COVID-19: medico-legal advice for doctors and practices

COVID-19: medico-legal advice for doctors and practices

Summary:

As the COVID-19 health emergency evolves and more information comes to hand, we will update this page with further medico-legal advice for members.

 

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17 / 03 / 2020

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The Australian National Cabinet has endorsed the AHPPC’s recommendation to temporary suspend all non-urgent elective surgery, resulting in many doctors seeing dramatic changes to their work. This includes the potential of providing healthcare in different settings and of a different nature, raising concerns about indemnity cover and causing a significant financial impact.

Our latest updates include information on:

  1. Am I able to undertake elective surgery?
  2. What is the position in relation to non-surgical cosmetic procedures?
  3. I am being asked to do work outside of the normal healthcare I provide. Will I be insured?
  4. I am being asked to do public work. Does Avant cover me?
  5. As I am not treating as many patients and my billings have dropped, can my premium be reduced?
  6. I am not able to practice in the current environment. Do I still have to pay insurance?

With advice changing rapidly, please check the Department of Health’s alert page and the RACGP’s coronavirus web page.

Updated: 27/03/2020

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Frequently asked questions

Elective and cosmetic surgery


  • A: On 25 March, the Australian Health Protection Principal Committee, comprising the chief medical officers of the states, territories and Commonwealth recommended suspension of all non-urgent elective procedures in both the public and private sector to free up PPE resources and ICU beds:

    The National Cabinet accepted this recommendation and the Prime Minister of Australia announced that non-urgent elective surgery in categories 2 and 3 below would be suspended in the public and private sectors from midnight on 25 March:

    Category 1 – Needing treatment within 30 days. Has the potential to deteriorate quickly to the point where the patient’s situation may become an emergency
    Category 2 – Needing treatment within 90 days. Their condition causes pain, dysfunction or disability. Unlikely to deteriorate quickly and unlikely to become an emergency
    Category 3 – Needing treatment at some point in the next year. Their condition causes pain, dysfunction or disability. Unlikely to deteriorate quickly.

    After the initial announcement, the National Cabinet extended the deadline for “… semi-urgent Category 2 and 3 elective surgeries at private hospitals” to 11.59pm on 1 April 2020.

    The result is that:

    Category 1 surgery can continue to be performed in public and private hospitals.

    Semi-urgent category 2 and 3 elective surgeries can be performed in private hospitals until 11.59pm on 1 April 2020.

    Non-urgent category 2 and 3 elective surgeries cannot be performed in public or private hospitals from midnight on 25 March 2020.


  • A: The Prime Minister announced on 24 March that the following is suspended from 11.59pm on 25 March:

    “Highly discretional services that require close and prolonged personal contact between the service provider and client, including beauty therapy, nail salons, massage parlours, body piercing services and tattoo parlours.”

    Avant’s underwriting department considers that cosmetic injectables are included in this category and therefore are suspended.

    On 26 March, the Australian Society of Plastic Surgeons advised plastic surgeons that in light of the Government’s announcements: “no cosmetic injectables, laser or “medispa” procedures should be provided”.

    The President of the Australasian College of Aesthetic Medicine issued a statement on 25 March stating:

    “After last night’s announcement of further restrictions to services, we now believe it would be wise for all our members to consider the possibility for closing their doors for all but essential medical services. Now is not the time to take unnecessary risks, for ourselves or our staff. As doctors, we may even be needed for front-line medical support in the near future. In the meantime, we need to keep ourselves, our families and our patients, and our staff and colleagues, safe from exposure and spread. Physical distancing is the best way to prevent the spread of COVID-19, and even with the best protection, our work involves close patient contact.”

Financial matters


  • A: You should only provide healthcare you are appropriately qualified and trained to do. AHPRA has provided the following information about medical practitioners being fast tracked into new roles in responding to the Covid-19 crisis.

    We are being asked a range of questions about how the National Boards would respond to requests for changes to the way that we register individuals in the context of managing the health sector impacts of COVID-19.

    As an overriding principle, the National Boards and Ahpra are prepared to be flexible in our approach although safety remains our first priority.

    In this context, we are considering how our regulatory requirements can adapt to emergency health service needs and support health service delivery while continuing to protect the public.

    Avant will continue to rely on and recognise the regulators assessments of appropriate qualification to act. To ensure you are covered you should only provide care where you are qualified and maintain your insurance coverage.

    You should maintain coverage with us that is appropriate for your practice and, if you are considering changing your area of practice, please check if you existing category or practice includes the new work you are undertaking.

    If you are still unsure or need to change category please call us for assistance on 1800 128 268.


  • A: For patients treated in public setting, your employer typically provides indemnity. We suggest you ensure that you are employer indemnified for any public work as this is not usually covered by your medical indemnity policy which is mainly for private practice.


  • A: Medical indemnity insurance premiums are based on several factors. Your annualised billings is one of these factors. If these have changed significantly from what is noted in your current policy documents, we can amend them which could reduce your premium. Please call us on 1800 128 268 to discuss possible changes.


  • A: Yes. However, if you have stopped all practice of medicine, we may be able to change eligible members’ category of practice to Absentee. This category continues to provide you with cover for claims against you that relate to your prior medical practice, but does not provide cover if you continue to practice.

