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Hospital headaches: workplace demands

27 May 2019 | Stephanie Penney, B Health Science (Nursing), LLB, Master Dispute Resolution (UTS), Practice Manager - Claims, NSW

Working in a hospital setting requires medical practitioners to interact with a large number of co-workers, including managers and trainees. We have seen an increasing number of employment related matters in recent years. The following are examples of situations with which we assist members.

Supervision scrutinised

We have assisted several consultants who have been notified about concerns from hospital administration about their levels of supervision. In one case, the supervision of a surgeon at a public hospital fracture clinic was scrutinised. A registrar was attending to patients in a consulting room adjacent to a supervisor, resulting in an accusation that ‘direct supervision’ was not provided. The matter was investigated by the hospital administration while a risk assessment was undertaken and colleagues interviewed.

During the investigation the scope of the issues broadened, causing the surgeon to contact Avant for assistance in preparing submissions answering a number of related concerns. Not only was the issue of ‘direct supervision’ addressed but, because the clinic services attracted Medicare benefits, compliance under the Medicare Benefits Schedule (MBS) was also examined. The investigation was extended to examine supervision in surgical cases.

In assisting our member, we attended a number of meetings with hospital administration and prepared a detailed response to the concerns. Our member was required to educate themselves around certain hospital policies and procedures, and also with respect to the MBS, but no further action was taken.

Wrongful termination

Another common issue is disputes between Visiting Medical Officers (VMO), staff doctors and hospitals which frequently relate to performance issues. Understandably they cause great anxiety and distress for the doctor, whose accreditation and/or employment status may be at risk.

A VMO member had an allegation made against him of practising outside the scope of his employment in the treatment and management of a hospital patient. The hospital had formed the view this was deliberate and his appointment was terminated.

In such circumstances, VMOs in NSW have the right to appeal under the Health Services Act. The VMO sought our assistance with his appeal.

We challenged the investigation and the hospital’s termination process, pressed for specific details about the allegations made, and the substantive allegations that the practitioner acted outside the scope of their clinical privileges.

For the appeal hearing we engaged a medical expert who presented an opinion in support of our member’s appeal and a barrister who was experienced in administrative and employment law.

After hearing the appeal, the committee concluded that our member’s conduct did not warrant a termination and determined to reinstate the practitioner’s appointment to the hospital as a VMO. So a fair outcome was achieved for our member.

Case comment 

Hospitals are becoming aware of the risks associated with leaving even the most skilled registrar unsupervised. This is relevant to surgical, consultation and clinic settings. 

Consultants must be aware of their registrars’ supervision requirements, which are often set by the hospital, or are recommended by the colleges. Supervision requirements may differ between specialities, and between private and public hospitals. Notwithstanding your confidence in a registrar’s skills, it is important to enquire with the hospital, check private and/or public hospital policy and directives and make enquires with the relevant college.

If a hospital appointment is suspended, doctors have to notify AHPRA and any other facilities at which they are accredited.

More information

Download our factsheets: How to negotiate difficult situations with your supervisor and What to do when requested to attend an employment meeting.

View our video: Meeting with hospital administration.

This article was originally published in Connect issue 9.

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