Senate Committee
Community Affairs Reference Committee
Australian Senate
Parliament House
Canberra.
Australia
Re: Public Submission into upcoming Senate inquiry into Administration of registration and notifications by the Australian Health Practitioner Regulation Agency and related entities under the Health Practitioner Regulation National Law
Dear Committee,
I offer a public submission based on information appearing in the Internet.
My submission begins with USA’s concerns about Australia in the year of 2014.
David Studdert from America’s Stanford University. He joined hands with Marie Bismark from Australia’s Melbourne University to research Australia.
Found: “Legal regimes in other countries, including New Zealand, the United States, and Canada, reports about impaired peers in certain circumstances. However, Australia’s mandatory reporting law is unusually far-reaching.”
The research of August 2014 carried a title: “Mandatory reports of concerns about the health, performance and conduct of health practitioners.”
They explained:
“Who has an obligation to report?
Employers, education providers and health practitioners.”
They explained “notifications.”
“AHPRA receives “notifications” on a prescribed form. Two of us helped AHPRA develop the form in 2011.”
‘We obtained data from two AHPRA sources: mandatory notification forms and the national register of health practitioners.’
They identified how they conducted research.
“We conducted a retrospective review and multivariate analysis of all allegations of notifiable conduct, involving health practitioners received by AHPRA between 1 November 2011 and 31 December 2012.”
They identified the amount of data of mandatory notification as 850 (with NSW) and 819 (without NSW)
They addressed the controversies.
“Mandatory reporting has sparked controversy and debate.
Critics charge that mandatory reporting fosters a culture of fear, deters help seeking, and fuels professional rivalries and vexatious reporting.
Concerns have also been raised about the subjectivity of reporting criteria.”
“Little evidence is available to evaluate the veracity of these different views.”
After reading these words, I concluded that they did not even try to find vexatious mandatory notifications owing to availability of little evidence to evaluate if anything is even vexatious or not. I did not conclude that they found “evidence” of vexatious mandatory notifications to be “little” in numbers or amounts.
Three years later, on November of 2017, the Australian researcher repeated the same in a report. It was a summary report of literature review prepared for AHPRA.
It was called: Reducing, Identifying and Managing Vexatious Complaints.
Marie Bismark worded:
“The limited literature on vexatious complaints focuses almost exclusively on complaints made by members of the public who display obsessive and unreasonable complaining behaviour.”
“There is essentially no empirical evidence on the incidence of professionals lodging vexatious complaints about each other for personal or professional gain, or as a bullying tactic.”
Marie explained that she prepared a summary report on review of grey and academic literature.
“The Australian Health Practitioner Regulation Agency (AHPRA) commissioned the authors of this report to conduct a literature review into the issue of vexatious complaints about health practitioners.”
Such a thing is not called a “research.”
So Marie explains:
‘There is a paucity of robust research about the actual incidence or impact of vexatious complaints in the health sector, but the best available estimates suggest no more than 1% of complaints are vexatious.’
They are complaints from members of the public, and not mandatory reports.
Marie described “truly” vexatious complaint:
‘A truly vexatious complaint is defined not by outcome or subject experience, but by a specific combination of basis and intent.’
In the meantime, the Senate Committee identified “Potential” as the opposite of “true” or “truly.” It happened in Chapter 6 of the 2017 report.
“6.5 Dr Fettke requested that the committee investigate whether AHPRA had breached parliamentary privilege.
AHPRA advised the committee that the issuing of the notice within hours of Dr Fettke giving evidence to the committee was coincidental.
Consequently, the committee was not satisfied that it could establish a clear link between Dr Fettke’s giving of evidence to the committee and the issuing of the notice.
Ultimately, the committee was not satisfied that a sufficient causal link could be drawn between Dr Fettke’s evidence to the committee and the media release, to warrant referral of the matter to the Senate Committee of Privileges.
Instead, the committee resolved to inform the Senate of the potential breach of privilege through this report.”
On May of 2016, NHPO introduced “voluntary notification” in public submission 12 in the November 2016 Senate Inquiry.
“While it is the case that anyone can make a notification, the National Law differentiates between circumstances where a person is required to make a mandatory notification and circumstances where a person may choose to make a voluntary notification.”