    The premium for Absentee cover is $200 for any period up to 12 months. You should only consider changing your policy to Absentee if you plan to stop all medical practice. You will need to notify us prior to returning to your practice to arrange appropriate cover.

Medicare telehealth services for coronavirus (COVID-19) consultations


  • A: The new items can be used for six months from 13 March 2020 until September 2020, with some items coming into effect from different dates. The new items are listed on the Department of Health website.


  • A: Yes. Although we expect this to change on 30 March to apply to all consultations, currently from 23 March 2020, eligible telehealth services have been expanded so that health professionals who are vulnerable because of a non-COVID-19 condition can use telehealth for consultations with their patients. Telehealth can now be used by doctors who are at increased risk of COVID-19 because they are:

    • aged at least 70 years old
    • indigenous and aged at least 50 years old
    • pregnant
    • a parent of a child under 12 months of age
    • immune compromised
    • under treatment for a chronic health condition.

    We suggest that you make sure you have evidence to support that you are a healthcare professional who falls within one or more of these categories. For practitioners in the first two categories, a copy of your driver’s licence would be appropriate, or if you have a child under 12 months, your child’s birth certificate.

    There is no definition of the term “chronic health condition”, so if you are immune compromised or have a chronic health condition that results in an increased risk of coronavirus infection, consider obtaining a letter from your treating practitioner confirming that you fall within this category.


  • A: Although we expect this to change on 30 March to apply to all consultations, currently you can use bulk-billed telehealth items for patients who are considered ‘at risk’ of COVID-19, that is, those patients who are:

    • diagnosed with COVID-19, but not a patient of a hospital or
    • already isolating themselves in quarantine in accordance with home isolation guidance issued by the Australian Health Protection Principal Committee (AHPPC).

    The Department of Health’s factsheet provides further clarification for the requirement for self-isolation. It refers to:

    • people need to be isolating themselves at home on the advice of a medical practitioner, in accordance with home isolation guidance issued by the AHPPC, and
    • people who meet the current national triage protocol criteria for suspected COVID-19 infection after consultation with either the national COVID-19 hotline, state COVID-19 hotlines, registered medical or nursing practitioner or COVID-19 trained health clinic triage staff.


  • A: Yes. You are also permitted to provide bulk-billed telehealth consultations to the following at risk patients who have not been diagnosed with COVID-19 and are not self-isolating due to the virus, but are considered to be more susceptible to the virus:

    • people aged over 70
    • Aboriginal and Torres Strait Islander people aged over 50
    • people with chronic health conditions or who are immunocompromised
    • parents with (or people who care for) a child under 12 months and people who are pregnant.

    However, you can only bulk-bill a telehealth consultation for a non-coronavirus matter if the patient has seen you or another doctor in the practice during the previous 12 months.


  • A: There are separate billing codes for specialists, physicians and psychiatrists. The requirements are:

    • people aged over 70
    • you still need a referral from a GP
    • the patient must be an out-patient
    • as the consultation is bulk-billed you can’t charge for anything else arising from that service.


  • A: If you are unable to attend your practice, due to self-isolation (either because you have been diagnosed with COVID-19 or advised to self-isolate in accordance with AHPPC), but are not a patient of a hospital, you can continue providing services to your patients by telehealth or telephone as long as you have the capacity to provide “… the full service through this means safely and in accordance with professional standards”.


  • A: Although we expect this to change on 30 March to apply to all consultations, currently telehealth consultations cannot be bulk billed simply because the practice is closed

    To use the bulk-billing item numbers, the service must still be required because either the patient fulfils the definition of 'at risk of COVID-19' or the practitioner fulfils the definition of 'health professional at risk of infection with COVID-19'.


  • A: No. Although we expect this to change on 30 March to apply to all consultations , currently to use the telehealth item numbers for your patients you must be:

    • in isolation or quarantine due to COVID19

    OR

    • aged at least 70 years old
    • indigenous and aged at least 50 years old
    • pregnant
    • a parent of a child under 12 months of age
    • immune compromised
    • under treatment for a chronic health condition.

    We understand that this may change.


  • A: The advice from the Department of Health is that patients are still required to consent to their telehealth service being bulk-billed, as per normal practice for bulk-billed services.

    This means the patient's signature is still needed on the General, Specialist and Diagnostic (assignment of benefit) form (DB4). You can get this form through Medicare Bulk Bill Webclaims using HPOS.

    The Department of Health advises there are three ways you can get the patient's signature:

    1. You can send the completed General, Specialist and Diagnostic (assignment of benefit) form (DB4) to the patient to sign and return to you.
    2. You can get an email agreement from the patient.
    3. The practitioner supporting the patient during the telehealth consultation can ask the patient to sign the General, Specialist and Diagnostic (assignment of benefit) form (DB4) and return it to you. An example of this is where a patient is using the local GP’s surgery for the telehealth consultation - when the patient signs the (assignment of benefit) form, the GP sends it to the provider performing the telehealth service.

    Given the circumstances with COVID-19 we anticipate a lot of doctors will rely on email agreements.

    The Department of Health provides the following guidance for a patient to assign their right to a Medicare benefit to you by email.

