Today’s correspondent, a paramedic, has:

… concerns regarding one of our colleagues, We found on the AHPRA website that he has conditions on his registration centred around clinical and behavioural issues.  This aligns with our observations of him and triggered our initial concerns.

We have notified our Project Manager, who informs us that the copy of registration supplied by this paramedic has no mention of these 5 conditions.   Our employer seems disinclined to pursue the matter of an apparently “altered” registration certificate.

Second, part of our duties involves conducting Drug & Alcohol tests which require a national qualification (HLTPAT005).  On passing the course, we are issued a statement of attainment and an individual certificate number.   We have now found our colleague who has been doing these tests alongside us, has been completing the paperwork in his name but quoting other paramedics certificate number, suggesting that he does not have the qualification but at the very least rendering the test invalid.  

We have stressed to our Project Manager that we believe this is a risk to the patients, the company and individually to each of us.   Our consensus is that we feel we are obligated to report our concerns to AHPRA in a timely manner should our employer fail to do so.   Are we so obligated?  Are there repercussions if we don’t? 

I’m not sure what state they’re from so I’ll use the Health Practitioner Registration National Law (Qld) as my exemplar noting that although it’s meant to be a national law, there is actually a separate law in each state and territory (see Health Practitioner Regulation National Law survives constitutional challenge (December 13, 2024)).

Paramedics, and employers of paramedics, are required to report incidents of ‘notifiable conduct’ (Health Practitioner Regulation National Law (Qld) ss 141 and 142); that is (s 140):

(a)         practising the practitioner’s profession while intoxicated by alcohol or drugs; or

(b)        engaging in sexual misconduct in connection with the practice of the practitioner’s profession; or

(c)         placing the public at risk of substantial harm in the practitioner’s practice of the profession because the practitioner has an impairment; or

(d)        placing the public at risk of harm by practising the profession in a way that constitutes a significant departure from accepted professional standards.

The relevant paragraph in this context is s 140(d).    

A practitioner may choose to make a notification (s 144) if he or she forms the view:

(a)           that the practitioner’s professional conduct is, or may be, of a lesser standard than that which might reasonably be expected of the practitioner by the public or the practitioner’s professional peers;

(b)           that the knowledge, skill or judgment possessed, or care exercised by, the practitioner in the practice of the practitioner’s health profession is, or may be, below the standard reasonably expected;

(c)           that the practitioner is not, or may not be, a suitable person to hold registration in the health profession, including, for example, that the practitioner is not a fit and proper person to be registered in the profession;

(d)           that the practitioner has, or may have, an impairment;

(e)           that the practitioner has, or may have, contravened this Law;

(f)             that the practitioner has, or may have, contravened a condition of the practitioner’s registration or an undertaking given by the practitioner to a National Board;

(g)            that the practitioner’s registration was, or may have been, improperly obtained because the practitioner or someone else gave the National Board information or a document that was false or misleading in a material particular.

Relevant paragraphs here may be (a), (b), (c), (e) and/or (f).

Prior conditions

If there were or are conditions on this paramedic’s registration we can infer that he has been previously dealt with by a Panel or Tribunal under the National Law.  Section 120 says:

(1)            A registered health practitioner who is registered on conditions must not knowingly or recklessly claim, or hold himself or herself out, to be registered without the conditions or any conditions.

(2)            A contravention of subsection (1) by a registered health practitioner does not constitute an offence but may constitute behaviour for which health, conduct or performance action may be taken.

A paramedic who has altered a certificate of registration will be in breach of s 120(1) and a belief that he may have done so is sufficient grounds for a voluntary referral under s 144(e).

Dishonesty

One might infer that a paramedic who has falsified his certificate of registration and who falsely uses another person’s qualification is not a fit and proper person to practice paramedicine and that such behaviour represents a significant departure from accepted professional standards.  Such behaviour, if proved, may also constitute a criminal offence in the nature of fraud or obtaining a benefit by deception (and I say that without looking though the Criminal Code of WA to identify specific possible offence).

