Today’s correspondent comes from a paramedic seeking to working, in effect, across the NSW and Victoria state border.  My correspondent’s questions appear to suggest a misunderstanding of some key legal provisions.  Those misunderstandings may be reasonable, and even common, but are still misunderstandings. Many of the issues raised will however be resolved by National Registration.

My correspondent

… graduated in 2007 with a Diploma of Paramedical Science (Ambulance) and went straight into the private sector in Victoria. I was employed (and continue to this day) with … [an organisation] registered in NSW as an ‘Ambulance Service’ under Chapter 5 and Chapter 5A (I believe) of the Health Services Act (NSW).  That company has, in accordance with the provisions of its licence, issued an Authority to Practice as an Advanced Life Support (ALS) Paramedic.

My question, I reside and work in Victoria, and currently operate a service providing Medium (and where I can) high acuity services under the Event Standby provisions of the Non-Emergency Patient Transport Act 2002 (Vic).

However this severely limits my scope of authority to practice.

I understand that [the organisation I work for has] … been authorised to provide services in Victoria under the Mutual Recognition Act (Cth) and I was going to follow the provisions of that act to seek authority to practice in Victoria.  However, there is no provision to register as a Paramedic in Victoria, and obviously, my main objective is to be permitted to provide care to my scope of practice (e.g. S4 pharmaceuticals (S8 morphine would be nice, but I can understand why they wouldn’t want me to utilise these).

My questions then are:

  1. As I am authorised to practice individually as a paramedic in NSW, and this includes the possession, and use (under protocol) of Schedule 4 and Schedule 8 pharmaceuticals, can I rely on this section to practice in Victoria; and if so
  2. Who would I need to make the relevant notifications to, being there are no registration authorities (save the Department of Health who licence NEPT Services, and their Drugs and Poisons Unit who provide health services permits)?

The Health Services Act 1997 (NSW)

Chapter 5 of the Health Services Act 1997 (NSW) deals with ‘Affiliated Health Organisations’. The company my correspondent works for (which was identified to me but which I chose not to name) does not appear in the list of Affiliated Health Organisations set out in Schedule 3 to the Act.

Chapter 5A deals with Ambulance Services.  Section 67E(1) says

A person must not:

(a) directly or indirectly provide or take part in the provision of transport for sick or injured persons for fee or reward, or

(b) conduct for fee or reward any operations similar to the operations carried on by the Health Secretary under this Chapter,

without the consent of the Health Secretary and except in accordance with such conditions (if any) as the Health Secretary may from time to time impose.

That restriction does not apply (s 67E(3) and Health Services Regulation 2013 r 26) to:

(a) St John Ambulance Australia (NSW);

(b) the Royal Flying Doctor Service of Australia (NSW Section);

(c) the mines rescue company, within the meaning of the Coal Industry Act 2001;

(d) a member of the New South Wales Mines Rescue Brigade established under the Coal Industry Act 2001, or

(e) The NSW Newborn & Paediatric Emergency Transport Service (NETS).

It follows that when my correspondent says the organisation for which they work is ‘registered in NSW as an ‘Ambulance Service’ under … Chapter 5A (I believe) of the Health Services Act (NSW)’ it must mean that my correspondent believes that the employer has permission under from the Health Secretary under s 67E of the Health Services Act. I have to say that I doubt that is true as to the best of my knowledge and belief no such permission has been given, but for the sake of the argument I will assume it is true because of course things change and I can’t see all (or any) documents to confirm that permission has been given.

Poisons and Therapeutic Goods Regulation 2008 (NSW)

My correspondent then uses the phrase ‘in accordance with the provisions of its licence’ and later ‘[the organisation I work for has] … been authorised to provide services in Victoria under the Mutual Recognition Act (Cth) …’ This implies, to me, a belief in a much more organised system that actually exists. There is no provision for anyone or any company to be ‘registered’ or ‘licensed’ as an ambulance service.  What I think is more likely is that my correspondent’s employer has an authority issued under the Poisons and Therapeutic Goods Regulation 2008 (NSW) r 170 with respect to the storage and administration of scheduled drugs, in particular schedule 4 and 8 drugs that form part of a paramedic’s tools of trade.

