PSR Newsletter, April 2020

Welcome to the April 2020 edition of the quarterly PSR Panel Newsletter.

Agency activity summary for the quarter

In the period from 1 January 2020 to 31 March 2020 the Agency received 35 new requests (including 2 practitioners who had previously been referred). The Agency finalised 26 requests. This comprised:

• 22 effective s 92 agreements
• 3 effective final determinations
• 2 s 91 ‘no further action’ outcomes

A total of $6,163,254 in repayment directions were made from the finalised matters. Of the finalised matters, 20 involved some form of disqualification.

In this period 6 new peer review Committees were established and 4 practitioners were referred to AHPRA because of significant patient safety concerns.
 

New appointments to the PSR Panel

The following appointments were made to the PSR Panel in the last quarter: Dr Caroline Badam, Endocrinologist

• Dr Carolyn Petersons, Endocrinologist
• Dr Carolyn Ross, Ophthalmologist
• Dr Cathy McGuckin, Psychiatrist
• Professor Desmond Yip, Oncologist
• Dr Colin Whitewood, Orthopaedic Surgeon
• Dr Fiona Joske, General Practitioner
• Dr Hugh Bartholomeusz, Plastic Surgeon
• Dr Kian Yong (Ken) Ho, Endocrinologist
• Dr Kurt Gebauer, Dermatologist
• Dr Lana Kossoff, Psychiatrist
• Dr Lawrence Malisano, Orthopaedic Surgeon
• Dr Nicole Gorddard, Oncologist
• Dr Peter Habersberger, Cardiologist
• Dr Robert Menz, General Practitioner
• Dr Sara Booth-Mason, Ophthalmologist
• Dr Scott Preston, General Practitioner
• Dr Stewart Einfeld, Psychiatrist

As a result of new referrals from the Chief Executive Medicare, the PSR is also in the process of making appointments in the following disciplines:

• Neurology
• Cardiology Maxillofacial surgery
• Neonatal / Perinatal Medicine
   

Interviews for Determining Authority

In February 2020, PSR advertised nationally for appointments to the Determining Authority. Interviews were held on 13 March 2020. A consultation process is underway and names of progressing applicants should be forwarded to the Minister for consideration in April with a planned start date in May 2020.
 

Panel member training Information

Panel member training for 2020 has been cancelled in line with government travel advice. Hopefully we will be able to reschedule training for the end of 2020 or early in 2021.
 

Changes to processes during COVID-19 Pandemic

PSR continues to implement Government advice. The current operational process is outlined below.

PSR Staff

PSR staff continue to work. All staff are now able to work from home. Staff can also come into the office if required to complete specific tasks. We have a rotating system in place to ensure the office remains open.

PSR office space is large and social distancing can be implemented in excess of Government restrictions. Office cleaning policies have been amended in line with Government advice. The Business Continuity Plan committee meet weekly to review processes. Staff flu vaccinations have been brought forward to early April. The office has adequate supplies of cleaning equipment, sanitisers and other essential supplies.

PSR is co-operating with a Directive from the APS and has reviewed every staff member to determine if any might be able to be redeployed into another Agency or Department if required. At this stage, PSR has been asked to continue operations and no staff member has been asked to redeploy.

Director stage

Director reviews have statutory timeframes and cannot be halted except for a narrow list of reasons which does not include pandemic. Therefore these are continuing, but the greatest flexibility available under legislation is being offered to practitioners under review.

Reviewers who provide advice to the Director at this stage of the PSR process will work from home, except in a small number of cases where they will come into the office. In these cases, the reviewer will keep away from other staff and review records in a self-contained office that is separated from other offices.

The Director will continue to offer practitioners under review a chance to meet and talk with the Director about their review. These meetings shall be held by teleconference or videoconference. Meetings with legal representatives shall also be held by teleconference.

Committee stage

All scheduled face-to-face Committee work in the coming months has been postponed and will be rescheduled once the COVID-19 pandemic has passed.

Background work to Committees will continue including drafting reports and considering submissions. Panel members will continue to be asked to provide input into draft and final Committee reports remotely through GovTEAMS.

New Committees will be established as required to meet statutory deadlines, but after establishment and a preliminary teleconference, we do not anticipate scheduling hearings at this stage.
 

Determining Authority

The Determining Authority will meet via teleconference until the end of the pandemic. Members can access documents securely through GovTEAMS.
 

Federal Court outcomes

National Home Doctor Service Pty Ltd v Director of PSR [2020] FCA 386

The Federal Court set aside the decision of the Director of Professional Services Review (PSR) to refer National Home Doctor Service Pty Ltd (NHDS) to a PSR Committee for investigation, but indicated that it remains open for the Director to do so again.

A number of medical practitioners had previously been referred to PSR and 14 practitioners had acknowledged that they had engaged in inappropriate practice in connection with rendering urgent after-hours MBS items while associated with NHDS. The nature of the conduct identified as raising a concern about inappropriate practice included:

• Concerns about clinical decision-making in prescribing antibiotics and schedule 4 and 8 medications,
• poor clinical input,
• inadequate record-keeping, and
• a concern that a large proportion of the services rendered involved conditions that either did not require treatment or could have reasonably waited until the next in- hours period.

The Court said that the Director was entitled to have regard to those practitioners’ conduct when referring NHDS to a PSR Committee to investigate whether NHDS engaged in inappropriate practice through the provision of urgent after-hours services by a further 56 practitioners.

The Court said that it was not unreasonable or irrational for the Director to have made that referral. However, the Court said that, before doing so, the Director should have provided NHDS with more information specific to the practitioners’ conduct and their relationship with NHDS that caused the Director concern so that NHDS would have had an opportunity to make submissions to dissuade the Director from referring the services of the 56 practitioners to a PSR Committee.

The Court upheld the PSR’s position that the Director did not need to make a positive finding concerning the legal relationship between NHDS and the practitioners, but merely have a concern that such a relationship may have existed, that the practitioners may have engaged in inappropriate practice in providing services, and that NHDS may have knowingly, recklessly or negligently caused or permitted a practitioner to engage in inappropriate practice.

The Director will comply with the Court’s feedback and gather further information and seek a response from NHDS before making a new decision.

The judgment can be accessed here.
 

PSR Outcomes

PSR publishes a monthly summary of case outcomes on its website. Each summary provides some idea of the person under review's practice profile (in comparison to their peers) and this helps understand why they were referred to PSR for review. In addition, the summaries detail the items investigated, the findings (in the case of a Committee) or the agreement reached between the person under review and the Director (PSR), and the sanctions applied.