NHPO do not have the power to find vexatious notification, or determine it’s incidence if present. Yet NHPO claims:
‘While it must be acknowledged that there is an identifiable risk that the notifications can be used vexatiously for bullying or harassment, the NHPOPC’s experience in handling complaints about the administrative actions of AHPRA and the National Boards does not suggest, that there is a high incidence of people intentionally using notification processes for vexatious purposes.’
“Potential” is not “true” or “real” to the Committee.
NHPO finds such a “potential” which does not mean true to the Committee.
‘A small number of complaints to the NHPOPC involve issues that have the potential to raise questions about the motivation of the notifier,
for example:
- notifications made by health practitioners about other health practitioners in circumstances where there has been a breakdown of a business or personal relationship.
- notifications about health practitioners made by friends or family members of the health practitioner, particularly in the context of a relationship breakdown (Now I would like to introduce the false and the misleading and quantify them too.
On 22 November 2016, Senator Rachel Siewert, the Chair, and the witness CEO of AHPRA, Martin Fletcher talked.
Warned Rachel Siewert: ‘It is unlawful for anyone to threaten or disadvantage a witness on account of evidence given to the committee, and such action may be treated as a contempt by the Senate. It is also a contempt to give false or misleading evidence.’
‘Welcome, Mr Fletcher, and thank you for coming today. Could I just confirm that you have been given information on parliamentary privilege and the protection of witnesses and evidence?’
Mr Fletcher: ‘Yes.’
Said Marie Bismark’s report: …..the Australian Health Practitioner Regulation Agency (AHPRA) commissioned the authors of this report to conduct a literature review…’
Martin Fletcher lies that he commissioned research. “Three, AHPRA will commission research on vexatious complaints to deepen our understanding.”
This is lie no. 1.
Senator XENOPHON: ‘You have said that AHPRA will commission research on vexatious complaints to ‘deepen our understanding’. Does that imply that—I do not want to say this in a provocative way—there is much more that can be learnt by AHPRA in relation to vexatious complaints? Is it that there is a lot that you do not know, or is it that there is more scope to deepen your understanding beyond the current levels of understanding that AHPRA has about bullying and harassment and vexatious complaints?’
Mr Fletcher: ‘What I am saying is that in all of the available data and research evidence that we have looked at, there does not appear to be a big problem with vexatious complaints.’
Xenophon already read NHPO’s report who said:
‘A small number of complaints to the NHPOPC involve issues that have the potential to raise questions about the motivation of the notifier.’
Senator XENOPHON: ‘When you say ‘not a big problem’, do use mean that in terms of numbers?’
Mr Fletcher: “In terms of numbers.”
This is 22 November 2016. On 16 April 2018, Mr Fletcher claims in AHPRA news: Vexing, Not Vexatious.
“The Senate committee quite rightly asked the question – Is this a big problem in Australia?”
Senate did not ask such a question. This is lie no. 2.
The summary report on literature review was a national review. It was not the international research or “view” with America’s Stanford University.
Mr Fletcher: ‘Commenting on the report’s release, AHPRA CEO Martin Fletcher said it was important to take an international and evidence-based view on vexatious complaints.’
This is lie no. 3.
AHPRA did not commission Melbourne University to research as their partners. They asked them to prepare a summary report on grey and academic literature review.
Mr Fletcher: ‘If I can give you one example, we have a research partnership with the University of Melbourne.’
This is lie no. 4
In 2014 Stanford and Melbourne University, USA and Australia looked into 850 with NSW and 819 without NSW mandatory notifications over 12 month period from Nov 2011 to 2012.
Says Fletcher, ‘They looked at 850 mandatory notifications over a 12-month period.’
David and Marie in 2014: ‘“We conducted a retrospective review and multivariate analysis of all allegations of notifiable conduct, involving health practitioners received by AHPRA between 1 November 2011 and 31 December 2012.’
“Little evidence is available to evaluate the veracity of these different views.”
Mr Fletcher gives false and misleading evidence about that first international research on Australia by the team of American and Australian researcher, David Studdert and Marie Bismark: ‘They found fewer than six that they believed potentially met the criteria for a vexatious notification.’
“Potentially” is not “truly” to the Committee. They indicated in the case of Gary Fettke.
