that go beyond the scope of this
inquiry related to both the administration of the process, and the regulatory
framework that governs it.
The committee agrees that the evidence it has received to date highlights
the need for a new line of inquiry, including:
the relationships between and roles of the different bodies
involved in the complaints process;
the administration and implementation of the complaints process; and
the adequacy of the regulatory framework for managing complaints
under the National Law.
This chapter recommends that the committee initiate a new inquiry to
investigate these matters.
New areas for inquiry
This inquiry focused on the intersection between bullying and harassment
in the medical profession – a problem identified to be prevalent across the
profession by a number of studies – and the medical complaints process in
Australia. As such, its primary focus was on the ways in which the complaints
process may be open to misuse as a tool of bullying and harassment within the
profession. However, in the course of investigating this issue, the committee identified
the following aspects of the medical complaints process that warrant further
Relationships between different
One point made by many of the submitters and witnesses to this inquiry
was that there are unclear boundaries and responsibilities amongst the many
bodies involved in the regulation and administration of the medical profession.
As illustrated in chapters 2 and 3, responsibility for different aspects
belongs to the Australian Health Practitioner Regulation Agency (AHPRA), the
National Boards for each profession, the health complaints entities in each
state and territory, professional colleges and individual workplaces.
The management of a notification lodged against an individual
practitioner may involve most or all of those bodies. Evidence to the committee
in this inquiry suggests that there is some confusion among patients and medical
practitioners as to the specific roles of each of these bodies in resolving
The committee agrees that these relationships – and the different
responsibilities held by each of these bodies – require further investigation
to determine whether any improvements can be made to better assist all parties
to the complaints process achieve a satisfactory outcome.
The committee is particularly interested in examining the roles of and
relationships between AHPRA, the National Boards, the State and Territory
Boards, panels established by National Boards and the health complaints
entities in relation to the complaints-handling process.
Administration and implementation
of complaints process
As discussed in chapter 2, one of the key concerns raised by many submitters
was about the administration and implementation of the complaints process.
Submitters identified a wide range of concerns, including:
the timeliness of the process;
the level and manner of communication from AHPRA;
the adversarial nature of the process;
perceived issues with conflict of interest;
the qualifications of AHPRA investigators; and
the failure to recognise that bullying and harassment within the
medical profession is a patient safety issue.
Evidence received during this inquiry indicates that the process as it
currently operates does not have the confidence of the entire medical
profession. In particular, the process' vulnerability to misuse as a tool of
bullying and harassment warrants further investigation.
In particular, the committee considers that the question of the
effectiveness of the current notifications and investigation process merits
further attention. AHPRA's legislated purpose is ensuring public safety, yet
the concerns raised with the notifications process by submitters to this inquiry
were focused, in the main, on the use of this process as a tool of bullying and
harassment. The committee intends to investigate the process more broadly to
gain an understanding of how well it is fulfilling its role in protecting
public safety and responding to complaints from patients and others.
The committee notes that the administration of AHPRA has already been
the subject of an inquiry by the Senate Finance and Public Administration
References Committee in 2011. However, that inquiry focussed specifically on
the AHPRA's role in health practitioner regulation following the introduction
of the national scheme in 2010, and only addressed the complaints process as a
related issue. The committee agrees with the conclusion of that inquiry that
'further development of the complaints process is urgently required'.
Adequacy of regulatory framework
Following on from the previous area of further inquiry, the committee considers
that there is scope for a broader investigation of the framework underpinning
medical regulation in Australia. The committee notes that the National
Registration and Accreditation Scheme (NRAS) has been the subject of several
reviews since its implementation in 2010, most notably the 2015 Independent
Review for the Australian Health Ministers' Advisory Council.
However, these reviews have not focussed specifically on the regulatory
principles and practices of the complaints process, which the committee regards
as warranting detailed examination.
On the basis of evidence received as part of this inquiry, the committee
does not have sufficient information to judge whether the concerns discussed
throughout this report are problems with the administration of the National
Law, or whether the underlying regulatory framework is itself in need of
review. The committee therefore considers this an important area for more
Conclusion and recommendations
The committee thanks all those who assisted in this inquiry by making
submissions or appearing at the public hearings. Through the large volume of
submissions and correspondence received for this inquiry, the committee was
able to gain an understanding of the concerns expressed by many submitters at
the forms bullying and harassment in Australia's medical profession takes.
The committee has established that there are significant concerns about
the way in which medical complaints in Australia are handled, particularly the
use of notifications as a tool of bullying and harassment. The cases
highlighted by submitters have demonstrated to the committee that there are
broader issues with the administration and regulation of the current medical
complaints process that warrant investigation.