Authorities under r 170 can be granted but are not publically available.  But some exemptions can be seen. With respect to ambulance services Appendix C to the Poisons and Therapeutic Goods Regulation 2008 (NSW) says (at cl 7):

A person:

(a) who is employed in the Ambulance Service of NSW as an ambulance officer or as an air ambulance flight nurse, and

(b) who is approved for the time being by the Director-General for the purposes of this clause,

is authorised to possess and use any Schedule 2, 3 or 4 substance that is approved by the Director-General for use by such persons in the carrying out of emergency medical treatment.

Regulation 101(1)(g), says:

a person:

(i) who is employed in the  Ambulance  Service of NSW as an  ambulance  officer or as an air  ambulance  flight nurse, and

(ii) who is approved for the time being by the Director-General for the purposes of this clause.

is authorised to have possession of, and to supply, drugs of addiction (ie Schedule 8 drugs) ‘for the purpose only of the lawful practice of the person’s profession or occupation’.

The exemption for NSW Ambulance paramedics is not an authority ‘to practice individually as a paramedic’ (no such authority being required) nor is it an individual authority to carry and supply drugs. The Director General is given the authority to approve which ambulance employees can use those drugs.

I doubt, very much, whether an employee of a private ambulance company would get any more generous authority. I would infer that any authority given under r 170 would say that an employee authorised by my correspondent’s company can carry and supply relevant schedule 4 and 8 drugs.  Whether that permission could or does extend to carrying and supplying drugs when not at work for that employer would depend on the terms of the authority, but I would doubt it.

The concept of an Authority to Practice is unclear (see What is a paramedic’s ‘authority to practice’? (August 19, 2014)).  I would infer that it is the authority given by the employer to allow my correspondent to use drugs in the course of his or her employment.

Mutual Recognition Act 1992 (Cth)

Next is the issue of the Mutual Recognition Act 1992 (Cth).  The principal purpose of the Act is to promote ‘freedom of movement of goods and service providers in a national market in Australia’ (s 3). With respect to the practice of occupations, the Act provides (s 17):

… a person who is registered in the first State for an occupation is, by this Act, entitled after notifying the local registration authority of the second State for the equivalent occupation:

(a)       to be registered in the second State for the equivalent occupation; and

(b)       pending such registration, to carry on the equivalent occupation in the second State.

This can’t apply to paramedics because there is no process to register as a paramedic in any Australian state.  When national registration comes in this Act also won’t apply because there will be national registration.  This is relevant to trades like electricians and plumbers who need a licence or authority to work in one state and can rely on this Act to also register in another state but they still need to maintain their licence or registration in both states.

This Act has no application to paramedics and no application to an ambulance service. A plumbing company that employs plumbers is not a plumber – and an ambulance service that employs paramedics is not a paramedic.  It follows that even if a person did have to register as a paramedic, it would not follow that an ambulance service had to ‘register’ as an ambulance service.  Whatever my correspondent has been told, the Mutual Recognition Act 1992 (Cth) is irrelevant.

Authorised to practice

Finally my correspondent says that he is authorised to practice as a paramedic in NSW.  There is no need for authority to practice as a paramedic because what ‘practice as a paramedic’ means is not defined.  Things that paramedics do, other than carry drugs, are not restricted.

In NSW the title of ‘paramedic’ is protected. To call oneself a paramedic a person has to hold the qualifications set out in r 19A of the Health Services Regulation 2013 (NSW) (see also Health Services Act 1997 (NSW) s 67ZDA).  The relevant qualifications are:

(a) a Bachelor of Paramedicine or a Graduate Diploma of Paramedicine conferred by a university,

(b) a nationally-recognised Diploma of Paramedicine issued by a registered training organisation.

For the purpose of that section:

“Paramedicine” includes Clinical Practice (Paramedic), Emergency Health (Paramedic), Health Science (majoring in Paramedicine), Paramedic Practice, Paramedic Science and Science (majoring in Paramedicine).

