Today’s question is about mandatory reporting and health impairments. A paramedic
… recently came across a situation at a CPD day that was being facilitated by my employer… One of the topics discussed were the new mandatory requirements of paramedics. A scenario was put to us as follows (I’m paraphrasing): “you are attending to a patient, suffering from a suspected drug overdose. During your attendance to the patient, you are made aware that the patient is at university studying paramedicine (and therefore a student paramedic who is required to be registered). Are you obliged to report the student paramedic to AHPRA?”
This scenario led to some quite spirited discussion and debate. Ultimately, the facilitator of the session read out a statement that essentially suggested (by my interpretation) that in this case we should report the student to AHPRA, despite the fact that this would require breaching of patient confidentiality. I am wondering where we would stand legally if we did this? Wouldn’t we be breaking the law to report the student paramedic to AHPRA as they are our patient and we are obliged under relevant legislation to maintain patient confidentiality?
The mandatory reporting requirements are set out in the Health Practitioner Regulation National Law. I’m not sure what jurisdiction my correspondent is from so I’ll quote the law as it applies in Queensland. The Health Practitioner Regulation National Law (Queensland) s 141 says:
(1) This section applies to a registered health practitioner (the “first health practitioner”) who, in the course of practising the first health practitioner’s profession, forms a reasonable belief that—
(a) another registered health practitioner (the “second health practitioner”) has behaved in a way that constitutes notifiable conduct; or
(b) a student has an impairment that, in the course of the student undertaking clinical training, may place the public at substantial risk of harm.
(2) The first health practitioner must, as soon as practicable after forming the reasonable belief, notify the health ombudsman of the second health practitioner’s notifiable conduct or the student’s impairment.
I infer that we are talking about a conscious choice to take the overdose regardless of whether it’s an overdose of an illegal, recreational drug or an attempt at self-harm and that it is not an accidental overdose of a prescribed medication or a situation of involuntary consumption eg ‘drink spiking’. I shall assume, without debating it, that identifying the student paramedic has deliberately overdosed does give rise to a reasonable belief that the ‘student has an impairment that, in the course of the student undertaking clinical training, may place the public at substantial risk of harm’.
Patients have a right to expect that their information will be held in confidence and that their privacy will be protected, but those rights can and are overridden by law. With respect to the privacy principles the obligation to use information only for the purposes for which it was obtained do not apply where the release of the information is required by another law. In Queensland Privacy Principle 10 (Information Privacy Act 2009 (Qld) Sch 3) says (emphasis added):
(1) An agency having control of a document containing personal information that was obtained for a particular purpose must not use the information for another purpose unless—…
(c) use of the information for the other purpose is authorised or required under a law…
In short the mandatory reporting requirements of the Health Practitioner Regulation National Law take precedence over the duty of confidentiality and the patient’s right to privacy.
It is well known that this issue is problematic as it may discourage practitioners seeking health care from their professional colleagues for fear of being reported. To that end Western Australia has granted an exemption. The Health Practitioner Regulation National Law (WA) (set out in the Schedule to the Health Practitioner Regulation National Law (WA) Act 2010) cl 141 adds paragraph (4)(ca). That section says:
(4) For the purposes of subsection (1), the first health practitioner does not form the reasonable belief in the course of practising the profession if —…
(ca) the first health practitioner forms the reasonable belief in the course of providing health services to the second health practitioner or student…
(See also AHPRA Mandatory reporting (2019)).
It’s true the obligation to report a student’s impairment is inconsistent with that person’s right to expect confidential treatment and to have their privacy respected. That these principles are inconsistent is neither new nor unknown. The legislature has considered this and determined that the obligation to report the impairment takes priority over the obligation to maintain the patient’s privacy (except in Western Australia). It is not ‘breaking the law to report the student paramedic to AHPRA’; it would be breaking the law to fail to do so (except in Western Australia).