‘Little faith’ in vexatious notifications filter

Jolyon Attwooll

10/01/2023 3:48:55 PM

A college submission to the Health Practitioner Ombudsman has suggested a number of improvements for AHPRA’s processes.

Stressed GP
A vexatious complaint notification 'can have devastating effects on practitioners', according to the RACGP.

Guidelines put together by AHPRA to identify and deal with vexatious complaints have done little to ease GPs’ concerns about the process, according to the RACGP.
In a response to a National Health Practitioner Ombudsman (NHPO) review, the college has queried the impact of AHPRA’s new vexatious notifications framework.
The five-page guidelines were released in late 2020 following a Senate inquiry into complaints under the Health Practitioner Regulation National Law. The framework’s creation was one of 14 recommendations put forward.
While the change was welcomed at the time, the college submission to the NHPO says the framework has not helped improve a process that has ‘significant consequences’ for those involved.
‘GPs have raised a multitude of concerns in relation to the process, and it appears that AHPRA’s vexatious notifications framework has done little to address these,’ the document reads.  
‘There is a prevailing sense that the process is unfair, lacks transparency, and can have devastating effects on practitioners who are not at fault.’
RACGP President Dr Nicole Higgins also says the process for weeding out vexatious notifications is not working as it should.

‘There is so much damage done when a complaint that should never been made is allowed to linger needlessly,’ she told newsGP
‘They need to be identified and cast out more swiftly so GPs can get on with their vital clinical work without this incredibly stressful and time-consuming distraction hanging over them.’
In a newsGP poll run last November, only 1% of 1705 respondents said they believed the AHPRA processes for dealing with vexatious complaints are working effectively.
One of the specific criticisms of the new framework in the college submission is that while it details the process, it does little to set out any action to deter or reduce vexatious complaints.
It simply says that if a manager forms a ‘reasonable view’ that the notification ‘appears to be vexatious’, it should present that information to the National Board ‘with appropriate recommendations to close the notification’.
‘Our members consider this blatantly unfair – while patients should have an avenue to make complaints, there must be some deterrent to prevent future vexatious notifications being made,’ the submission authors write.
Dr Higgins raises the same issue.
‘As it stands, there are almost no disincentives for bad actors looking to damage GPs in this way,’ she said.  
‘Stronger measures to stop unreasonable and malicious complaints from being made in the first place can’t come quickly enough.’
The same Senate inquiry that suggested the framework also recommended the Council of Australian Governments (COAG) Health Council (now known as the Health Ministers’ Meeting) ‘consider whether recourse and compensation processes should be made available to health practitioners subjected to vexatious claims’.
However, that suggestion was dismissed in 2018.
The definition of vexatious is also raised by the RACGP, with members expressing concerns it is ‘too narrow’.
While research commissioned by AHPRA suggests that vexatious complaints account for less than 1% of notifications, many believe the number is likely to be significantly higher.
‘[RACGP members] advise that this does not include many frivolous claims that are not classified as vexatious, and a clear and transparent approach is needed for dealing with these,’ the submission reads.
‘Concerns have also been raised about the literature review upon which the <1% figure is based, which members have described as limited.
‘There is very little published independent evidence regarding the rate of vexatious or frivolous complaints against health practitioners across the world.’
The submission states that college members who provided their feedback feel that ‘any complaint that is found meritless by other practitioners should be deemed vexatious’.
In the past 12 months, newsGP has covered several controversial complaints made against GPs.
In one instance, Adelaide GP Dr Alvin Chua received a notification, which was later dismissed, after he was injured in an alleged assault by the complainant.
In another example, NSW GP Dr Simon Holliday was told by the NSW Health Care Complaints Commission to watch the way he spoke publicly, after an anonymous, error-strewn complaint conflated remarks he had made to local media about the vaccine rollout.
The complaint was ultimately dismissed, but Dr Holliday believes the system was effectively ‘weaponised’ against him. While acknowledging that the complaint was not made through AHPRA, Dr Holliday believes that process is also open to similar abuse.
Dr Holliday says he knows of complaints made against GPs by patients who were refused scripts or certifications for Centrelink, work and disabled parking.
According to Dr Holliday, groundless complaints have also been repeatedly made against the same doctor by the same patient, triggering an investigation each time.
All complaints should be triaged by practising doctors, he believes – and he also queries whether anonymous complaints should be accepted, another possibility raised in the RACGP submission.
‘The quality of a clinician is not defined by whether he/she always leaves the “customer” satisfied,’ Dr Holliday told newsGP.
‘The patient is not just a customer and so the customer is not always right.’
One of the most serious implications of a vexatious complaint includes the possibility of driving GPs away from the profession, an outcome the RACGP submission warns about.
‘Losing a competent GP from the workforce due to poor handling of the notifications process is extremely concerning, particularly given current poor workforce projections in the sector,’ it states.
‘In areas of workforce need, such as rural and remote areas, the loss of a GP may leave whole communities without access to medical care.’
In its 2021–22 annual report, AHPRA reported that of 5874 closed notifications, 58.2% resulted in no further action, with only 0.8% leading to a practitioner having their registration surrendered, suspended or cancelled.
It did not detail the number of vexatious or frivolous complaints.
Meanwhile, the most recent NHPO annual report said there were 823 complaints to the Ombudsman about AHPRA, a 42% increase from the previous financial year.
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Dr Anjum Ahmed Shaikh   11/01/2023 7:38:19 AM