    For privacy reasons, the Department of Health advises that you should not include the patient’s Medicare card number or the doctor’s provider number in your email to the patient.

    Step 1
    At the telehealth consultation, tell the patient you wish to bulk bill Medicare for the service. To do this the patient will need to:

    • agree to the service being bulk billed
    • check the details in the email sent to their nominated email address
    • reply to your email, which will be considered a signature agreeing to assign the benefit.

    Step 2
    Before submitting the claim, you need to send an email to the patient that includes all of the below:

    • the details of the service
    • item numbers or a description of the services
    • benefit amount for both the base and derived fee items
    • date and time of the services
    • patient's name (don’t include the Medicare card number)
    • practitioner's name (don’t include the provider number).

    Include in your email this statement:

    'If you (the patient) agree to the assignment of the Medicare benefit directly to the provider (bulk- bill), reply to this email including the following words:

    Yes, I agree to the assignment of the Medicare benefit directly to the provider, and your (the patient's) name'

    and this privacy note:

    'Your personal information is protected by law, including the Privacy Act 1988, and is collected by the Australian Government Department of Human Services for the assessment and administration of payments and services. This information is required to process your application or claim. Your information may be used by the department or given to other parties where you have agreed to that, or where it is required or authorised by law (including for the purpose of research or conducting investigations). You can get more information about the way in which the department will manage your personal information, including its privacy policy.

    Step 3
    When you get a reply email from the patient with the required information:

    • complete a General, Specialist and Diagnostic (assignment of benefit) Voucher form (DB4)
    • for manually submitted claims write in the signature block ‘unable to sign, written email agreement provided’
    • for electronic claims, you don’t need to note the email signature but you must keep the patient's email consent on file
    • submit the claim to us in accordance with the Health Insurance Act 1973, 1975 Health Insurance Regulations and MBS
    • send a completed copy of the General, Specialist and Diagnostic (assignment of benefit) Voucher form (DB4) to the patient
    • keep the email with the patient's consent and email signature, in hard copy or electronic form for audit purposes for at least two years.

    By noting 'email agreement' on the manual General, Specialist and Diagnostic (assignment of benefit) form (DB4), you acknowledge you’ve followed steps 1-3 above. This process complies with section 10 of the Electronic Transactions Act 1999, which outlines the steps to be taken for an electronic signature to be recognised. It also meets the legal requirement of needing a patient signature to assign a Medicare benefit.

    Example email

    Dear (patient),

    Details of the telehealth consultation to be claimed with Medicare:

    Item number: ……. Benefit amount: $

    Item number: …. Benefit amount: $

    Date and time of consultation: ……2020 …. am

    Patient name: …

    Provider name: …

    Agreement

    If you (the patient) agree to the assignment of the Medicare benefit directly to the provider (bulk bill), reply to this email including the following wording:

    Yes, I agree to the assignment of the Medicare benefit directly to the provider your (the patient's) name or the name of parent or guardian (where a child is the patient and unable to sign).

    Regards,

    Dr …

    Privacy note:Your personal information is protected by law, including the Privacy Act 1988, and is collected by the Australian Government Department of Human Services for the assessment and administration of payments and services. This information is required to process your application or claim. Your information may be used by the department or given to other parties where you have agreed to that, or where it is required or authorised by law (including for the purpose of research or conducting investigations). You can get more information about the way in which the department will manage your personal information, including its privacy policy


  • A: The Department of Health advises that you should use the provider number for your primary location.


  • A: No. These are bulk-billed services, so no additional charge can be raised for the service that is billed.


  • A: Yes. You can bill privately, but you need informed financial consent from the patients. Patients need to understand there is no Medicare rebate. This consent can be given verbally and documented in the medical records or confirmed in an email (see below for a suggested email agreement).

    Example Email Agreement – Privately Billed Telehealth Consultation

    Dear …

    Details of the telehealth consultation to be privately billed and paid:

    Date and time of consultation: … 2020 … am

    Patient name: …

    Provider name: …

    Cost of consultation: …

    Agreement

    If you (the patient) agree to this payment for the telehealth consultation please reply to this email including the following wording:

    Yes, I agree to pay for the telehealth consultation on … 2020 and acknowledge there is no Medicare rebate available for this consultation.

    your (the patient's) name or the name of parent or guardian (where a child is the patient and unable to sign).

    Regards,

    Dr …

    Privacy note: Your personal information is protected by law, including the Privacy Act 1988. You can get more information about the way in which we manage your personal information by reviewing our privacy policy.


  • A: GPs and specialists/physicians/consultant psychiatrists can bulk-bill both COVID-19 telephone and video consultations if the criteria is satisfied.

    To claim ‘telehealth’ items, practitioners must have video conferencing. There are separate item numbers for video and telephone consultations.


  • A: You can use any platform. No specific equipment is required to provide Medicare-compliant telehealth services. Services can be provided through widely available video calling apps and software such as Zoom, Skype, FaceTime, Duo, GoToMeeting and others.

    If video is not available, you can offer audio-only services. There are separate items available for audio-only/telephone services.

    The Department of Health has noted that free versions of these applications (i.e. non-commercial versions) may not meet applicable laws for security and privacy.

