This is a long question, so I’ve broken it up with answers and comments along the way.
I have just finished reading serval of your posts relating to “What is a paramedic’s authority to practice”? (19 August 2014) and “Doctors Delegating authority to carry drugs” (20 August 2014).
I found the explanation of “authority to practice’ as defined by the South Eastern Sydney Local Health District very interesting as the definition clearly states that such a document can only be issued by a ‘National Registration Board on a year to year bases.
Yes, but the definition of that health district was quoted to point out that the term means whatever the person using it wants it to mean. The point was that paramedics don’t have a particular ‘authority to practice’ nor do they need it. As I said in that post, the South Eastern Sydney Local Health District was ‘using the term ‘authority to practice’ as a shorthand or ‘catch all’ phrase to cover the various documents that may be issued for registered health practitioners. The critical issue here is that paramedics are not registered health professionals.’
Continuing with your article [state employed] paramedic’s are not registered with such a National Board so their ability while on duty to carry and administer scheduled drugs and controlled drugs is derived from the employer and the duty statement the paramedic is employed under.
You also very eloquently explained how private resource paramedic’s are able to with dispensation from relevant State authorities are able to act in a similar capacity as State employed paramedic’s.
In relation to both the private and State employed paramedic’s I identified a commonality that both are not registered with a National Board.
Which is true. Although it has been announced that paramedics will be brought into the registration scheme established by the Health Practitioner National Law that has not yet happened (see ‘National Registration for Paramedics’ Council of Australian Governments (COAG) Health Council Communique – 7 October 2016).
As a Defence medic (employment category (031-2) Medical Technician (MT)) I am trained and registered as an Enrolled Endorsed Nurse. To maintain employment in Defence I must maintain the requirements of the civilian National Board. A MT is employed by Defence to work in both a primary Health facility and in a prehospital care roll. The pre hospital roll requires MT’s to carry and administer medications including s4 and s8 drugs.
Upon receiving such scheduled drugs, the MT is issued an ‘authority to carry and an authority to practices’ from an issuing medical officer (Doctor).
Medical Techs often work independently in remote and isolated locations where they may issue s3-s4 and s8 medication.
When issuing medication, the MT may consult with the issuing Doctor via phone or radio to dispense for an example antibiotics s-4. There has been no relationship between the Doctor or patient, the patient is not in a medical centre, the issued medication the MT has in possession is not prescribed to the patient on a drug order form. In this instant the MT is acting on behalf of the Doctor.
They are not acting ‘on behalf of the doctor’ any more than a nurse who administers drugs to a patient is acting ‘on behalf’ of the prescribing doctor. The doctor makes a clinical judgment that the drugs are required, the nurse administers them in his or her capacity as a nurse. In the scenario described the MT makes a decision that a drug is required. According to my correspondent the ‘the MT may consult with the issuing Doctor’ and I assume the use of the term ‘may’ (not ‘must’) is deliberate. So there is someone you can ring, discuss the patient’s presentation and confirm the treatment decision. Each person in that conversation is responsible for their part in it, but the MT is acting as an MT, not as the doctor’s agent.
If “A Doctor has no ability to legally delegate permission to carry and dispense s4-s8 drugs to a Registered Nurse outside of a hospital environment or government sanctioned medical centre for the purpose of providing first aid” and if MTs hold a registration with a national board and this forms the primary function and employment with Defence could this be viewed as breaching registration by administering s4-s8 medications?
Answer – No. An MT may have to maintain their registration with the Nursing and Midwifery Board of Australia but that is hardly to the point. The Enrolled nurse standards for practice may set out the minimum requirements for an enrolled nurse but it doesn’t mean that one can’t have other qualifications and skills. I suppose it is possible that a person could be both an enrolled nurse and a registered medical practitioner. Their practice as a doctor would not somehow mean they are breaching their registration standards as a nurse.
More likely there are enrolled nurses who are employed as paramedics. Their practice as a paramedic, in accordance with the authorities granted to them as paramedics would not be a breach of the minimum standards expected as an enrolled nurse. The definition of ‘unsatisfactory professional conduct’ that applies in NSW (Health Practitioner Regulation National Law (NSW) s 139B) is “Conduct that demonstrates the knowledge, skill or judgment possessed, or care exercised, by the practitioner in the practice of the practitioner’s profession is significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience”. An MT that applies his or her training and skills in accordance with the authority granted by the ADF is not acting below, but in accordance with the standard expected of someone with that ‘level of training or experience’.
If their conduct does fall below the expected standard, they can expect to lose both their employment and their registration. For example, a paramedic who steals drugs or assaults their patient may lose both their job and their enrolment. But, in context, supplying drugs that one is authorised to supply as a paramedic or MT in accordance with one’s training, skills and authority is providing care beyond or above, not below, the standard of a person who is an enrolled nurse but not a paramedic or MT. Consider the ‘standards of practice’ as the minimum skill set, not the only skill set one can have.
Secondly MT’s may be issued s4-s8 drugs in one state and then travel to another state to support Military activities.
As you stated that private resource paramedic’s need authorisation from relevant Sate Departments to act in their roll within that state. Would the Defence Force by issuing s4-s8 in for example in South Australia and then transport the drugs to another sate [Queensland] be in breach of that states laws or is there a Federal dispensation allowing such movement solely for Defence.
Answer – No, there is no offence here or alternatively; Yes there is a federal law that allows such movement. The Australian Constitution, s 109 says that where there is an inconsistency between a valid state law and a valid Commonwealth law, the Commonwealth law prevails. The relevant Commonwealth law here is the Defence Act 1903 (Cth) s 123(1) which says:
A member of the Defence Force is not bound by any law of a State or Territory
(a) that would require the member to have permission (whether in the form of a licence or otherwise) to use or to have in his or her possession, or would require the member to register, a vehicle, vessel, animal, firearm or other thing belonging to the Commonwealth; or
(b) that would require the member to have permission (whether in the form of a licence or otherwise) to do anything in the course of his or her duties as a member of the Defence Force.
Where the MT is carrying drugs in accordance with the authority granted by the ADF he or she is not required to comply with state laws with respect to an authority issued by a state health department to carry (s 123(1)(a)) or use (s 123(1)(b)) drugs.
A medic employed by the ADF who is also a registered enrolled nurse commits no breach of the standards expected of an enrolled nurse if he or she uses the skills, training and authority provided by the ADF unless that behaviour is conduct that falls below, not just is different from, that expected of an enrolled nurse. Having a different skill set and authorisation is not conduct that is ‘below’ that expected of a nurse and applying those skills in a competent way is not going to suggest that the person is not competent as an enrolled nurse.
A medic employed by the ADF is not required to have any authority from a state agency to carry or use scheduled drugs. Their authority comes from the ADF.