This is lie no. 5
NHPO had said on May 2016: “A small number of complaints to the NHPOPC involve issues that have the potential to raise questions about the motivation of the notifier,.”
Mr Fletcher makes similar point of small number.
‘The point I am also making is that, even though the numbers are small, we recognise that the impact on the individuals involved can be significant.’
Senator XENOPHON: ‘Can we go back a step. You said there were 850 mandatory notifications and six were found to—‘
Mr Fletcher: ‘Under six. They said ‘under half a dozen’.
Senator XENOPHON: ‘Under half a dozen were found to be vexatious.’
David and Marie worded “criteria” back then.
“Critics charge that mandatory reporting fosters a culture of fear, deters help-seeking, and fuels professional rivalries and vexatious reporting.
Concerns have also been raised about the subjectivity of reporting criteria.
[…]
Little evidence is available to evaluate the veracity of these different views.”
Xenophon: ‘Can you provide, on notice, the criteria for that assessment?
In other words, how did they come to that conclusion?
It could be an eminently reasonable conclusion they came to.
Was there a natural justice process involved?
In other words, what was the process to establish whether it is vexatious or not?
There are 850 cases. What was the rigour involved?
What were the mechanisms?
Was there a like-for-like comparison?
I am just trying to understand the robustness of the process.’
Back then, David and Marie explained: “We obtained data from two AHPRA sources: mandatory notification forms and the national register of health practitioners.”
Fletcher talks about the form.
Mr Fletcher: ‘The process involved a review of some of the core documentation in relation to, for example, the correspondence that is sent to a practitioner about a notification that has been received.’
‘I can give you a couple of examples to give you just the flavour.’
But David and Marie found no vexatious mandatory notifications let alone it’s flavour.
Mr Fletcher: ‘One, for example, related to a couple who were both medical practitioners, who had been married and who were divorcing. There was an issue about the future of the practice in the context of their divorce.’
This is Lie No. 6
‘Another one related to two health practitioners who were in a relationship with the same other health practitioner, and notifications were made in the context of that.’
This is Lie No. 7
And Ombudsman said about potential vexatious.
‘notifications made by health practitioners about other health practitioners in circumstances where there has been a breakdown of a business or personal relationship.’
Senator XENOPHON: ‘Would that be one of the criteria?
Now Xenophon specifically asked about mandatory notifications made by peers.
‘In other words, if the complaint is motivated by other doctors rather than patients,
in other words, there is no question of an adverse outcome for patients but doctors are complaining about another medical practitioner—
is that a factor where that might raise a yellow flag, at least, to say that this is something that could potentially be a vexatious complaint, because it is not generated by any safety concerns as such?’
Potential is not real in the eyes of Xenophon’s Ssenate committee though.
COMMUNITY AFFAIRS REFERENCES COMMITTEE
Page 4 Senate Tuesday, 22 November 2016
Mr Fletcher: ‘In relation to the comment you made earlier, Senator, there are examples of where the intent in the reporting may not have been particularly honourable but in fact, when we have looked at the issue, there has been an issue of patient safety that has required some sort of regulatory response.’
Only a moment ago he had said they were less than 6/850 or under half a dozen.
This is Lie no 8.
- The Senate committee found similarity between Martin’s stories and that of NHPO. In the 2016 report, they write this.
- ‘2.23 Ms Samantha Gavel, current (and first) Ombudsman, further outlined her responsibilities and powers, emphasising that the Ombudsman’s office is focused on AHPRA’s procedures, rather than the details of the original complaint:
- It is important to note that the role of my office is not to review the conduct or performance of health practitioners;
- 31 The Ombudsman noted that ready access to the complaints mechanism is important for public health and that, while complaints can be lodged vexatiously, there is limited evidence of this happening often:
- … the NHPOPC’s [National Health Practitioner Ombudsman and Privacy Commissioner] experience in handling complaints about the administrative actions of AHPRA and the National Boards does not suggest that there is a high incidence of people intentionally using notification processes for vexatious purposes.32
- 32 Mr Martin Fletcher, Chief Executive Officer of AHPRA, made a similar point, drawing on existing research:
- What I am saying is that in all of the available data and research evidence that we have looked at there does not appear to be a big problem with vexatious complaints, and by ‘vexatious’ I mean a harmful intent on the part of the person making the complaint and no patient safety concern emerging when we look at the issue.
