Review finds chaperones have limited effectiveness when it comes to protecting patients
Doctors accused of sexual misconduct face being sidelined from practice after AHPRA agreed to scrap the system of using chaperones to monitor their interaction with patients while allegations are investigated.
The regulator announced the decision last week, saying it accepted all 28 recommendations presented by Professor Ron Paterson after an independent review in response to a high-profile case in which a specialist molested patients, despite being under supposed surveillance.
Professor Paterson, an authority on patient safety from the University of Auckland, found nothing to praise about the chaperone system.
“Chaperones are of limited effectiveness in protecting patients, their use is largely confined to private medical practice, the system relies on inadequately informed and trained chaperones, many in a conflicted situation by being employed by the doctor they are to observe and report on,” he said.
In addition, patients were being kept “in the dark” about the doctor’s status and why a chaperone was required.
From now, if a doctor is accused of sexual misconduct, authorities will be required, as an immediate measure, to restrict what patients they can see – most probably decided by gender – or suspend them from practice.
Chaperones may later be used in cases where the allegation involves only one patient, and the alleged conduct would not, if proven, constitute a criminal offence, and the practitioner had no relevant notification or complaint history. However, the chaperone may not be an employee and must be a registered health practioner.
AHPRA has yet to establish what training would be required.
Last year, 39 doctors were working under chaperone conditions, including 20 GPs.
Medical defence organisations were disappointed by the outcome.
“MDA National’s main concern … is that doctors will face prolonged periods of being unable to practise if an allegation of sexual misconduct is made against them by a patient,” Dr Sara Bird, manager of medico-legal and advisory services, said.
“If suspension or patient contact prohibitions are the only regulatory options while allegations of sexual misconduct are investigated, then GPs will be unable to work until the matter is resolved.”
Dr Bird pointed out that criminal investigations could take many years to conclude or proceed to trial. AHPRA investigations could also be prolonged.
“I note the report states the responsibility for delays cannot simply be laid at the door of AHPRA, and the justice system also has a critical role to play… However, it is difficult to see how this will speed up the progress of these criminal investigations.”
MDA National’s main concern … is that doctors will face prolonged periods of being unable to practise.
In a submission to the Paterson inquiry, the top medical insurer, Avant, claimed chaperone conditions were effective as an interim protective measure and in balance with a practitioner’s right to the presumption of innocence.
“While the circumstances that led to this review are serious, there is little to support the conclusion … that chaperoning conditions should not be part of regulatory toolkit,” the submission said.
The review was sparked by media revelations last year that Melbourne neurologist Andrew Churchyard had abused a teenage male patient behind a curtain while he was under supposed chaperone conditions and facing charges of assaulting other patients.
The teenager was the son of Melbourne GP Dr Sharon Monagle, who made a 17-page submission to the inquiry, detailing the flaws in the chaperone system and describing how predatory practitioners could evade detection.
Dr Monagle said the reporting experience, from the victim’s perspective, was reminiscent of the Catholic church and other institutions’ handling of sex abuse case, “whereby complaints were dealt with in-house and not reported to police”.
The Paterson report also recommended that AHPRA’s Register of Practitioners include web links to published disciplinary decisions and court rulings.