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For doctors with mental health or substance use disorders, publication of their name and sensitive medical history in disciplinary decisions may adversely impact their health and may reinforce barriers to accessing early support and treatment. This article challenges the view that naming impaired doctors or disclosing the intimate details of their medical condition in disciplinary decisions always serves the public interest in open justice. We analysed and compared the approach of Australian and New Zealand health tribunals to granting orders that suppress the name and/or medical history of impaired doctors. This revealed that Australian tribunals are less likely to grant non-publication orders compared to New Zealand, despite shared common law history and similar medical regulatory frameworks. We argue that Australian tribunals could be more circumspect when dealing with sensitive information in published decisions, especially where such information does not directly form a basis for the decision reached. This could occur without compromising public protection or the underlying goals of open justice. Finally, we argue that a greater distinction should be made between those aspects of decisions that deal with conduct allegations, where full details should be published, and those that deal with impairment allegations, where only limited information should be disclosed. [ABSTRACT FROM AUTHOR]

Doctors’ mental wellbeing is a critical public health issue. Rates of depression, anxiety, and substance use are higher than in the general population. Regulating unwell doctors who pose a public risk is challenging, yet there is little research into how medical regulators balance the need to protect the public from harm against the benefits of supporting and rehabilitating the unwell doctor. We analysed judgments from Australia, New Zealand, Ireland, United Kingdom, Ontario, and Singapore between 2010 and 2020 relating to impaired doctors. We found similarities in how decision-makers conceptualise impairment, how they disentangle impairment from associated conduct or performance complaints, and how regulatory principles and sanctions are applied. However, compared to other jurisdictions, Australian courts and tribunals tended to prioritise deterrence above the rehabilitation of the impaired doctor. Supporting impaired doctors’ recovery, when appropriate, is critical to public protection and patient safety. [ABSTRACT FROM AUTHOR]

Medical regulators protect the public from unsafe, unwell, or unscrupulous medical practitioners. To facilitate a swift response to serious allegations, many regulators are equipped with far-reaching emergency powers to immediately suspend, or impose conditions on, medical practitioners' registration before facts are proven. Failing to take urgent action may expose the public to ongoing avoidable harm and may erode public trust in the profession. Equally, imposing immediate action in response to allegations that are not subsequently proven can precipitously and irreparably injure a practitioner's career and emotional wellbeing. This is the second of two articles published in the Journal of Law and Medicine that explores the emerging jurisprudence in relation to these emergency regulatory powers. This article compares the approaches to immediate action in seven countries, providing insights for policy-makers and decision-makers into how modern regulatory frameworks attempt to balance the inherent tensions between the profession, the public and the State. [ABSTRACT FROM AUTHOR]

Background: Coroners in Australia, Canada, New Zealand and other countries in the Commonwealth hold inquests into deaths in two situations. Mandatory inquests are held when statutory rules dictate they must be; discretionary inquests are held based on the decisions of individual coroners. Little is known as to how and why coroners select particular deaths for discretionary inquests. Methods: We analyzed the deaths investigated by Australian coroners for a period of seven and one-half years in five jurisdictions. We classified inquests as mandatory or discretionary. After excluding mandatory inquests, we used logistic regression analysis to identify the factors associated with coroners' decisions to hold discretionary inquests. Results: Of 20 379 reported deaths due to external causes, 1252 (6.1%) proceeded to inquest. Of these inquests, 490 (39.1%) were mandatory and 696 (55.6%) were discretionary. In unadjusted analyses, the rates of discretionary inquests varied widely in terms of age of the decedent and cause of death. In adjusted analyses, the odds of discretionary inquests declined with the age of the decedent; the odds were highest for children (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.54-3.06) and lowest for people aged 65 years and older (OR 0.38, 95% CI 0.28-0.51). Using poisoning as a reference cause of death, the odds of discretionary inquests were highest for fatal complications of medical care (OR 12.83, 95% CI 8.65-19.04) and lowest for suicides (OR 0.44, 95% CI 0.30-0.65). Interpretation: Deaths that coroners choose to take to inquest differ systematically from those they do not. Although this vetting pro cess is invisible, it may influence the public's understanding of safety risks, fatal injury and death. [ABSTRACT FROM AUTHOR]

The article analyzes the disciplinary cases for doctors charged with professional misconduct in Australia and New Zealand from 2000 to 2009. More male doctors were disciplined for misconduct than their female colleagues at 91 versus 22 cases per 100,000 doctor-years. Highest rates of disciplinary cases were noted in the specialties of psychiatry, obstetrics and gynaecology. About 24% of the cases involved sexual misconduct followed by unethical prescribing at 21%.

Objective: To examine how disciplinary tribunals assess different forms of misconduct in deciding whether to remove doctors from practice for professional misconduct., Design and Setting: Multivariable regression analysis of 485 cases in which tribunals found doctors guilty of professional misconduct. The cases came from four Australian states (New South Wales, Victoria, Queensland and Western Australia) and New Zealand and were decided over a 10-year period (1 January 2000 - 30 September 2009)., Main Outcome Measures: Type of misconduct, the tribunal's explanation for why the misconduct occurred, and the disciplinary measure imposed., Results: 43% of the cases resulted in removal of the offending doctor from practice, 37% in restrictions on practice and 19% in non-restrictive sanctions. The odds of removal were very high in cases involving sexual relationships with patients (OR 22.59; 95% CI 10.18 to 50.14) and moderately high in cases involving inappropriate sexual conduct (not in the context of a relationship), commission of criminal offences, and forms of inappropriate conduct unrelated to patients. Cases in which the misconduct was judged to be due to willful wrongdoing (OR 17.14; 95% CI 8.62 to 34.09), incompetence (OR 6.02; 95% CI 2.87 to 12.63) and issues in the doctor's personal life (OR 4.17; 95% CI 2.07 to 8.41) also had higher odds removal from practice., Conclusion: Tribunals in Australia and New Zealand tend to remove doctors from practice for behaviours indicative of character flaws and lack of insight, rather than behaviours exhibiting errors in care delivery, poor clinical judgement or lack of knowledge. The generalisability of these findings to regulatory regimes for health practitioners in other countries should be tested.

In the wake of adverse events, injured patients and their families have a complex range of needs and wants. The tort system, even when operating at its best, will inevitably fall far short of addressing them. In Australia and New Zealand, government-run health complaints commissions take a more flexible and expansive approach to providing remedies for patients injured by or disgruntled with care. Unfortunately, survey research has shown that many patients in these systems are dissatisfied with their experience. We hypothesised that an important explanation for this dissatisfaction is an 'expectations gap'; discordance between what complainants want and what they eventually get out of the process. Analysing a sample of complaints relating to informed consent from the Commission in Victoria (Australia's second largest state, with 5.2 million residents), we found evidence of such a gap. One-third (59/189) of complainants who sought restoration received it; 1 in 5 complainants (17/101) who sought correction received assurances that changes had been or would be made to reduce the risk of others suffering a similar harm; and fewer than 1 in 10 (3/37) who sought sanctions saw steps taken to achieve this outcome initiated. We argue that bridging the expectations gap would go far toward improving patient satisfaction with complaints systems, and suggest several ways this might be done.