    You should check whether the platform you wish to use complies with Australian privacy and security laws. You can do this by asking the vendor or checking the vendor’s website.


  • A: Some practices are already set up already for telehealth consultations with specialists. For those practices requiring guidance, the RACGP’s video consultation guidelines provide helpful information on getting started.

    You need to consider what you need to do if you are conducting the consultation from the practice or from home. Some of these things are:

    • How are you going to provide patients with the ability to contact you by phone or video conference?
    • Do you have remote access to your medical records system from home? If you don’t have access, you will need to keep records that can be scanned into the system, including billing information. You also need to be mindful of the limitations of the advice you can provide without immediate access to the patient’s medical records.
    • How will prescriptions and medications be provided to patients if they cannot visit the practice or pharmacy? Some of the options include getting consent for a family member to collect the prescription or sending them to a local pharmacy and arrange for delivery of the medications to the patients.
    • Do you have a printer at home if you need to send a letter?

    Telehealth and telephone consultations will be a new experience for many patients, so the RACGP recommends communicating with patients about the process and the benefits before they take part. A template patient brochure is available from the RACGP website.


  • A: It is a MBS requirement that you have the capacity to provide the full service through telehealth or telephone safely and in accordance with professional standards. The MBS telehealth item number descriptors also require general practitioners to undertake the following in each telehealth or telephone consultation:

    • take a short patient history
    • arrange any necessary investigation
    • implement a management plan;
    • provide appropriate preventative health care;

    Always be aware of the limits of what you can achieve via the phone or video link if you are unable, for example, to check a patient’s blood pressure or temperature (and they cannot reliably do this remotely).

    You will need to consider whether a physical examination is necessary and have a plan in place for referral of the patient if you are in self-isolation. This may be to a colleague in your practice if they are available to see the patient, the local hospital if appropriate or to another practice in the area if your practice is closed or the doctors cannot see additional patients.

    The Good medical practice code of conduct applies to telehealth consultations as it does for face-to-face consultations. Doctors providing care via any form of technology are also required to follow the Medical Board’s Guidelines for Technology-Based Patient Consultations.

    What this means in practice is:

    • you need to be able to verify the identity of the patient
    • the usual principles apply for obtaining your patient’s informed consent and protecting their privacy
    • you need to keep appropriate records of the consultation
    • if providing prescriptions you need to have enough information about the patient’s past medical history and current medical conditions, and medications to satisfy yourself that the prescription is appropriate and not contra-indicated.

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Patient appointments


  • A: Yes. This is a reasonable question. The RACGP advises: “Key for GPs and practice teams is to ensure good triage protocols and avoid having patients suspected of having the virus, in the waiting room with other patients. Practices can utilise the available patient alert posters to quickly identify, and appropriately manage, patients presenting with symptoms.”

    The RACGP has also recommended that GPs should not treat or test patients suspected of COVID-19 unless they have appropriate Personal Protective Equipment (PPE), so if your practice does not, direct patients to local hospitals or collection centres.

    Otherwise, pass the call onto a nurse to assess their symptoms – if they are very unwell with a cough and high fever, advise them to go directly to their local hospital.

    If a nurse is not onsite, pass the call onto the patient’s usual treating doctor or another doctor who is able to take the call.

    If the patient is mildly unwell and they have travelled to the countries at risk, and can be given an appointment, tell them to come straight to reception. Take a surgical mask and isolate them in a spare room.

    If they are a new patient and have no relationship to your practice, ask them to call their usual practice.


  • A: Yes. You may place signs telling people to call the reception desk and/or tell reception the moment they come in if they have been travelling and have symptoms of COVID-19. Visit the RACGP’s website for patient alert posters.


  • A: Doctors are not legally obliged to treat patients unless it is an emergency or a contractual requirement.

    Discrimination laws prevent medical practice staff from discriminating against patients on the basis of disability/impairment (e.g. COVID-19) or ethnic origin. However, you could refuse to see a patient if it is reasonably necessary to protect the health and safety of any person (including medical practice staff).

    In determining whether discrimination is “reasonably necessary” you need to consider the up-to-date expert advice. View the Department of Health’s guidelines about managing patients with suspected COVID-19 in a GP setting.

    The RACGP also issued guidance about the use of PPE when managing patients with suspected COVID-19 in a GP setting. The guidelines state:

    “GPs should not treat or carry out testing on suspected coronavirus patients if they do not have the correct PPE equipment. They should seek advice from their local public health unit on where to send the patient for treatment or testing and how to minimise the risk of infection while the patient is being transported.”

    In our view, it is reasonable to refuse to see patients with symptoms of COVID-19 if the practice cannot comply with the safety guidelines provided by the Department of Health and RACGP.


  • A: The Department of Health does not currently classify pregnant women as a high-risk category and has not provided any guidance about the need for pregnant healthcare workers to self-isolate or not attend work. View current advice from the Department of Health about healthcare workers attending work.

    The RACGP has not provided any guidance about the need for pregnant healthcare workers to self-isolate or not attend work.

    The advice from RANZCOG is that "At this time, pregnant women do not appear to be more severely unwell if they develop COVID-19 infection than the general population. It is expected the large majority of pregnant women will experience only mild or moderate cold/flu like symptoms”.