- […]
- If I can give you one example, we have a research partnership with the University of Melbourne. They looked at 850 mandatory notifications over a 12-month period. They found fewer than six that they believed potentially met the criteria for a vexatious notification. The point I am also making is that, even though the numbers are small, we recognise that the impact on the individuals involved can be significant.33
Another inquiry was held in 2017. The Government responded to that inquiry. It rejected a recommendation arguing:
‘AHPRA has commissioned research to better understand the extent of vexatious complaints.’
This is a lie no. 9.
AHPRA commissioned a summary report on literature review of grey and academic literature. They did not commission any research.
Government: ‘The currently available evidence suggests that the incidence of vexatious notifications is very low, and that greater risk is posed to the public from people not reporting their concerns.’
This is a lie no. 10. No one found evidence of vexatious notifications.
Government’s words “incidence of vexatious notifications is very low,” are quite similar to Ombudsman’s words:
‘the NHPOPC’s [National Health Practitioner Ombudsman and Privacy Commissioner] experience (???) in handling complaints about the administrative actions of AHPRA and the National Boards does not suggest that there is a high incidence of people intentionally using notification processes for vexatious purposes.’
Also similar to the language of AHPRA’s news “Vexing, not Vexatious” published in their website:
While vexatious reports are frequently talked about, Assoc Prof Bismark maintains there is very little hard evidence about how often they occur.
The best available evidence suggests that truly vexatious complaints are very rare, and that under-reporting of well-founded concerns is likely a far greater problem.
Identically, Government: ‘The currently available evidence suggests that the incidence of vexatious notifications is very low, and that greater risk is posed to the public from people not reporting their concerns.’
The international research wrote: ‘Critics charge that mandatory report- ing fosters a culture of fear,9 deters help seeking,10 and fuels professional rivalries and vexatious reporting.11,12
Concerns have also been raised about the subjectivity of reporting criteria.13
The Australian Medical Association opposed the introduction of the mandatory reporting regime for medical practitioners, citing several of these objections.14
Little evidence is available to evaluate the veracity of these dif- ferent views.’
Mr Fletcher air-lifts “little evidence” and “vexatious reporting” in the news.
‘While vexatious reports are frequently talked about, Assoc Prof Bismark maintains there is very little hard evidence about how often they occur.’
Government: ‘It is acknowledged however that vexatious notifications can have a significant impact on practitioners.’
Only Martin Fletcher acknowledged:
‘If I can give you one example, we have a research partnership with the University of Melbourne. They looked at 850 mandatory notifications over a 12-month period. They found fewer than six that they believed potentially met the criteria for a vexatious notification. The point I am also making is that, even though the numbers are small, we recognise that the impact on the individuals involved can be significant.’
In Feb 2017, Ombudsman found 12 or 6.5% health practioners alleging vexatious notification made about them.
‘Evaluation of complaints received from 1 July 2016 to 30 December 2016, does, however, reveal an increase in complaints from health practitioners raising concerns about allegedly vexatious notifications. While the data for this period is yet to be audited, the NHPOPC estimates that twelve complaints have been received from health practitioners during this period where the health practitioner has raised an allegation of vexatiousness in relation to a notification. This represents 6.5 per cent of the 182 complaints received during this period.’
Delete: ‘Evaluation of complaints received from 1 July 2016 to 30 December 2016, does, however, reveal an increase in complaints from health practitioners raising concerns about allegedly vexatious notifications. While the data for this period is yet to be audited, the NHPOPC estimates that twelve complaints have been received from health practitioners during this period where the health practitioner has raised an allegation of vexatiousness in relation to a notification. This represents 6.5 per cent of the 182 complaints received during this period.’
Edit: ‘Evaluation of complaints received from 1 July 2016 to 30 December 2016, does, however, reveal an increase in vexatious notifications. While the data for this period is yet to be audited, the NHPOPC estimates that twelve complaints have vexatiousness in relation to a notification. This represents 6.5 per cent of the 182 complaints received during this period.’
The edited alteration appears in senate report, but reworded.