In particular, the committee was concerned by the evidence suggesting
that Australia's medical complaints process – a system designed to ensure
public safety and optimal patient outcomes – has been misused by some for their
own purposes. A world-class health system requires an open, transparent and
rigorous process for patients and others to raise concerns with the healthcare
they receive, and the undermining of this process for vexatious purposes is
The committee recognises that the NRAS, now just over six years old,
faced some implementation problems, particularly with regard to the management
of individual complaints. The committee notes that AHPRA, along with the MBA
and NMBA, has worked to improve this process. However, it is clear from the
evidence received for this inquiry that the process does not have the
confidence of the entire medical profession. Just as a complaints process is a
necessary component of a health system, practitioner confidence in the fairness
and transparency of that system is necessary.
The committee recommends that all parties with responsibility for
addressing bullying and harassment in the medical profession, including
governments, hospitals, speciality colleges and universities:
acknowledge that bullying and harassment remains prevalent within
the profession, to the detriment of individual practitioners and patients
recognise that working together and addressing these issues in a
collaborative way is the only solution; and
commit to ongoing and sustained action and resources to eliminate
The committee agrees that bullying and harassment should be addressed at
the very first opportunity – at university. The committee considers that it is
imperative that students are prepared at university to feel comfortable about making
a bullying and harassment complaint, to know who has responsibility for them
during placement and subsequent employment, and to know their options in making
a complaint and any appeal processes that may be available to them.
The committee recommends that all universities adopt a curriculum that
incorporates compulsory education on bullying and harassment.
The committee is particularly concerned by evidence that indicates a
lack of clarity around reporting bullying and harassment for medical students
while on placements in hospitals. The committee notes evidence from Ms Elise
Buisson, President of the Australian Medical Students' Association, who told
In a hospital, if you are being taught by a doctor—which does
not mean that they are employed at the university anyway, it just means that
you are following them around for perhaps three months at a time—and you make a
complaint against that doctor, that complaint needs to be made to the hospital
ostensibly, but you are not covered by hospital policy. That generally covers
employees and volunteers, and you are neither.
The committee agrees that universities need to accept responsibility for
students who are on placement in a hospital so these students do not fall
through the cracks of the system.
The committee recommends that all universities accept responsibility for
their students while they are on placement and further adopt a procedure for
dealing with complaints of bullying and harassment made by their students while
on placement. This procedure should be clearly defined and a written copy
provided to students prior to their placement commencing.
The committee considers that all hospitals should be required to have a
provision in their code of conduct that specifically states that bullying and
harassment in the workplace is not tolerated. The code of conduct should also
state that this applies to students and volunteers.
The committee recommends that all hospitals review their codes of
conduct to ensure that they contain a provision that specifically states that
bullying and harassment in the workplace is strictly not tolerated towards
hospital staff, students and volunteers.
The committee is concerned that despite the apparent prevalence of
bullying and harassment identified by the speciality medical colleges, few
practitioners have been formally sanctioned. The committee notes evidence from
Mr John Biviano, Director of Fellowship and Standards, Royal Australasian
College of Surgeons (RACS), who told the committee that RACS had 7 000 members;
however, to date, none had been sanctioned for bullying and harassment.
The committee considers that there should be a requirement on all
speciality colleges to report each year on how many complaints their members
have been subject to and how many sanctions they have imposed.
The committee recommends that all specialist training colleges publicly
release an annual report detailing how many complaints of bullying and
harassment their members and trainees have been subject to and how many
sanctions the college has imposed as a result of those complaints.
While this inquiry's focus has been on bullying and harassment, it has
also identified broader systemic issues with Australia's medical complaints
process that go beyond the scope of this inquiry's terms of reference. For that
reason, the committee intends to establish a new inquiry focused on the process
itself, rather than this inquiry's examination of the ways in which the process
can be used and misused.
The committee recommends that a new inquiry be established with terms of
reference to address the following matters:
the implementation of the current complaints system under the
National Law, including role of AHPRA and the National Boards;
whether the existing regulatory framework, established by the
National Law, contains adequate provision for addressing medical complaints;
the roles of AHPRA, the National Boards and professional
organisations – such as the various Colleges – in addressing concerns within
the medical profession with the complaints process;
the adequacy of the relationships between those bodies
responsible for handling complaints;
whether amendments to the National Law in relation to the
complaints handling process are required; and
other improvements that could assist in a fairer, quicker and
more effective medical complaints process.
Senator Rachel Siewert
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