    RANZCOG recommends that, where possible, pregnant health care workers be allocated to patients, and duties, that have reduced exposure to patients with, or suspected to have, COVID-19 infection. All personnel should observe strict hygiene protocols and have full access to Personal Protective Equipment (PPE). The College also urges employers to be sensitive to the fact that pregnant women are, appropriately, often anxious about their own health and protective of their unborn baby. Consideration should be given to reallocation to lower-risk duties, working from home or leave of absence.

    View RANZCOG’s guidelines.

    The Australian and New Zealand Intensive Care Society has released COVID 19 guidelines. At page 22, the guidelines say:

    Staff members who are at higher risk caring for COVID-19 patients

    We recommend that staff who are judged to be of high risk should not enter the COVID-19 isolation area. This includes staff who are pregnant, have significant chronic respiratory illnesses or are immunosuppressed.

    The international experience is that mortality is higher in older patients, particularly with comorbidities related to cardiovascular disease, diabetes mellitus, chronic respiratory diseases, hypertension and malignancy. Staff member risk decisions should be made on a case by case basis by the unit director with the support of the local occupational health and safety unit. We recommend that these staff would be reallocated to other roles and not enter COVID-19 areas.

    As a worker, a doctor has an obligation under workplace health and safety laws to ensure their own health and safety and the health and safety of others.

    If you have a genuine concern that you or your baby are at a higher risk of contracting COVID-19 or of suffering serious illness as a result of COVID-19 because you are pregnant, you should speak with your employer/practice principal about the situation. They may agree that you are not required to come to work or may allocate you to another role which is less likely to have contact with suspected or confirmed cases of COVID-19.

    If your employer/practice principal insists that you come to work, they must consider what reasonable adjustments can be made to the workplace to accommodate your specific needs (i.e. being the additional protections that are necessary because of your medical conditions). You will need to consider whether the proposed measures are sufficient to keep you safe. If not, you can refuse to attend work on health and safety grounds.

    For employed doctors who are pregnant, there is legislation entitling you to transfer to a safe job or not attend work in certain circumstances. You should seek specific advice about your personal circumstances.

    This is general advice. You should consider whether there are any specific conditions or requirements in your contract of employment, services agreement and policies and procedures.


  • A: If a patient cannot be tested at the practice they should be informed to:

    - go straight to the pathology collection service or Emergency Department from the GP’s rooms

    - wear a surgical mask

    - not travel to the collection centre or ED by public transport

    - be advised about good respiratory etiquette and hand hygiene.

    The practice should call ahead to the pathology provider to advise a patient is on their way. For example, NSW Health has a list of collection centres that are providing specimen collection for COVID-19 testing, or you can phone your local collection centre to check before referring your patient.

    Please note that if a patient does present at your practice with symptoms and there is a medical emergency, the patients should be assessed to ascertain what assistance is required. The doctor should wear suitable PPE during this treatment.

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Patient testing and treatment


  • A: Testing is only required for ‘suspected’ cases, which means the patients have clinical symptoms. Otherwise, the result is likely to be negative and falsely reassuring.

    Duplicate specimens are recommended to enable parallel testing for other respiratory pathogens - one nasopharyngeal swab and one oropharyngeal swab (Dacron or Rayon, flocked preferred). There is no diagnostic blood test at present.

    The pathology provider will test for common viral respiratory pathogens and the other swab will be forwarded to a reference laboratory for COVID-19 testing.


  • A: As we anticipated, the testing guidelines are changing as community transmission increases. You should check for updates via the Communicable Disease Networks Australia’s National Guidelines for Public Health Units. We are also aware that the states and local health districts are distributing their own guidelines on testing, so you should be aware of testing criteria at your local level.

    Doctors should continue to use their clinical discretion and recognise there may be situations in which testing patients outside of the guidelines may be clinically appropriate.


  • A: Whilst doctors should exercise their clinical discretion, the Chief Medical Officer has confirmed that at present there is no definite requirement for individuals with cold or flu symptoms to be tested if they have no other risk factors for COVID-19.


  • A: Patients can’t demand that doctors undertake testing. This is a clinical decision based on the circumstances of each patient. Further, Medicare normally doesn’t cover ‘screening’ tests, they have to be paid for privately. There needs to be a clinical indication to justify testing and in the absence of any directive from Medicare on this point, there is no reason to take a different approach in relation to COVID-19 testing.

    Doctors can, however, use their clinical discretion and judgment to decide if a test is required or clinically necessary in situations where a patient does not meet the strict criteria for a ‘suspected case,’ taking into account recent advice from the Minister for Health that they would rather “over test, than under test”.

    Patients can also be referred to the screening services or collection agencies for advice.


  • A: Without patient consent, a doctor cannot perform testing. Where there is concern that a patient who is a ‘suspected case’ is refusing testing or will not follow up with testing, the doctor should contact the public health unit for advice. There are powers under state and territory-based legislation to compel testing in certain circumstances.