AHPRA should introduce a compulsory lodgement fee of $100 for all complaints made against a health practitioner. It would be enough to weed out any vexatious complaints. It's a win win situation as it will also reduce the workload on AHPRA and bring in more revenue to AHPRA. If the small claims court and the justice system can charge you a lodgement fee for filing a fee, there is no reason why AHPRA can not charge a similar fee to the complainant.

Dr Dhara Prathmesh Contractor   11/01/2023 7:57:12 AM

Great article.
Hope the omnipresent truth of this article that GP’s in community go through, gets across and ombudsman and AHPRA , they understands the constant threats that practitioners go through each day.
Unfortunately, being a GP in community and these vexatious complaints and litigation, makes one feel unsafe citizens in the community , with deprived freedom of speech.
When our soul purposes are to keep our community healthy and achieve best health outcomes! As per RACGP and AHPRA guidelines!

Dr Rolf Tsz Kit Tsui   11/01/2023 10:30:11 AM

Making lodging complaints via AHPRA equivalent to a Statutory Declaration would help significantly. The notifier will be made aware making a false or misleading statements would be regarded as an offence and punishable under the current sanctions for Stat Decs. It does not prevent a person from making a compliant, however the onus will be on them to make sure it is truthful and limit weaponising it.

Dr Greg Saville   13/01/2023 9:01:54 AM

It is good to see Dr Anjum Ahmed Shaikh championing my idea from a comment I made to Australian Doctor several months ago. My idea then was for AHPRA to establish a filling fee of $100 so that people making a complaint understand the gravity of what they are doing. At the moment, the AHPRA complaints web form looks like an online survey into the character of their doctor. There is little to be seen of the potential life changing and career changing impacts of such complaint. As such, AHPRA has given the aggrieved anti-vaxxer, hostile colleague, or run-of-the-mill sociopath carte blanche . The online complaints form should start with "please enter your credit card details" . Only then might the vexatious complainant realise that the AHPRA process is not an axe-grinding exercise but a genuine attempt to keep patients safe. In cases of genuine hardship, measure could be put in place to waive this fee (e.g. submission of the past 3 years tax returns to confirm low income status).

Dr Alvin Kian Chung Chua   20/01/2023 4:31:11 AM

As the victim of an assault by a racist patient who then had the audacity to report me ejecting him off my premises after the assault as having an “impact on his mental health”, the most distressing aspect of the entire process was having that phone call from AHPRA then the 6 week delay before notification of the case being dismissed was finally received! Notwithstanding that the day of the phone notification, I was about to undergo neurosurgery for cervical disc fusion, contributed to, though not caused by my assailant! The day I was notified case was dismissed was the day before my 2nd surgery for failed anterior disc fusion!