For examples where there have been statements about health practitioner honesty see:

These cases are not direct parallels but allow one to infer the attitude the Tribunals take to honesty within the health care professions and Tribunals will take very seriously the obligation upon paramedics to both comply with any conditions on their registration and to be frank in admitting that those conditions have been applied. 

A case of direct application is the case of Pickard-Clark (discussed in the post Paramedic suspended for 12 months for dishonesty (October 31, 2023)). Mr Pickard-Clark sought to obtain a contract to provide paramedic services at a school cadet camp. In order to better his chances he ‘doctored’ his certificate of registration to hide the conditions that had been imposed on his practice.  In the decision in Paramedicine Board of Australia v Pickard-Clark (Review and Regulation) [2023] VCAT 1204 the Victorian Civil and Administrative Tribunal said (at [20]-[22]):

It was agreed that by engaging in the conduct described, Mr Pickard-Clark failed to comply with:

a. Clauses 1.2, 3.1, 3.2 and 8 of the Paramedicine Board of Australia Code of Conduct (‘Code’); and

b. S 120 of the National Law.

Those provisions of the Code relevantly require that paramedics be ethical and trustworthy, honest, and display a standard of behaviour that warrants the trust and respect of the community.

Section 120(1) of the National Law provides that a health practitioner who is registered on conditions must not knowingly or recklessly claim, or hold themselves out, to be registered without such conditions. Section 120(2) provides, in effect, that a breach of that obligation may constitute a basis for disciplinary proceedings against the practitioner.

The tribunal was satisfied (at [24]-[26]):

… that the conduct comprises professional misconduct within the meaning of (c) and (a) of the definition of that term in the National Law’.

That is, regarding (c), it was conduct inconsistent with the practitioner being a fit and proper person to hold registration in the profession. Honesty is a bedrock requirement for any registered professional. Members of the community should be able to accept without question the word of a registered health practitioner, particularly in relation to such a fundamental matter as whether their registration is subject to conditions or not. The proper functioning of the profession, and of the regulatory controls put in place for the protection of the public, rely on this. The dishonesty displayed by Mr Pickard-Clark on 28 February 2021 was clearly inconsistent with him being a fit and proper person to practise…

We also find, as agreed, that the falsification of the registration certificate amounted to unprofessional conduct which is substantially below the standard reasonably expected of a registered health practitioner of an equivalent level of training or experience. This is underscored by the fact that the conduct breached the above provisions of the Code, and s 120 of the National Law. Hence, we find, it amounted to professional misconduct within the definition of that term under (a) in s 5 of the National Law.

Code of Conduct

The Code of Conduct applicable to paramedics says (at [8.1] good practice requires that practitioenrs:

  1. are aware of these [mandatory] reporting obligations
  2. comply with any reporting obligations that apply to your practice, and
  3. seek advice from your National Board, professional indemnity insurer or other relevant bodies if you are unsure about your obligations.

Conclusion

My correspondent must make a referral to AHPRA, or the Paramedicine Board, or a relevant state health complaints body (such as the health ombudsman in Queensland or the Health Care Complaints Commission in New South Wales) if he or she believes that the other paramedic’s conduct is ‘placing the public at risk of harm by practising the profession in a way that constitutes a significant departure from accepted professional standards’.  From what has been described one would think that there would be little difficulty coming to that view. Failure to make a mandatory notification may itself be a matter for professional discipline (s 141(3)). If my correspondent has doubt about whether or not the alleged conduct requires a mandatory notification her or she should seek advice from the Paramedicine Board, not from this blog nor the employer.

In any event my correspondent could make a voluntary referral on the basis that the other practitioner has breached s 120 of the National Law and that the practitioner, inter alia ‘is not, or may not be, a suitable person to hold registration in the health profession, including, for example, that the practitioner is not a fit and proper person to be registered in the profession’.

This blog is made possible with generous financial support from (in alphabetical order) the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), the Australian Paramedics Association (Qld), 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.

This blog is a general discussion of legal principles only.  It is not legal advice. Do not rely on the information here to make decisions regarding your legal position or to make decisions that affect your legal rights or responsibilities. For advice on your particular circumstances always consult an admitted legal practitioner in your state or territory.