February 2019

Issue 22

• Message from the Chair
• Board news 
  • Revised Capabilities for osteopathic practice − update 
  • Issues in notifications and how to prevent them
• Registration 
  • Latest registration update released
• National Scheme news 
  • Osteopathy Board supports more public information on the national register
  • Proposed changes to practitioners’ names published on the national register 
  • A win for public safety through AHPRA and Western Australia Police working together
• Keep in touch with the Board

Message from the Chair

Welcome to our first newsletter for 2019. This is an important year for the Board with progress on a number of projects.

This year we will hold registrant information forums in different locations, starting with Canberra, then Perth and Hobart. We will contact local registrants directly closer to the events and look forward to meeting you and hearing your insights about the regulation-related issues you face as an osteopath.

We will publish the revised Capabilities for osteopathic practice (the capabilities) this year. An article below summarises how we consulted on the capabilities, what to expect as we prepare to publish them, and the plans for phasing them in this year.

We also highlight some important ethical and professional issues that come to our notice through the Board's Registration and Notifications Committee (the RNC). These insights are shared as a learning aid to help you better understand your ethical and professional obligations. We talk about our regulatory decision-making using de-identified case examples, and how we make decisions on notifications and registration using our guidelines, standards and legislation. The decisions of the RNC are not published.

In a related article we explain that when serious allegations have been proven against a registered practitioner at a tribunal we will soon introduce links on the public register to those published tribunal decisions.

Dr Nikole Grbin
Osteopath
Chair, Osteopathy Board of Australia

Board news

Revised Capabilities for osteopathic practice − update

The Board consulted on the draft document with targeted stakeholders and then held public consultation. We received very helpful feedback and have published these submissions. We also selected a project team via a public request for quote process to take the preliminary and public consultation feedback and produce the next versions of the document. We then met with stakeholders in late November 2018 to discuss any issues that could inform minor amendments before release. This is a significant project for the Board and we appreciate the input of all who participated in this revision journey.

Planning for the implementation of the revised capabilities is underway and the Board intends to release the revised capabilities and any necessary supporting materials in mid-2019. We look forward to engaging with stakeholders and registrants in the following months to ensure a smooth implementation. The existing Capabilities for osteopathic practice will remain effective in the transition period (of up to six months) after publication of the revised capabilities.

More information will be shared with you as this work progresses − please check the Board’s communiqués and news section for updates.

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Issues in notifications and how to prevent them

The Board delegates its powers to consider registration and notification matters to its Registration and Notifications Committee (RNC), which meets monthly. The role of the RNC is to make decisions about notifications (complaints) made about osteopaths and applications for registration by individuals. To assist its decision-making the RNC refers to the registration standards and codes and guidelines set by the Board.

Under the Health Practitioner Regulation National Law (the National Law), anyone can make a complaint about an osteopath’s health, conduct or performance. Complaints may be received from any member of the public, including patients, employers or colleagues.

Since 1 July 2010, the following types of complaints have been received by AHPRA on behalf of the Board. This figure does not include notification data for NSW. In NSW, notifications are managed by the Osteopathy Council of New South Wales and the Health Care Complaints Commission.

Notifications received by AHPRA by issue category for Osteopathy Board of Australia from 2010/11 to 2017/18

1) New typology adopted in 2016/17 onwards that comprises ‘national law breach’ from previous years.
2) New typology adopted in 2016/17 onwards that comprises ‘offence’ from previous years.
3) Initial typology adopted at transition to the National Law. A new typology implemented from 2011/12 formed the basis for reporting in future years.

The Board’s 2017/18 annual report is now available to download and provides more information on notifications data from the past two years in particular. Here we explain some common issues and outcomes of notifications for osteopaths.

RNC decisions

As a result of a complaint the RNC may decide to:

• take no further action
•  caution the practitioner
• impose conditions on a practitioner’s registration (such as to complete further education)
• accept an undertaking from a practitioner
• refer a complaint to the health complaints entity in the relevant state, or
• refer a matter for a panel hearing (a health panel or a performance and professional standards panel) or to the relevant state tribunal.

The National Restrictions Library is used when conditions and undertakings are made by the RNC.

