Today’s correspondent is
… wondering if paramedics can complete a medical certificate that states fit or unfit for work? In his case it has a spot for a ‘physician’ practitioner’ to sign. I have attached a copy minus the company details.
The Royal Australasian College of Physicians says
In Australia and New Zealand physicians … are medical doctors who have completed Advanced Training in a medical specialty with the RACP to diagnose and manage complex medical conditions.
Clearly not a paramedic.
An “attending practitioner” who refers to a medical examination by inference must be a medical practitioner ie a person registered with the Medical Board (Health Practitioner Regulation National Law s 113).
We can say with some certainty that the author of this certificate wants a medical practitioner to sign it. It is a medical certificate so the short answer is a paramedic cannot sign that certificate.
The Fair Work Act 2009 (Cth) s 12 defines a medical certificate as ‘a certificate signed by a medical practitioner’. A paramedic cannot provide or sign a medical certificate.
An employer must not terminate a person’s employment if they are temporarily absent due to illness or injury and provide a medical certificate or statutory declaration (Fair Work Act 2009 (Cth) s 352 and Fair Work Regulations 2009 (Cth) r 3.01(2)). Clearly a paramedic cannot provide a medical certificate.
The Regulation also provides that the person must not be dismissed if the terms of their employment provide other means to substantiate their illness and the employee complies with that requirement (r 3.01(3)). If a relevant ‘workplace instrument’ provides that certification by a paramedic is sufficient evidence to substantiate their claim to be sick or injured, then that would be sufficient.
The National Employment Standards provide for 10 days sick leave per year (Fair Work Ombudsman, Fair Work Information Statement, February 2023). To take paid leave the employee must ‘if required by the employer, give the employer evidence that would satisfy a reasonable person that … -the leave is taken for a reason specified in section 97’ (s 107(3)). One of the reasons listed in s 97 is that the employee is ‘not fit for work because of a personal illness, or personal injury, affecting the employee’ (s 97(a)). The exact form of evidence is not specified (Fair Work Ombudsman, Notice and Medical Certificates: Types of Evidence needed for sick/carer’s leave (accessed 23 February 2023). As noted, the Act only requires ‘evidence that would satisfy a reasonable person’.
The Pharmacy Guild of Australia says
Under the Fair Work Act 2009, pharmacists have authority to issue Absence from Work Certificates to people covered by the Act as proof of legitimate absence from work.
See also Pharmaceutical Society of Australia and Pharmacy Guild of Australia, Absence from Work Certificates: Guidelines for Pharmacists (2018). The reference to support this authority is given (at p. 5) as s 107(3) of the Act (quoted above). Neither s 107(3) nor the regulations refer to pharmacists. It appears that it is pharmacists themselves that have decided that it is within their scope of practice to issue certificates, rather than anything in the legislation (see also Industrial Relations Claims, Don’t rely on a sick note from your pharmacist, experts warn (April 19, 2018); Australian Employee Manual Who Can Issue a Medical Certificate for Sick Leave in Australia? (15 October 2018)).
Given the terms of s 107(3) a paramedic could issue an absence of work certificate and that would be sufficient if it ‘would satisfy a reasonable person that … -the leave is taken for a reason specified in section 97’. For example, if a paramedic transported a person to hospital they could issue a certificate to that effect so that a person could claim sick leave for their day of missed work. It may be beyond a paramedic’s scope of practice to say how long the person will be unfit, but they could say they were not well the day they met and transported them. That evidence would probably satisfy a ‘reasonable person’ that the patient did not attend work that day as they were ‘not fit for work because of a personal illness, or personal injury, affecting the employee’.
As far as I’m aware no professional body (such as the Paramedicine Board or the Australasian College of Paramedicine (a sponsor of this blog)) has engaged with the idea or given guidance to paramedics in the way the Pharmacy Guild and the Pharmaceutical Society of Australia have given guidance to pharmacists.
Whether the employer would accept that would be a matter for the employer however If the employee thought it should satisfy the ‘a reasonable person’, but the employer did not, then it may be a matter that required resolution by the Fair Work Commission.
A paramedic cannot sign a medical certificate.
There is no law however that says who can sign a certificate as evidence that a person is not fit for work because of a personal illness, or personal injury, affecting the employee’ (s 97(a)) or for the other reasons listed in s 97. The Act requires ‘evidence that would satisfy a reasonable person’. Pharmacists seem to have taken it upon themselves to issue certificates and I’m not aware of any case law that either confirms or challenges that authority. It follows that paramedics could issue those sorts of certificates provided they were reporting on their knowledge and observations.
Having said I would not advise paramedics to start writing certificates. As you can see from the Pharmacy guidelines there is much to consider but, given the scope of this blog (law but not legal advice) the law does not say who can or cannot issue such certificates. The law requires evidence that would satisfy a reasonable person. In some circumstances that I can imagine that could be evidence from a paramedic but if paramedics want to get into that business, they would be advised to have professional development and guidance along the lines of that adopted by the pharmaceutical profession.
This blog is made possible with generous financial support from the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), Natural Hazards Research Australia, NSW Rural Fire Service Association and the NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.
A common practice I’ve noticed seems to be paramedics being asked to witness stat decs – with an inference that the paramedic is agreeing the person was unwell (rather than just witnessing the declaration).
As a Paramedic, I’m in two minds about this. While I’d always advocate for an increasing role for Paramedics, I think not in this case or we’ll end up with people calling 000 for us to attend and sign a sick note.
But in the interests of being part of the health system as a whole I don’t see why extended care/community paramedics can’t issue medical certificates where their whole mandate is avoiding unnecessary trips to hospital.
Interesting proposal, especially given that paramedics are registered health professionals with an ever expanding scope.