  • A: The current advice from the RACGP is that PPE is required to undertake testing:

    “GPs should not treat or carry out testing on suspected coronavirus patients if they do not have the correct PPE equipment. They should seek advice from their local public health unit on where to send the patient for treatment or testing and how to minimise the risk of infection while the patient is being transported”.

    If taking specimens from patients with mild symptoms the advice is to use standard, contact and droplet transmission precautions: long sleeved gown, gloves, protective eyewear/face shield and surgical mask.

    Specimen collection from patients with severe symptoms should be carried out in the Emergency Department with airborne precautions, including a P2 mask. For more information, view the Department of Health’s factsheet.

    You can also contact your local Primary Health Network for supplies of PPE.


  • A: Notify your local public health unit immediately after being notified of a positive COVID-19 result. Patients with mild symptoms do not need to be sent to the Emergency Department, unless there is another reason why they may require hospital treatment. The patients should be referred for co-management with the local infectious disease physician and the public health unit.


  • A: If staff have worn PPE when dealing with a patient who is then confirmed as having COVID-19, this is not considered a close contact, so self-isolation for 14 days is not required.

    If staff were not wearing PPE they need to consider if they had ‘close contact’ with the patient.

    Close contact means greater than 15 minutes face-to-face contact in any setting with a confirmed case in the period extending from 24 hours before onset of symptoms in the confirmed case or sharing of a closed space with a confirmed case for a prolonged period (e.g. more than two hours) in the period extending from 24 hours before onset of symptoms in the confirmed case. View more information on the explanation of these definitions.


  • A: The only type of ‘certification’ a doctor can provide is to the effect that, on the day of assessment, the patient was symptom free (this relies on a patient history and the patient being honest) and exhibited no clinical features indicating a viral infection. These are relatively limited, but would include normal temperature and heart rate, nil respiratory distress, clear chest, no rhinorrhoea or pharyngitis.

    For more information, read our article on medical clearance certificates.


  • A: There are no public health requirements for clearance certificates to return to work, school or university.

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Healthcare worker testing


  • A: In addition to the standard criteria for testing of all people, including healthcare workers, referred to in A and B above, healthcare workers should also be tested for COVID-19 if they provide direct care to patients and have both:

    • a fever (≥38C*) or history of fever (e.g. night sweat, chills) AND
    • symptoms of an acute respiratory infection (e.g. shortness of breath, cough, sore throat).

    You should not go to work while you wait for the test results and seek advice from your doctor/ public health unit, as to when it is safe for you to return to work.

    Some state governments and/or local health districts are implementing differing guidance about testing and returning to work for healthcare workers. Therefore, you should stay up-to-date with your own local guidelines, especially if you are work in a hospital or other public setting, and you are subject to local policies and procedures under your contract.

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Workplace and staff


  • A: The advice from the Commonwealth Department of Health is that healthcare workers should not go to work if they have:

    • symptoms of an influenza like illness, as per usual practice OR
    • returned from any country overseas and have fever OR symptoms of acute respiratory infection (e.g. shortness of breath, cough, sore throat). These healthcare workers should be isolated and tested for COVID-19 OR
    • have been in close contact with a confirmed case of COVID-19 (either in the community or at work) within the past 14 days and have not been protected with appropriate PPE OR
    • returned from a higher-risk country within the past 14 days. Visit the Department of Health’s website for a list of at-risk countries and quarantine requirements.

    In addition, healthcare workers who have returned from overseas after midnight on 15 March 2020, are required to self-isolate for 14 days.

    The advice from the Department of Health is there is no work restriction on healthcare workers who are casual contacts of COVID-19 cases and are well, including those who have provided direct care for confirmed cases while using adequate personal protective equipment (PPE). In this instance, healthcare workers should self-monitor for symptoms and self-isolate if they become unwell, until COVID-19 is excluded.

    In settings where the temporary exclusion of healthcare staff will have a significant impact on a service, an individual risk assessment should be conducted in collaboration with the local public health unit.

    Some state governments and/or local health districts are implementing differing guidance about testing and returning to work for healthcare workers. Therefore, you should stay up-to-date with your own local guidelines, especially if you are work in a hospital or other public setting, and you are subject to local policies and procedures under your contract.

    For more information, view the Department of Health’s website.


  • A: The Department of Health has identified the following people as being at higher risk of COVID-19. These people may be at higher risk of contracting the disease or of suffering serious illness as a result of the disease.

    In Australia, the people most at risk of getting the virus are those who have:

    • recently been in in a high-risk country or region (mainland China, Iran, Italy or Korea)
    • been in close contact with someone who has a confirmed case of COVID-19.

    Based on what we know about coronaviruses, those most at risk of serious infection are:

    • people with compromised immune systems (such as people who have cancer)
    • elderly people
    • Aboriginal and Torres Strait Islander peoples (as they have higher rates of chronic illness)
    • people with chronic medical conditions
    • people in group residential settings
    • people in detention facilities.

    The Department of Health has not provided any guidance about the need for healthcare workers to self-isolate or not attend work if they are in a high-risk category or if a family member is in a high-risk category. View the Department of Health’s current advice about healthcare workers attending work.

    The RACGP has not provided any guidance about the need for healthcare workers to self-isolate or not attend work if they are in a high-risk category or if a family member is in a high-risk category.

