Understanding decision making - Investigating complaints Tony Kofkin Director of Investigations...
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Understanding decision making - Investigating complaints Tony Kofkin Director of Investigations Health Care Complaints Commission Dr Walid Jammal Medical
Understanding decision making - Investigating complaints Tony
Kofkin Director of Investigations Health Care Complaints Commission
Dr Walid Jammal Medical Practitioner, GP Expert, Medical
Advisor(Avant)
Slide 2
Investigating complaints The Commission must investigate
complaints that: Raise significant issues of public health or
safety or significant questions as to the appropriate care or
treatment of a client by a health service provider. If
substantiated would provide grounds for disciplinary action against
a health practitioner Appears to be a breach of the Code of Conduct
for unregistered health practitioners that is considered a risk to
the health or safety of the public
Slide 3
Who was referred for investigation 2013-14?
Slide 4
Investigating complaints During an investigation evidence is
gathered from a variety of sources that may prove or disprove the
allegations raised in a complaint Commission has powers to compel
information. External experts advice is crucial in determining
whether or not to take disciplinary action.
Slide 5
Investigating complaints Before finalising an investigation,
Commission presents its findings to the relevant provider and
invites their submission If the provider is a registered
practitioner, the Commission consults with the relevant
professional council -> All parties are informed about the
outcome of the investigation
Slide 6
Outcomes of investigations
Slide 7
Outcomes of investigations 2013-14
Slide 8
Role of an expert during investigation Experts are recruited
through Colleges and Associations and are provided with regular
training by the Commission Experts are matched as closely as
possible to the provider who is subject of the investigation Expert
is provided with all relevant material and asked to provide their
expert opinion When evaluating the evidence, expert refers to what
would be a reasonable standard for practitioners in the same
profession with an equivalent level of training or experience There
may be different versions of events- it is NOT the experts role to
judge the credibility of these versions different opinions may be
needed for different versions
Slide 9
Role of an expert during investigation Expert, based on the
facts presented to them, formulates an opinion by : Defining where
the reasonable standard of care lies not the gold standard and not
best practice Deciding whether the practitioner departed from the
standard expected from someone of equivalent level of training or
experience Deciding whether the departure from the standard was
significant Deciding whether this departure would invite strong
criticism from the profession
Slide 10
Role of an expert during investigation Expert needs to clearly
define the reasons for the opinion, citing reference material
and/or experience Expert needs to be careful about hindsight bias;
outcome bias; retrospective micromatching Distinguish between
standard of the records vs standard of care An expert must remain
in their level of expertise
Slide 11
Case 1 Alternative medicine The complaint Dr G was a doctor who
practised alternative medicine. He believed in the value of
manipulation of the spine in order to correct problems of blood
flow to the brain. He developed a philosophy that most illness can
be cured by manipulation of the cervical spine. For example, a
child with pneumonia; a person with inflamed conjunctiva; a child
with autism; a person with tonsillitis. -> Doctor was assessed
by Medical Council and suspended, complaint referred to Commission
to investigate
Slide 12
Case 1 Alternative medicine How the expert adviser approached
the case the standard of care was clearly defined the manipulation
embarked upon was in no way indicated; no evidence at all not
expected from a GP; no peer would ever agree. -> significant
departure from accepted standards Given the multitude of patients,
and the strict adherence by Dr G to such a philosophy -> strong
criticism
Slide 13
Case 1 Alternative medicine Decision The investigation was
referred to the Commissions Director of Proceedings to consider
prosecution before a Tribunal or Professional Standards Committee
Ultimately, Dr G was de-registered by Tribunal for a minimum period
of three years
Slide 14
Case 2 phone consultations The complaint Dr S was engaged to
undertake phone consultations for a sexual health clinic. Dr S
prescribed medications which were off label, which were then
purchased from the same company that engaged Dr S. The Commission
alleged that Dr S failed to: physically examine the patient before
recommending a treatment program that lasted for about 18 months at
a cost of almost $4,000 discuss alternative treatment options keep
appropriate medical records of the consultation.
Slide 15
Case 2 Phone Consultations The main issues for the expert to
consider were: Whether selling of these medications presented a
conflict of interest Off label use of medication Informed consent
issue. Whether any other choices of treatment were discussed
Whether conducting phone consults with new patients is sufficient
and reasonable Adequacy of medical records -> Expert found
significant departure in relation to most of the above points and
was strongly critical.
Slide 16
Case 2 Phone Consultations Decision Investigation was referred
to the Director of Proceedings who determined to prosecute before a
Professional Standards Committee Committee found most of complaint
proven (except lack of follow up recommendation) and reprimanded
the practitioner
Slide 17
Summary Decision making when investigating complaints There is
a legislated threshold for the Commission to investigate a
complaint (section 23 HCCA 1993) Commission has extensive powers to
obtain information Commission commonly tasks experts to evaluate
relevant evidence Provider always has the opportunity to make a
submission Where required, the Commission consults wit the relevant
professional Council