If the RNC reasonably believes that a practitioner has behaved in a way that constitutes professional misconduct, then it MUST refer the matter to the responsible tribunal in the jurisdiction where the behaviour occurred. A panel or tribunal can suspend a registration, and only a tribunal can cancel registration. Such tribunal decisions are publicly available and will soon be linked to a practitioner’s public register record (see article below). If an osteopath’s registration is cancelled their name will appear on the section of the public register for cancelled and/or prohibited health practitioners.

Case studies

Case 1: An osteopath did not offer a towel or covering for modesty, and requested disrobing that was not required for assessment of the patient. There were also communication issues that were neither professional nor mindful of the power imbalance between osteopath and patient. The Board imposed conditions on the practitioner’s registration which included education.

Case 2: An osteopath fraudulently obtained payments from the Workers’ Compensation and Traffic Accident Commission schemes. The practitioner was sentenced in the Magistrates Court and fined over $20,000. The Board decided under section 193 of the National Law to refer the matter to a tribunal, which decided to suspend registration for three months; to reprimand; and to impose conditions upon return to practice.

Case 3: The complaint related to alleged behaviour over 10 years before the complaint was lodged. In addition, there was insufficient detail provided, and without this it would be not possible to obtain an effective response from the practitioner. The Board decided to take no further action.

Common issues that arise in investigations include communication, informed consent and record keeping. Issues about communication and informed consent can underpin many complaints, even though the complaint may be triggered by something else such an adverse event or treatment not meeting expectations.

Communication

Good practice includes good communication and the Board’s Code of conduct highlights the importance of good communication in several areas. In particular, section 3.3 of the Code of conduct outlines the expectations of effective communication, including:

• discussing with patients their condition and the available healthcare options, including their nature, purpose, possible positive and adverse consequences, limitations to treatment and reasonable alternatives where they exist
• listening to patients and responding to their concerns and preferences
• giving patients adequate opportunity to question or refuse intervention and treatment, and
• ensuring that patients are informed of the material risks associated with any part of a proposed management plan.

The above list is not exhaustive and you are encouraged to review and consider the Code of conduct in your everyday practice.

When an osteopath fails to communicate effectively with a patient or carer this can affect how well the information provided is understood and the expectations of treatment. This can ultimately lead to patient dissatisfaction and potentially, worse health outcomes for the patient. Make sure you maintain respectful, clear, appropriate and timely communication with all patients and carers to reduce the risk of problems arising.

Informed consent

An osteopath also has legal and ethical responsibilities to ensure informed consent is obtained from the patient or carer in the proposed examination, treatment or procedure after they have provided appropriate advice and information. Good practice in obtaining informed consent is outlined in the Board’s Code of conduct and the Guidelines for informed consent.

Informed consent should be considered a process – not an event. It is a dynamic, continual, two-way process which is documented by the practitioner in their records. The Board’s Guidelines for informed consent outline information for practitioners about:

• the definitions of informed consent and why it is necessary
• the principles and practical steps to obtaining informed consent
• how to document informed consent
• how to gain informed consent if there is no capacity to give it
•  the continual nature of consent and triggers for renewal, and
•  withdrawal of consent.

The above information is not exhaustive and we encourage you to review and consider the Code of conduct, in particular section 3.5, to inform your practice.

When an osteopath fails to disclose to a patient or carer the risks and nature of treatment, they take away the right of the patient or carer to make a voluntary decision about treatment. This can affect the quality of the therapeutic relationship and can also result in harm and adverse outcomes for the patient. Make sure you are aware of the process for obtaining informed consent and documenting the patient or carer’s consent or refusal of treatment.

Record keeping

The Board’s Code of conduct and Guidelines on clinical records also set out the importance of osteopaths maintaining clear and accurate health records for the continuing good care of patients. The guidelines explain the professional and legal responsibilities a practitioner has when recording health information, including:

• the general principles of storing and maintaining contemporaneous records
• the personal and clinical information to be recorded as part of a consultation, such as examination, treatment, clinical findings and observations, advice provided and response to treatment.

The above list is not exhaustive and we encourage you to review and consider the Code of conduct, in particular section 8.4, in your everyday practice.