    The Australian and New Zealand Intensive Care Society has released COVID 19 guidelines. At page 22, the guidelines say:

    Staff members who are at higher risk caring for COVID-19 patients

    We recommend that staff who are judged to be of high risk should not enter the COVID-19 isolation area. This includes staff who are pregnant, have significant chronic respiratory illnesses or are immunosuppressed.

    The international experience is that mortality is higher in older patients, particularly with comorbidities related to cardiovascular disease, diabetes mellitus, chronic respiratory diseases, hypertension and malignancy. Staff member risk decisions should be made on a case-by-case basis by the unit director with the support of the local occupational health and safety unit. We recommend that these staff would be reallocated to other roles and not enter COVID-19 areas.

    As a worker, a doctor has an obligation under workplace health and safety laws to ensure their own health and safety and the health and safety of others.

    If you have a genuine concern that you are at a higher risk of contracting COVID-19 or of suffering serious illness as a result of COVID-19, you should speak with your employer/practice principal about the situation. They may ask for information from your treating practitioner about the nature of your medical conditions and the risks of COVID-19 exposure, and may agree that you are not required to come to work or may allocate you to another role which is less likely to have contact with suspected or confirmed cases of COVID-19.

    The current telehealth item numbers do not allow you to bulk-bill telehealth services that you provide from home if you are not required to self-isolate (i.e. you are at home because you are in a high-risk category). We understand this is under review. You can privately bill for telehealth services.

    You are allowed to bulk-bill patients who are at risk for telehealth services, provided the relevant criteria are met. You can find further information about the new telehealth item numbers here.

    If your employer/practice principal insists that you come to work in your usual role, they must consider what reasonable adjustments can be made to the workplace to accommodate your specific needs (i.e. being the additional protections that are necessary because of your medical conditions). You will need to consider whether the proposed measures are sufficient to keep you safe. If not, you can refuse to attend work on health and safety grounds.

    This is general advice. You should consider whether there are any specific conditions or requirements in your contract of employment, services agreement and policies and procedures.


  • A: The requirement for self-isolation or quarantine is unusual. It is not contemplated under existing laws and no specific leave entitlements are available.

    We have set out the legal position below, but it is up to each practice to determine how best to manage the situations that arise with their staff. A number of Australian employers have announced they intend to provide paid special leave for certain employees who are required to self-isolate as a result of COVID-19 or who contract COVID-19.

    Workplace health and safety laws require businesses to ensure (as far as reasonably practicable) the health and safety of workers and others at the workplace. Workers must also protect themselves and others.

    Businesses must identity and eliminate or minimise health and safety risks that arise in their workplace. In identifying and managing risks, businesses should consider relevant expert advice.

    The Department of Health provides regularly updated advice about the risks associated with COVID-19.

    If a worker has been in ‘close contact’ with someone who has a confirmed diagnosis of COVID-19, the worker can minimise the risk of transmission by self-isolating. Similarly, a business can manage the risk of transmission by requiring the worker to self-isolate.

    Any workers who can work from home during a self-isolation period should do so and should continue to be paid as usual.

    If a worker is not able to work from home (e.g., due to the nature of their role), the business will need to consider how to manage the worker’s engagement, taking into account the ‘legal’ position below.

    Employee (other than casual)

    The usual position is that an employer does not have to pay an employee if the employee is unable to work and is not on some form of paid leave

    An employee in self-isolation or quarantine is not entitled to paid sick leave (because they are not sick) but given the unusual circumstances of COVID-19, employers may wish to allow such employees to take paid sick leave.

    An employee in self-isolation or quarantine is not entitled to paid sick leave (because they are not sick) but given the unusual circumstances of COVID-19, employers may wish to allow such employees to take paid sick leave.

    Employee (casual)

    A casual employee is not entitled to paid leave.

    An employer does not have to pay a casual employee if the employee is unable to work.

    An employee is entitled to take paid annual leave or long service leave by agreement with their employer.

    Contracted GP or allied health professional

    Most service agreements do not contemplate the possibility of self-isolation or quarantine. However, it is important to confirm this by checking the agreement (e.g., stand down, force majeure or suspension clauses).

    In the absence of a specific requirement in the agreement, a practice does not have to pay a contractor if they do not work.

    Other contractors

    The practice should consider how it manages the risks of other contractors such as cleaners.


  • A: The requirement for self-isolation or quarantine is unusual. It is not contemplated under existing laws and no specific leave entitlements are available. The legal position is outlined below, but it is up to each practice to determine how best to manage these situations with their staff.

    If a worker has been diagnosed with COVID-19, the worker needs to follow the Department of Health’s guidance and minimise the risk of transmission by self-isolating. Similarly, the practice can manage the risk of transmission by requiring the worker to self-isolate.

    Managing the worker

    The worker should not be allowed to attend the workplace, even to collect their personal belongings.

    An employee (other than a casual employee) is entitled to paid sick leave or another form of paid leave.

    A casual employee is not entitled to paid leave or any other form of payment.

    In the absence of a specific requirement in the agreement between a contracted health practitioner and a practice, the contracted health practitioner is not entitled to paid leave or any other form of payment.

    A worker may be entitled to benefits under their income protection insurance. The worker would need to speak to their insurer about this.

