Outcomes of notifications to health practitioner boards: a retrospective cohort study

Abstract

BackgroundMedical boards and other practitioner boards aim to protect the public from unsafe practice. Previous research has examined disciplinary actions against doctors, but other professions (e.g., nurses and midwives, dentists, psychologists, pharmacists) remain understudied. We sought to describe the outcomes of notifications of concern regarding the health, performance, and conduct of health practitioners from ten professions in Australia and to identify factors associated with the imposition of restrictive actions.MethodsWe conducted a retrospective cohort study of all notifications lodged with the Australian Health Practitioner Regulation Agency over 24 months. Notifications were followed for 30–54 months. Our main outcome was restrictive actions, defined as decisions that imposed undertakings, conditions, or suspension or cancellation of registration.ResultsThere were 8307 notifications. The notification rate was highest among doctors (IR = 14.5 per 1000 practitioners per year) and dentists (IR = 20.7) and lowest among nurses and midwives (IR = 2.0). One in ten notifications resulted in restrictive action; fewer than one in 300 notifications resulted in suspension or cancellation of registration. Compared with notifications about clinical care, the odds of restrictive action were higher for notifications relating to health impairments (drug misuse, OR = 7.0; alcohol misuse, OR = 4.6; mental illness, OR = 4.1, physical or cognitive illness, OR = 3.7), unlawful prescribing or use of medications (OR = 2.1) and violation of sexual boundaries (OR = 1.7). The odds were higher where the report was made by another health practitioner (OR = 2.9) or employer (OR = 6.9) rather than a patient or relative. Nurses and midwives (OR = 1.8), psychologists (OR = 4.5), dentists (OR = 4.7), and other health practitioners (OR = 5.3) all had greater odds of being subject to restrictive actions than doctors.ConclusionsRestrictive actions are the strongest measures health practitioner boards can take to protect the public from harm and these actions can have profound effects on the livelihood, reputations and well-being of practitioners. In Australia, restrictive actions are rarely imposed and there is variation in their use depending on the source of the notification, the type of issue involved, and the profession of the practitioner.

Complaints about dental practitioners: an analysis of 6 years of complaints about dentists, dental prosthetists, oral health therapists, dental therapists and dental hygienists in Australia

“…Dentists, including general dentists and dental specialists, are at higher risk of complaints to health regulators than any other registered health profession in Australia. Most of the complaints about dentists and dental prosthetists related to treatments and procedures, which may reflect the high risk, and often irreversible, nature of procedures such as prosthodontics, endodontics, restorative dentistry, oral surgery, implants and orthodontics . In addition, dentists work on conscious patients and do many procedures per day.…”

“…AHPRA provided us with data on all health practitioners registered between 1 January 2011 and 31 December 2016. This ‘practitioner extract’ consisted of variables indicating the period during which each practitioner was registered; the practitioner's age band, sex, profession and state or territory of practice, and the remoteness (as defined by the Australian Standard Geographical Classification Remoteness Structure) based on the main practice location provided by the practitioner …”

Sexual misconduct by health professionals in Australia, 2011–2016: a retrospective analysis of notifications to health regulators

“…Further, any person may lodge a notification of sexual misconduct. Substantiated allegations can trigger sanctions ranging from a caution to cancellation of registration …”

Serious misconduct of health professionals in disciplinary tribunals under the National Law 2010–17

“…Bismark et al 4,7,8 assessed complaint data gathered by the national regulator, the Australian Health Practitioner Regulation Agency (AHPRA), and identified trends and risk factors across and within the regulated health professions. In a retrospective study of all notifications made to AHPRA during 2011 and 2012 (excluding New South Wales (NSW)) concerning the original 10 regulated professions, Spittal et al 9 found that the notification rate was highest among doctors and dentists and lowest among nurses and midwives. Spittal et al 9 reported that the likelihood of 'restrictive action' (a broad category that included voluntary undertakings and conditions, as well as suspension or deregistration) was higher for cases involving impairment, improper prescribing or use of medication, and sexual misconduct than for cases involving clinical care.…”

“…In a retrospective study of all notifications made to AHPRA during 2011 and 2012 (excluding New South Wales (NSW)) concerning the original 10 regulated professions, Spittal et al 9 found that the notification rate was highest among doctors and dentists and lowest among nurses and midwives. Spittal et al 9 reported that the likelihood of 'restrictive action' (a broad category that included voluntary undertakings and conditions, as well as suspension or deregistration) was higher for cases involving impairment, improper prescribing or use of medication, and sexual misconduct than for cases involving clinical care. Doctors were less likely to face restrictive action than all the other professions.…”