Poor and inconsistent communication, along with a lack of protocol when it comes to escalating concerns about a practitioner’s mental health, make up AHPRA’s biggest points of failure, new research reveals.
The regulator responded to high-level findings of the report in March, when it was revealed that at least 16 healthcare professionals had died by suicide either during an AHPRA investigation or immediately following.
AHPRA’s response included commitments to reduce investigative timelines, provide better updates and help at-risk practitioners access mental health support.
Professor Steve Robson, president of the AMA, told Rheumatology Republic that the association had been “appalled” when it first heard the findings of the report earlier this year and that it felt the reforms did not go far enough.
“Doctors continue to suffer under the weight of Australia’s current regulatory complaints process,” he said.
“While we are pleased that AHPRA is already acting on the findings and has made improvements, the recommendations completely let the health ministers off the hook.
“It was the health ministers who introduced mandatory reporting through their reforms to the National Law and the health ministers who have again amended the National Law to allow AHPRA to make public statements before the completion of an investigation.”
RACGP president Dr Nicole Higgins told Rheumatology Republic that she had personally observed signs of improvement in the process already, but that it remained a “kick in the guts”.
“I received an AHPRA notification a couple of months ago,” she said.
“It sat in my inbox for an hour before I had the guts to open it, all while I was in the middle of trying to see patients.”
When she did open it, Dr Higgins said she was relieved to see that it had already been investigated, deemed vexatious and dismissed.
“An AHPRA complaint actually goes to the core of who you are as a GP,” she said.
“You question not only your clinical ability, but your professionalism and your identity, whether it be something small or something that doesn’t progress or something that is a serious complaint.”
The full report into AHPRA and practitioner distress was published in the International Journal for Quality in Health Care in late September and featured in-depth interviews with practitioners who had recently gone through an investigation, alongside an analysis of the 16 deaths.
Common themes among practitioners who were the subject of a complaint included distress at having had a complaint made about them at all, frustration with AHPRA’s opaque and infrequent communications and the length of time taken to close the complaint.
“[Having the complaint against me was] virtually daily grief but I managed it,” one interviewee said.
“It didn’t make me sleep poorly, it didn’t give me an ulcer, but it was in the background the whole time.”
As many have pointed out in the past, one of the crueller aspects of the complaints process is that the practitioner can spend months or years in limbo while the investigation continues.
“Sitting around not knowing and waiting for an email, was … absolutely gut-wrenching,” another participant said.
“It dragged on over years, so you’d literally be sitting in a cold sweat every day, just looking through emails waiting for the next message to come from AHPRA, which was invariably bad news,” said one practitioner.
The people who fared better were those who were able to access support from family, friends and colleagues or from professional representatives like indemnity providers.
“Support from GPs and mental health practitioners, as well as connecting with other practitioners with similar experiences, were identified as helpful for managing distress through the complaint,” the researchers wrote.
Some participants received a call from AHPRA informing them that a notification had been made prior to the regulator sending out a written notice.
The people who received these calls remarked to the researchers that it had been an empathetic and largely positive experience, standing in contrast to the “aggressive and confronting” tone that some have come to expect from AHPRA.
It’s the section on serious incidents – self-harm, attempted suicide and completed suicide – that has drawn the most attention since high-level findings of the report were released in March.
Researchers identified 20 cases from the last four years where practitioners who were involved in an AHPRA investigation were involved in a serious incident.
Of those 20 incidents, 16 resulted in death – 12 of these are confirmed suicides and the remaining four are suspected suicides.
Eight of the practitioners were doctors, eight were nurses and four were other healthcare practitioners.
All of them were being investigated for complaints relating to their professional conduct, concern that they had a health impairment, or both.
None of the 20 practitioners who either self-harmed or died by suicide were being investigated for a complaint related to their clinical performance.
Regulatory action had been taken in 12 cases, and the outcome was not yet determined in eight cases.
Most of the practitioners who died by suicide, the researchers said, had pre-existing mental health issues – depression, anxiety and PTSD – or a history of substance abuse.
A small subgroup were potentially facing serious criminal or misconduct allegations, which the researchers said seemed to be predominant factors in their distress.
AHPRA’s approach to managing health-related concerns was found to be “inconsistent”, and staff had no clear path to escalate concerns about a practitioner’s wellbeing.
“In some cases, staff appeared to be very mindful of the practitioner’s wellbeing, attempting to follow up or move cases along,” the authors wrote in the International Journal for Quality in Health Care.
“However, researchers also found health concerns where once regulatory action was taken, such as suspension, the case was delayed for long periods.
“In some matters, staff appeared aware of the need for additional support for practitioners with a mental health concern or substance use disorder, but there did not appear to be a systematic approach, for example, for escalating identified risks of self-harm or suicide.”
The researchers also noted that there was no uniform process for debrief following a death, meaning that there was no feedback loop to training, so no lessons were learned.
The serious incidents tended to occur on or around a set of “trigger points”.
These were: receiving the initial notification that they were under investigation, AHPRA making the decision to suspend, receiving the results of an independent health assessment or being referred to a tribunal.
If this article caused distress or if you are prompted to reach out for support, these services are available:
Doctors4doctors crisis support hotline: 1300 374 377
Lifeline: 13 11 14
Beyond Blue: 1300 22 46 36