    - A worker may be entitled to Centrelink benefits and would need to speak to Centrelink about this.

    Managing other workers

    The practice should not disclose that a particular worker has been diagnosed with COVID-19, but can advise there has been a recent diagnosis connected with the practice and appropriate steps are being taken.

    The practice should consider the latest guidelines from the Department of Health and the RACGP.

    If the worker has had ‘close contact’ with other workers, the practice should require those other workers to self-isolate. The practice should speak with their state public health unit to determine whether the practice will need to close or whether cleaning and sterilisation of the practice is sufficient.

    See above for payment obligations for these workers.

    Managing patients

    If a worker has had ‘close contact’ with patients, the practice should contact their state public health unit for assistance with contact tracing and general advice.


  • A: If you feel well, and have no symptoms, you can return to work. You do not need to have a test for COVID-19.

    View current advice from the Department of Health about returning to your community and about healthcare workers attending work.


  • A: The public health unit will advise you about the requirements for you to return to work. You will require negative test results for COVID-19 before being allowed to return to work.


  • A: Annual leave

    An employer does not have a right to cancel an employee’s annual leave which has already been approved. Annual leave can only be cancelled/postponed by agreement.

    An employer must not “unreasonably refuse” an employee’s request for annual leave under section 88 of the Fair Work Act. An employer should consider issues such as the need for staff to work during a pandemic/health crisis and balance this against the personal circumstances of the employee (e.g. leave requested for their son’s wedding).

    Long service leave

    State based entitlements. For example in Queensland:

    An employer does not have a right to cancel an employee’s long service leave which has already been approved. Long service leave can only be cancelled/postponed by agreement.

    An employer and an employee must agree about taking long service leave. An employer must not “unreasonably refuse” an employee’s request for long service leave. An employer should consider issues such as the need for staff to work during a pandemic/health crisis and balance this against the personal circumstances of the employee (e.g. leave requested for their son’s wedding).


  • A: There are a range of options that a practice can consider if it needs to cease operating from its premises temporarily.

    Work from home

    Any workers who can work from home during a self-isolation period should do so and should continue to be paid as usual.

    Taking leave by agreement

    An employer and employee can agree the employee will take paid leave during the practice closure period.

    Direction to take annual leave

    An employer has a right to direct an employee to take leave in the circumstances provided for under the relevant awards below:

    Health Professionals and Support Services Award 2010

    Clause 31.4 Close down periods — dental and medical practices

    “Where an employer temporarily closes a dental or medical practice, an employee may be directed to take paid annual leave during part or all of this period provided such direction is reasonable. Where an employee does not have sufficient accrued annual leave for this period, they may be required to take annual leave in advance where such requirement is reasonable.”

    Nurses Award 2010

    Clause 31.9 Close down periods—medical practices

    “Where an employer temporarily closes a medical practice, an employee may be directed to take paid annual leave during part or all of this period. Where an employee does not have sufficient accrued annual leave for this period, they may be required to take annual leave in advance.”

    Direction to take long service leave

    Long service leave is different in each state. In some states, an employer can direct an employee to take long service leave in certain circumstances.

    Stand down of employees without pay

    The Fair Work Act 2009 (Cth) allows employers to stand down employees without pay if there is a stoppage of work for which the employer cannot reasonably he held responsible. View section 524 under the Act.


  • A: An employee can take carer’s leave to provide care or support to a member of the employee's immediate family, or a member of the employee's household, who requires care or support because of a personal illness or personal injury, affecting the member or an unexpected emergency affecting the member. View section 97 of the Fair Work Act 2009.

    • The definition of a “personal illness” includes diagnosed COVID-19.

    • An “emergency” includes school or child care closure without notice.

    An employee (other than a casual employee) is entitled to take paid carer’s leave if the employee has a paid personal/carer’s leave entitlement.

    An employee (including a casual employee) is entitled to take two days of unpaid carer’s leave for each occasion if they do not have an entitlement to paid personal/carer’s leave. View section 102 and section 103 of the Fair Work Act.

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Avant Practitioner Indemnity Insurance


  • A: Telehealth activities are covered under your practitioner policy. This includes consultations conducted via video conference and telephone, as well as SMS. You are covered anywhere in Australia.

    Where there is a pre-existing clinical relationship with your patient, you are covered for telehealth activities where you are outside of Australia (for less than 120 days) and the patient is in Australia, or where the patient is outside of Australia (for less than 90 days) and you are in Australia (please refer to the policy wording for all details).


  • A: Your policy covers you for up to $20 million for claims for compensation made against you under your practitioner policy. It also provides cover for legal fees and expenses for disciplinary matters, including Medical Board inquiries and investigations.


  • A: You are covered under your practitioner policy for defending complaints in relation to breaches of workplace health and safety laws, as well as any fines and penalties as a result.

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Avant Practice Medical Indemnity Policy


  • A: Yes. Your practice policy also has cover for telehealth activities.


  • A: Yes. Your practice policy provides cover for claims for compensation made against the practice which relate to the healthcare services you provide. Legal fees and expenses for disciplinary matters (e.g. tribunal or registration board) are also covered under your practice policy.

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