Other healthcare professionals rely on such documentation to ensure the safe and necessary provision of healthcare in the context of a patient’s prior history. Conscious focus on good record-keeping can improve your professional practice and strengthen health outcomes.

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Registration

Latest registration update released

There are 2,512 registered osteopaths in Australia as at 31 December 2018, an increase of 124 since the last report in September. Of the registered workforce, 2,414 have general registration, six have provisional registration and 92 have non-practising registration.

For more data about the profession, visit our Statistics page.

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National Scheme news

Osteopathy Board of Australia supports more public information on the national register

Changes to the national online register of practitioners will make it easier to access public information about health practitioners across Australia.

The online register has accurate, up-to-date information about the registration status of all registered health practitioners in Australia, including osteopaths. As decisions are made about a practitioner’s registration renewal or disciplinary proceedings, the register is updated to inform the public about the status of individual practitioners and any restrictions placed upon their practice.

Along with other National Boards, the Osteopathy Board of Australia has decided to introduce links to public tribunal and court decisions when serious allegations have been proven, in the interests of transparency and on the recommendation of the Independent review of the use of chaperones to protect patients in Australia.

No information about the notifications received by the National Boards and AHPRA will be published. The change is simply helping to make already publicly available information easier to find.

Further information is available on the Board’s website.

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Proposed changes to practitioners’ names published on the national register

Governments recently consulted on possible changes to the Health Practitioner Regulation National Law, as in force in each state and territory (the National Law), one of which would allow AHPRA and the National Boards to publish the names that registered health practitioners use in practice and not just their legal name. The national online register of practitioners is a vital part of Australia’s system of regulating health practitioners to support patient safety.

The public and employers can look up the names of all health practitioners who are registered to practise, as well as information about any limits or restrictions placed on the way an individual practitioner is allowed to practise.

The national online register must remain an authoritative and trusted source of information about health practitioners. Consumers rely on it for accurate, up-to-date information to inform their healthcare decision-making and employers rely on it to validate their employees’ registration status.

Some health practitioners practise their profession using a name that is different from their legally recognised name published on the register (an alias). AHPRA has asked governments to consider changes to the National Law, that would enable registered health practitioners to nominate one or more aliases to be recorded on the public register.

AHPRA believes that recording additional names (or aliases) on the register will help to inform and protect the public by making it easier to identify a practitioner who may be registered and able to practise but who is not using their legal name.

AHPRA and the National Boards will keep practitioners and the public informed of any changes to the law and reporting requirements. For more information, read the media release on AHPRA’s website.

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A win for public safety through AHPRA and Western Australia Police working together

AHPRA and Western Australia Police have announced a Memorandum of Understanding (MoU) enabling greater coordination and communication between the two agencies for the protection of the public.

The development of this MoU follows the successful MoU established with Victoria Police in 2018. The MoU recognises the learning that resulted from the Independent review of the use of chaperones to protect patients in Australia and formalises the existing processes for the release of information by AHPRA when it identifies information relating to criminal offences, including physical harm, sexual offending, production of exploitative material and/or drug offences.

The MoU also documents the mechanism for WA Police to share information with AHPRA about practitioners they suspect may pose a risk of substantial harm to the public or individuals posing as registered health practitioners when they are not.

Security protocols around the transmission, storage, use and disclosure of information that is shared between WA Police and AHPRA are also detailed within the agreement.

Read the full media release.

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Keep in touch with the Board

• Visit www.osteopathyboard.gov.au for the mandatory registration standards, codes, guidelines and FAQs. Visiting the website regularly is the best way to stay in touch with news and updates from the Board.
• Lodge an enquiry form via the website by following the Enquiries link on every web page under Contact us.
•  For registration enquiries, call the Australian Health Practitioner Regulation Agency (AHPRA) on 1300 419 495 (from within Australia) or +61 3 8708 9001 (for overseas callers).
• To update your contact details, see important emails about registration renewal and get other Board updates, log in to the AHPRA portal using your User ID and password.

Address mail correspondence to: Dr Nikole Grbin, Chair, Osteopathy Board of Australia, GPO Box 9958, Melbourne, VIC 3001.

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