My correspondent has a Diploma of Paramedical Science (Ambulance).  Paramedic Science is listed, but not Paramedical Science.  I doubt whether anything would turn on that and we can accept that my correspondent has a prescribed qualification and can, therefore, use the title ‘paramedic’ in NSW.

Rewriting the question

All of that discussion means that I think my correspondent has asked the wrong question.  The question should be:

I graduated in 2007 with a Diploma of Paramedical Science (Ambulance) and went straight into the private sector in Victoria. I was employed (and continue to this day) with a private ambulance service that has the authority to endorse employees to use Schedule 4 and 8 drugs.  That company has, in accordance with the provisions of its authority, endorsed me to use drugs in the course of my employment.

My questions then are:

  1. As I am a ‘paramedic’ in NSW and whilst acting in the course of my employment I am allowed to possess, and supply (under protocol) Schedule 4 and Schedule 8 pharmaceuticals, can I rely on this section to practice in Victoria; and if so
  2. Who would I need to make the relevant notifications to, being there are no registration authorities (save the Department of Health who licence NEPT Services, and their Drugs and Poisons Unit who provide health services permits)?

Victorian law

To answer that question we need to look to Victorian law.  In January 2015, the Victorian Government established the Ambulance Performance and Policy Consultative Committee.  That Committee released its final report –  Victoria’s Ambulance Action Plan: Improving Services, Saving Lives –  on 10 December 2015.   That report recommended a review of the Ambulance Services Act 1986 (Vic). A public consultation was conducted from 2 December 2016 to 3 January 2017.  As part of that process a consultation paper was released.  The Review of the Ambulance Services Act 1986 and supporting legislation: Consultation Paper (2016) noted at p. 15:

Currently any ambulance service or paramedic from outside Victoria, not employed by Ambulance Victoria, is not legally allowed to possess or administer any drugs, poisons or controlled substances as defined in the Act. This is of concern in border town settings, and in crisis situations such as bushfires, where interstate emergency services staff will travel to Victoria to assist in emergency management. This also impacts on Victorian paramedics providing care in other jurisdictions.

The Drugs, Poisons and Controlled Substances Act 1981 (Vic) s 13 identifies ‘Persons authorized to have possession etc. of poisons or controlled substances’ and includes for example, medical and nursing practitioners.  They are registered under the national scheme so a medical practitioner based in NSW is also a medical practitioner in Victoria.  That will be relevant for paramedics in due course and provided that ‘paramedic’ is added to the list in s 13(1)(a) but that doesn’t help my correspondent today.   Section 13 does not say that a person with an authority issued in another Australian state can rely on that authority in Victoria.

It follows that if my correspondent’s employer has an authority issued by NSW that in turn allows the employer to endorse employees to carry and supply schedule 4 and 8 drugs in the course of their employment, that authority does not extend to allow that employee to carry drugs when not at work for that employer or when in Victoria.  If the employer has an authority issued by Victoria, then presumably it can endorse its employees to carry drugs when acting in the course of their employment in Victoria.  That would not extend to allowing an employee to carry and supply scheduled drugs when operating their own service or outside their employment.

Conclusion

The first question I was asked (after I rewrote it) was:

  1. As I am a ‘paramedic’ in NSW and whilst acting in the course of my employment I am allowed to possess, and supply (under protocol) Schedule 4 and Schedule 8 pharmaceuticals, can I rely on this section to practice in Victoria;

The answer to that question is ‘No’.

Because the answer to question 1 is ‘no’, question 2 does not arise.

If my correspondent wants an authority to carry and supply scheduled drugs when conducting his or her ‘service providing Medium (and where I can) high acuity services under the Event Standby provisions of the Non-Emergency Patient Transport Act 2002 (Vic)’ he or she would have to apply to the Department administering the Drugs, Poisons and Controlled Substances Act 1981 (Vic) and make an application for a relevant authority.

My correspondent’s authority to carry and supply schedule drugs when working for the company that has a drugs authority would depend on the conditions (if any) attached to that Authority and the terms of any endorsement issued by that company.

National Registration

With national registration a paramedic, once registered, will be a paramedic across Australia. Whether the right to carry and use scheduled drugs attaches to that registration so that a paramedic can carry and supply drugs as a doctor can, remains to be seen.