Sexual misconduct by health practitioners is a serious issue which can cause significant harms to individuals and undermine trust in the health system.
One of the major challenges in reducing the incidence of sexual misconduct is that people who have been sexually abused by a health practitioner can be reluctant to register a complaint due to fears about the process they may have to undergo if the complaint is pursued, including giving evidence at a tribunal and being questioned by a barrister.
Support services for patients making complaints against health practitioners can play an important role in minimising the stress and anxiety involved in this process. Through encouraging more people who have been sexually abused by health practitioners to come forward they can also reduce the incidence of sexual misconduct overall and improve the safety of the health system.
Below, Dr Kerry J Breen AM and Ms Carmel Benjamin AM, describe a successful support service set up by the Medical Practitioners Board of Victoria and their frustration that the gains made by this service appear to have been forgotten in the decade since it was abolished.
Kerry Breen and Carmel Benjamin write:
Sexual misconduct is the most common reason why doctors are de-registered in Australia and is a continuing problem according to a recent detailed review conducted by a research team led by Dr Marie Bismark.
This study reviewed all the sexual misconduct matters handled by the Australian Health Practitioner Regulation Agency (AHPRA) over the years 2011 to 2016. It covers 1507 notifications involving 1167 health practitioners, including 381 categorised as sexual relationships with a patient and 1126 cases of sexual harassment or sexual assault.
The authors describe sexual misconduct by health practitioners as a “profound breach of trust” and argue that “Patients, health care practitioners, and the public deserve focused efforts to prevent sexual misconduct in health care, fair and thorough investigation of allegations of sexual misconduct, and prompt and consistent action by regulators when misconduct is confirmed.”
These views reflect those we expressed in Croakey a year ago when we highlighted the emotional harm involved in sexual misconduct cases.
Carmel stated in that article: “In my ten years leading the Support Service of the Medical Practitioners Board of Victoria I saw at firsthand the terrible harm that had been done to women whose trust had been violated by doctors. I also saw the trauma and distress these women faced before, during and after disciplinary hearings. Many women would not have gone through with their complaints without such support”.
The Victorian program
We also described a successful support program run and funded by the Medical Practitioners Board of Victoria for ten years.
This program operated independently from the Medical Board and provided confidential support to both consumers and health care practitioners throughout the complaints process. One of the key aims of the program was to make it easier for complainants to come forward to the Board.
This program was not continued when the Australian Health Practitioner Regulation Agency (AHPRA) took over the regulation of medical practitioners from the state medical boards in 2010. This has left consumers experiencing sexual misconduct by health practitioners without the care, support and expertise this service provided.
It is difficult to quantify the impact that the lack of this high quality support service has had on individuals experiencing sexual misconduct by a health practitioner and their trust in the regulatory process but there is no doubt that it has been significant.
After ten years of little or no progress by AHPRA on this issue we are encouraged to see signs that the lack of adequate support services for people experiencing sexual misconduct may finally be addressed.
A recent public statement from AHPRA responds to the ‘Chaperone report: Three years on’, an independent report by Professor Ron Paterson on the regulatory management of allegations of sexual misconduct against health practitioners.
In this statement AHPRA commits to several improvements to its current processes for managing complaints.
- extending training for all staff involved in managing notifications by supporting all remaining investigators to attend the three-day training course within 18 months of the publication of the report and developing specialised sexual boundary training for other notifications staff and delivering it within six months of the publication of the report
- better communication with notifiers…including:
- talking on the phone to notifiers more often, to keep them up to date and engaged with what we are doing
- developing the engagement skills of team members in rapport building, best practice methods for interviewing, managing welfare and appropriate referral to external support services
- commencing a pilot program to provide support to notifiers/targets in sexual boundary matters involving a medical practitioner or psychologist to:
- provide emotional and procedural support to them throughout the notification process, and
- decreasing disengagement rates, when matters are discontinued because notifiers opt out
These recommendations are heartening to read. However, it is frustrating that much of this was already standard practice in the medical boards of the larger states that AHPRA replaced.
In fact, the planned pilot program described in AHPRA’s statement appears to be very similar to the one that was already in place a decade ago in Victoria.
This issue raises some important questions (below) about both the management of sexual misconduct among health practitioners and also about how knowledge and experience within the health sector are passed on during periods of re-organisation or staffing and management changes, to reduce duplication and re-invention. These questions are:
- Why were examples of good practice by the states in this area not followed by AHPRA from the outset?
- Why was Professor Paterson unaware of the past existence of a support service in Victoria?
- Why has no progress been made in this area by AHPRA since 2010?
- Why is a ‘pilot program’ needed when a successful full scale program has already been run for ten years here in Victoria?
We welcome a response from AHRPA on these issues.
Rather than conducting an unnecessary pilot program, we recommend the immediate reinstitution of the Victorian service before more emotional harm is done to those appearing before disciplinary enquiries, both the notifiers (using the modern word for complainants) and also the health professionals facing the allegations.
The person who established the original service is available to guide AHPRA or, if independent advice is desired, the current leadership at Victorian Court Network on which the Medical Practitioners Board’s support service is modelled can be approached.
Sexual misconduct by health practitioners is a serious issue that if not managed with sufficient expertise and effort and can cause serious harm to individuals and undermine trust in the health system. The lack of urgency on the part of AHPRA on this issue is a failing that the broader community deserves to know about.