A gynaecologist accused of "troubling" behaviour was allowed to continue to practise — as long as he didn't sit in the same room as the people he treated.
A psychologist who initiated a sexual relationship with a former client who had just turned 18 was allowed to keep seeing patients after an 18-month suspension.
A doctor who admitted to inappropriately touching a patient's vagina was allowed to return to work on the condition he's not left alone with female patients older than 13.
These are real examples of Australia's system of medical regulation in action: one that claims to prioritise public safety, but often falls short of public expectations.
Data from the Australian Health Practitioner Regulation Agency (AHPRA) shows complaints about what it calls "boundary violations" are on the rise, increasing from 75 notifications in 2012-13 to 841 in 2022-23.
Four Corners aired an investigation into the regulatory system's response to sexual misconduct almost exactly one year ago. We found cases where doctors convicted of offences including possessing and distributing child exploitation material were still practising. We found situations where patients would have no idea if their doctor had previously been sanctioned for inappropriate, even criminal conduct.
It was difficult – impossible, in most matters dealt with outside of New South Wales – to find out why practitioners previously deemed an unacceptable risk to the public had been allowed to return to the treatment room because it is currently illegal for AHPRA to release this information. (NSW has a slightly different system.)
In the wake of our story, which included devastating testimony from patients, AHPRA and state and territory health ministers pledged to examine whether the system was up to scratch.
It's taken some time, but all health ministers, led by Victoria, are now consulting on potentially dramatic reform to address some of the issues highlighted in that Four Corners episode, Do No Harm.
According to documents published on the Victorian government's Engage platform, the proposed changes could:
- Mean more information on a practitioner's registration when there are proven findings of sexual misconduct or sexual offences, with some exceptions (for example, if the practitioner has an impairment);
- Require a person who has had their registration revoked to apply to an independent tribunal for a reinstatement order before being allowed to return to practise, meaning more transparency around what is currently a secret process. This is already the process in NSW;
- Make it an offence for practitioners to seek a non-disclosure agreement from a patient that prevents them from making a complaint to the regulator.
In a statement, Victorian Health Minister Mary-Anne Thomas said: "Every Australian rightfully expects their doctor-patient relationships to be respectful, appropriate and above all else, strictly professional," Ms Thomas said.
"These reforms will aim to improve transparency for patients so they can make an informed choice when choosing which health practitioner is right for them."
An uncomfortable issue
There will be a diversity of views in response to the proposed changes.
Many tribunals are already sagging under heavy caseloads – adding to their work will inevitably worsen these waits. Health practitioners, the vast majority of whom are professional and trustworthy individuals, may resist further regulation and scrutiny from AHPRA, which released a report last year that found 16 doctors tragically suicided while under investigation. Professional boards already have the power to take swift (albeit temporary) action in situations where a practitioner is believed an unacceptable risk to the public.
This is a complex, delicate space, and a difficult issue to balance. Doctors, nurses and other health professionals have to be able to do their jobs without fear of being reported. Patients must be able to trust that the necessarily invasive requests made by their treating practitioners are purely professional.
So here's why we need to think about this uncomfortable issue. The patients I have spoken with, those who have been directly affected by these behaviours, are badly affected by what has happened. They almost uniformly struggle to seek healthcare after their experience, because their trust has been too severely breached. The impacts are lifelong and devastating – and often extend to that person's friends and family.
In a British Medical Journal special on sexual violence within the UK's NHS last year, orthopaedic surgeon Simon Fleming was firm: "We do not need any more surveys to see whether there is a problem — evidently there is. We do not need any vague general statements or more silence on the issue. We need decisive action."
Consultation on the proposed changes closes on February 19.
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