The latest insights from our Health Law team.

In this edition:

Managing private medical practice in public hospitals

New report on Australian hospital statistics

SHPA new Standards of Practice

Maternity report proposes changes for rural mums

Federal Court rules that Medevac assessments by Australian doctors must be considered by Minister

APC accredited for five more years

Victorian health practitioners warned against medicating aged care residents without informed consent

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Managing private medical practice in public hospitals

The Victorian Auditor-General’s Office (VAGO) has recently tabled an audit report in Parliament which examined whether Victorians are receiving optimal outcomes when they enter a public health service as a private or public patient.

Patients may elect to enter a health service as a public or private patient, which will affect how the health service will bill that patient’s health insurer – whether through Medicare or a private health insurer. Private patients are able to enter public health services through health services’ arrangements with medical specialists. This enables health services to receive a mix of funding (from Commonwealth, State and private sources) that ensure the provision of quality healthcare services.

However, the Department of Health and Human Services (DHHS) is the manager of the Victorian public health system and has a mandate to ensure that access to healthcare services is equal to both private and public patients. The report examined DHHS’ role in the sector, as well as three health service providers, to ensure that health services are complying with their government funding agreements and health insurance legislation.

The audit report made ten recommendations, including seven specifically relating to DHHS.

You are able to read the full report here; an overview of the report can be found here.

New report on Australian hospital statistics

A new report, Hospital resources 2017–18: Australian hospital statistics has been released by the Australian Institute of Health and Welfare (AIHW).

The report presents information about public and private hospitals in Australia. It continues the AIHW series of Australian hospital statistics reports, which describe the characteristics, and activity of Australia’s hospitals.

The Report reveals that there were 693 public hospitals and 657 private hospitals in Australia. Most recent funding data available from 2016–17 shows that, 92% of public hospitals services were funded by the state/territory government and the Australian government. In contrast, 69% of private hospital funding came from non‑government sources.

The Report showed that total recurrent spending on public hospital services increased by 3.3% to $71 billion in 2017–18, with about 62% of this being spent on wages and salaries and superannuation. Nationally, 373,000 full-time equivalent staff were employed in providing public hospital services in 2017–18. About 42% of staff were Nurses (157,000) and 12% were Salaried medical officers (46,000).

Read more about the Report here.

SHPA new Standards of Practice

The Society of Hospitals Pharmacists of Australia (SHPA), in consultation with members of specialty practice committees, is comprehensively reviewing and expanding its Standard of Practice series, which provides guidance to pharmacists and health professionals on the “delivery of clinical, operational and specialty hospital pharmacy services”.

The first in a twenty four part series sets the foremost standard on pain management and includes information about “staffing ratios, consideration of patient factors for commencing treatment and discussion of emerging practice, such as opioid stewardship”.

For more information on SHPA’s review and upcoming releases, click here.

Maternity report proposes changes for rural mums

Due to the recent Rural Taskforce Report, expectant mothers in rural and remote Queensland will have a choice of where they give birth.

Previously, there has been a focus on the clinical risk of childbirth in a remote location, however this report draws attention to expectant mothers wishes and the effect that travel can have on a pregnant woman. Medical services in 110 rural towns across Queensland are to be reviewed to find out the possibility of retraining and bringing in new staff to enable births to occur.

In further response to the report, a $500,000 fund will be established by the Queensland Government in order to support rural midwives and doctors to rotate through larger hospitals. These rotations will ensure that staff are equipped with the correct and current skills to enable childbirth to occur in remote communities.

The report specifically proposed the following changes:

  1. rural doctors and midwives to travel to see more births;
  2. Ministers to approve any changes to maternity services;
  3. offering more rural maternity services where safe; and
  4. the needs of mums to be considered.

These changes will ensure security and opportunity for future services in rural communities.

To find out more, please click here.

Federal Court rules that Medevac assessments by Australian doctors must be considered by Minister

In a recent case involving a critically ill man on Nauru, the Federal Court of Australia ruled that two Australian doctors’ medical assessments were valid under the Medevac laws, despite the doctors not having any personal engagement with the patient.

Under the Medevac laws, the Home Affairs Secretary must notify the Minister for Home Affairs once two registered doctors have made valid recommendations for medical transfer.

This requirement has been complicated due to legislation passed by the Nauruan government that bans doctors from speaking with patients on Nauru for the purpose of medical assessment.

In its findings, the Court noted expert opinion that medical professionals can evaluate a patient’s needs for further assessment or treatment using notes of other practitioners or information gathered from third parties.

The process of applying for a medical transfer remains the same. The Minister retains discretion to refuse Medevac applications on national security or character grounds in every case.

For more information on the Federal Court’s ruling and the process for medical transfers, click here.

APC accredited for five more years

The Australian Health Practitioner Regulation Agency (AHPRA) has effected ten new accreditation agreements with various authorities in the health sector to improve transparency surrounding the standards of study programs and to achieve further outcomes that are key to the national accreditation scheme.

The Australian Pharmacy Council (APC) has joined the Pharmacy Board of Australia (PBA) in one of the ten agreements, pledging to provide the public with greater accountability and protection with regard to accredited study. Referred to as the ‘APC pact’, the agreement forms part of the National Registration and Accreditation Scheme.

The new agreement further entrenches the APC as a peak body in the health sector. Brett Symonds, PBA Chair, touts the APC as playing a “crucial role” in achieving the aims of national accreditation efforts.

Other outcomes the agreement is tailored to address include protecting cultural safety in accredited programs, reducing regulatory burden, and capitalising on multi-profession collaboration to meet the community’s advancing and contemporary healthcare needs.

For more information on the APC pact, click here.

Victorian health practitioners warned against medicating aged care residents without informed consent

Evidence from the Royal Commission into Aged Care Quality and Safety (Royal Commission) has revealed a tendency for Victorian health practitioners and residential aged care facilities to administer prescription medications, especially anti-psychotic medications, without the informed consent of the patient/resident.

Amendments to the Medical Treatment Planning and Decisions Act 2016 (Vic) in 2016 now define “medical treatment” to include “treatment with prescription pharmaceuticals”.

In response to evidence at the Royal Commission that Victorian residential aged care facilities are administering anti-psychotic medications to residents without their informed consent to surreptitiously “control behaviour and save on staff costs”, President of the Law Institute of Victoria, Stuart Webb, said:

“Let there be no doubt about what the law requires in Victoria. If the resident has capacity to consent to medical treatment, then the health practitioner must first obtain informed consent from the resident. If the resident lacks this capacity, the health practitioner must obtain consent from the resident’s medical treatment decision-maker. If they cannot identify a medical treatment decision-maker, they should contact the Office of the Public Advocate for consent,”

Chair of the Law Institute of Victoria Elder Law Section, Bill O’Shea said:

“A health practitioner who treats a resident with prescription pharmaceuticals without first getting informed consent commits medical trespass and faces civil liability as well as a charge of professional misconduct at AHPRA,”

For more information, click here.