2.28 NHPOPC’s submission to the committee also indicates vexatious notifications for the 2016–17 year were trending higher than in the previous two years, with an estimated twelve complaints received at the time of submission, or 6.5 per cent of the total notifications received during the period.30
2.25 The considerable anecdotal evidence provided by practitioners stood in contrast to independent evidence provided to the committee by the National Health Practitioner Ombudsman and Privacy Commissioner (NHPOPC). 2.52 Whilst the committee acknowledges the concerns raised by health practitioners, the independent evidence received by the committee (NHPO) does not suggest that vexatious notifications are a widespread issue; rather, they appear to be relatively infrequent.
On the basis of such an alteration, a false recommendation 3 was crafted.
COAG may consider whether recourse and compensation process be made available to —- “health practioners subjected to vexatious claims.”
This is the only recommendation rejected by the Government. It was based on alteration of facts.
Following such an inquiry, a victim of the vexatious, Dr Yap committed suicide with a note blaming AHPRA and a text blaming the gamut of lies:
Dead doctor Yap: “Being <1% is no excuse for the regulators to ignore the serious harms to innocent victims and their families.”
After his protest death, Senate committee have the same inquiry on AHPRA.
Terms of reference:
(a) the current standards for registration of health practitioners by the Australian Health Practitioner Regulation Agency (AHPRA) and the National Boards under the Health Practitioner Regulation National Law (National Law);
(b) the role of AHPRA, the National Boards, and other relevant organisations, in addressing concerns about the practice and conduct of registered health practitioners;
(c) the adequacy and suitability of arrangements for health practitioners subject to supervised practice as part of the registration process or due to a notification;
(d) the application of additional requirements for overseas-qualified health practitioners seeking to become registered in their profession in Australia;
(e) the role of universities and other education providers in the registration of students undertaking an approved program of study or clinical training in a health profession;
(f) access, availability and adequacy of supports available to health practitioners subject to AHPRA notifications or other related professional investigations;
(g) the timeliness of AHPRA’s investigation of notifications, including any delays in handling, assessment and decision-making, and responsiveness to notifiers;
(h) management of conflict of interest and professional differences between AHPRA, National Boards and health practitioners in the investigation and outcomes of notifications;
(i) the role of independent decision-makers, including state and territory tribunals and courts, in determining the outcomes of certain notifications under the National Law;
(j) mechanisms of appeal available to health practitioners where regulatory decisions are made about their practice as a result of a notification;
(k) how the recommendations of previous Senate inquiries into the administration of notifications under the National Law have been addressed by the relevant parties; and
(l) any other related matters.
My submission is under:
(k) how the recommendations of previous Senate inquiries into the administration of notifications under the National Law have been addressed by the relevant parties.
Because, Rome Statute’s Article 7 of International Criminal Court defines government crimes against humanity.
Article 7 of the treaty stated that:
For the purpose of this Statute, “crime against humanity” means any of the following acts when committed as part of a widespread or systematic attack directed against any civilian population, with knowledge of the attack:[53]
[…]
(f) Torture; Torture (from Latin tortus: to twist, to torment) is the act of deliberately inflicting severe physical or psychological suffering on someone by another as a punishment or in order to fulfill some desire of the torturer or force some action from the victim. Torture, by definition, is a knowing and intentional act;
(k) Other inhumane acts of a similar character intentionally causing great suffering, or serious injury to body or to mental or physical health;
Crimes against humanity are certain acts that are purposely committed as part of a widespread or systematic policy, directed against civilians, in times of war or peace. They differ from war crimes because they are not isolated acts committed by individual soldiers, but are acts committed in furtherance of a state policy.
Unlike war crimes, crimes against humanity can be committed during peace or war.[2] They are not isolated or sporadic events, but are part either of a government policy (although the perpetrators need not identify themselves with this policy) or of a wide practice of atrocities tolerated or condoned by a government.
The Senate Committee has yet to conclude vexatious notifications, voluntary and mandatory before recommending Government to grant the victims recourse and compensation. Most importantly to avoid further suicide protest with suicide notes blaming lies and AHPRA.
Otherwise what you, the Senate Committee have done is created a story with your theatre and offered it along with your reputation to aspiring storytellers to tell and sell it to the international market of readers. The role of Senate Committee was never to develop such creative content with such community experiments.
Regards,
Dr. Chandrika Barman