Whistle-blowing: the curse of the Black Pearl
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Transcript of Whistle-blowing: the curse of the Black Pearl
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Whistle-blowing: the curse of the Black Pearl
Dr Phoebe-Anne MainlandMA (Medical Law & Ethics)FANZCA FHKCA FACLM
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Declaration Chinese University of Hong Kong Alfred Health Alfred Health Ethics Committee MDA National
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Ethics and reporting colleagues Voluntary and mandatory notification of
health professionals Does codifying address problems of
voluntary reporting? Ethical & moral approach to aberrant
behavior
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Whistleblowing Reporting behavior or an action that fails to
conform to standards of law or morality
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July 2010
Australian Health Practitioner Regulation Agency
AHPRA
National organization for registration & accreditation of 10 health professions Including doctors
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The ActHealth Practitioner Regulation National Law
Act
Requires of registered HP ‘Mandatory Notification’ of other HP
Whose professional practice has placed the public at risk of substantial harm Notifiable conduct
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Notifiable conduct Practised the practitioner’s profession while intoxicated
by alcohol or drugs; or Engaged in sexual misconduct in connection with the
practice of the practitioner’s profession; or Placed the public at risk of substantial harm in the
practitioner’s practice of the profession because the practitioner has an impairment; or
Placed the public at risk of harm because the practitioner has practised the profession in a way that constitutes a significant departure from accepted professional standards.
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Previously Moral & ethical reasons to report conduct
that could place a patient at harm
Principalism Virtues Codes of ethics
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Principalism Beauchamp & Childress
Autonomy Beneficence Non-maleficence Justice
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Virtues Honesty Integrity Respectfulness Compassion Tolerance
Patience Diligence Professionalism Collaborativity Humility
ANZCA Code of Professional Conduct
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http://www.wma.net/
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A PHYSICIAN SHALL Deal honestly with patients and colleagues,
and report to the appropriate authorities those physicians who practice unethically or incompetently or who engage in fraud or deception.
WMA International Code of Medical Ethics
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Other health professions Not all had codes of ethics or practice
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A PHYSICIAN SHALL Deal honestly with patients and colleagues,
and report to the appropriate authorities those physicians who practice unethically or incompetently or who engage in fraud or deception.
WMA International Code of Medical Ethics
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A PHYSICIAN SHALL Deal honestly with patients and colleagues,
and report to the appropriate authorities those physicians who practice unethically or incompetently or who engage in fraud or deception.
WMA International Code of Medical Ethics
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Doctors have a long history of codes of ethics
Advance for other health professions
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Why did Australia codify? Perceived failure of voluntary notification
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Jayant Patel, Bundaberg Hospital
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How did this occur? Failure of appointment system to identify
problem practitioner Exposure by media
After Google search
Failure of attempts by colleagues to be heard Failure of voluntary reporting
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Problems of Voluntary Reporting Not reported Reported
Whistleblower Subject Profession Public
Process
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Not reported Harm to the patient Harm to standard of health care Lack of trust of professions by society Undermining professionalism
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Whistleblower Whistleblower protection legislation
‘Grassing on mates’ Discredited Personal life dredged
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Subject Professional and personal life upset
Mud sticks
Indignation of being investigated Refusal to accept
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Profession Destabilize the profession Destabilize team
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Public Blame, accusations, accountability Suspicion of profession
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Process How to report, to whom? Conflicts of interests of institution/employer Consequences of reporting Transparency Mandate of those making judgments
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Will codifying address these problems?
Cross professional reporting Recognize team Other professions in better position to observe Empowering, as requirement & pathway is
unambiguous
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Not reporting Opposite problem
Overwhelming reports Vexatious notifications
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Whistleblower Same issue of ‘disloyalty’
Justification ‘I had to’ Protection for vexatious reports Detrimental to relationships
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Subject No progress for subject
Harrowing even if exonerated Denial
Denial after investigation Lack of insight Unchangeable
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Accusation cascade Confronts sense of self
Professionally Personally
Defensive Mistrust Abandonment Destructive to self Counterproductive
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Subject No progress for subject
Harrowing even if exonerated Denial
Further problems No warnings No performance management No remedial intervention Discourage HP own health care Conflicts with other ethical duties
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A PHYSICIAN SHALL Act in the patient’s best interest when
providing medical care.
Behave towards colleagues as he/she would have them behave to him/her.
WMA International Code of Medical Ethics
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Process Suspicion for both voluntary & mandatory
notification Lack of confidence worse No solution to
Unknown consequences of reporting Lack of transparency Mandate of authority
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Bottom line There will be outliers of performance
Need to protect patients Responsibility to look after colleagues
Is mandatory notification necessary?
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Ethical and moral values Reinforce principles & virtues
Role models, leadership & example Curriculum and ongoing professional development
‘Normalize’ peer review, self audit Reflection, awareness, insight Whistleblowing unnecessary
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Ethical and moral values Transparency of process
Acceptance of reviewers Engage professionals in appointment
What is the ‘appropriate authority’?
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‘…if Dr Patel had been working in a major tertiary hospital, any sub-standard performance would have been "very evident.” ’
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The MVSA Audit
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Support Subject Whistleblower
Profession Public