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    Issue 14


    The COVID-19 matters members sought advice on


    Kate Gillman

    BA LLB

    Head of Medico-legal Advisory Service, Avant

    transitioning telehealth  

    The call notes from over 1,000 queries we received on COVID-19, chronicle the minefield of medico-legal issues to emerge from the pandemic, as well as the personal health and wellbeing challenges faced by doctors and their practice staff.

    Unsurprisingly, nearly half of our calls have been from general practitioners, who early in the pandemic were at the frontline as patients returned from overseas with symptoms that required testing. Patients and staff grappled with how to keep themselves and patients safe, wanting to know if it was legal to put signs on their doors, whilst navigating the constantly changing testing guidance and sourcing PPE supplies.

    Employers were demanding medical clearance certificates from GPs not understanding that you can’t ‘clear’ someone from COVID-19, but rather you could only state that at the point in time they are not presenting any symptoms.

    The introduction of temporary telehealth item numbers from 13th March for six months generated a lot of calls. While the change was welcomed it took several weeks and lobbying, including from Avant, for the Government to put in place a billing regime that enabled all doctors the option of providing telehealth consultations. This was a great relief to vulnerable doctors who otherwise faced the prospect of having to stop work altogether at a time when their patients really needed their support.

    Practices have adapted rapidly to telehealth, but it is still necessary to consider when and how a face-to-face examination can be conducted, to avoid the risk of missing a key symptom or condition. To assist, we have produced a fact sheet on telehealth consultations during COVID-19. Needless to say, good documentation is vital, particularly when patients are advised to attend the hospital for follow up.

    As the numbers of positive cases and deaths rose and concern mounted about the availability of PPE, the Government suspended non-urgent elective surgery. This created immediate issues for surgeons worried not only about what they could do legally, but also how to manage workplace issues it raised for their administrative staff and the financial implications for their businesses.

    14% of our calls have been from doctors-in-training, seeking advice on a range of issues including their re-deployment to work in different units, concerns about the impact of COVID-19 on their training roles, and personal wellbeing issues. Our medical advisers have provided advice to DIT supervisors on medico-legal issues arising from remote supervision for telehealth consultations. At the other end of the spectrum, we have helped doctors come out of retirement so they are available to provide additional clinical care if required.

    In all groups, the supply of PPE has been a key issue of concern in the calls we have received and at every opportunity, we have provided this feedback to the Department of Health.

    As the curve started to flatten and the National Cabinet contemplated easing restrictions and re-commencing elective surgery, our calls changed to respond to queries such as ‘point of care’ serology testing and whether this could be used as a screening test (see Testing for SARS-CoV-2 article).

    The Government’s push to get the community to download the COVID-Safe app, in turn, has resulted in calls from doctors who wanted to know if they could require patients and/or staff to download the app. Legislation has, however, been enacted to make it an offence to coerce anyone to use the app or to withhold a service from someone who doesn’t have the app.

    Throughout this period we have used the questions we have been asked to inform our FAQs and resource page, which has received nearly 100,000 page views, is also the resource on medico-legal issues recommended by the Medical Council of NSW. As we move into the next phase of the pandemic, including the introduction of electronic prescribing, we will keep our FAQs updated and provide personal support and advice through our telephone advisory service.

    Calls for advice by specialty group (1 Jan - 30 Apr 2020)

    • 47% General practitioners
    • 14% Doctors in training
    • 13% Practices
    • 8% Surgeons
    • 6% Physicians
    • 5% Psychiatrists
    • 3% Acute hospital care doctors
    • 2% Other doctors
    • 2% Retired doctors
    • 1% Investigative specialists

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