Newsletter: December 2018

As oral health practitioners, we occasionally become concerned about our colleagues and the potential harm to patients from the way they practise.

The concerns may be about our colleague’s clinical competence, their behaviour, or their health.

Without your help and support, a practitioner who is unwell or falling below the minimum levels of competence puts the public at potential risk, and also risks damage to their reputation and to the profession. Ignoring or covering up a competence or health issue is not the right thing to do. At the same time, notifying the Council about one of your colleagues is a difficult step to take.

In this article, we outline the relevant professional standards that apply in this situation and ways to act on your concerns.

The Standards Framework

The Standards Framework sets out the minimum standards of ethical conduct, and clinical and cultural competence that patients and the public can expect from oral health practitioners.

Registered oral health practitioners must adhere to the ethical principles at all times. One of the five ethical principles in the framework is to ‘maintain public trust and confidence’.

Under this principle sit two professional standards that outline how you should deal with concerns about risk of harm.

• Professional standard 27: You must protect the interests of patients and colleagues from any risk posed by your personal issues or health, or those of a colleague.
• Professional standard 28: You must protect the interests of patients and colleagues from any risk posed by your competence or conduct or that of a colleague or an employee.

When do I have a legal obligation to notify Council?

Most professional standards include guidance notes to help practitioners meet the professional standards.

The most important things to note from the guidance for professional standards 27 and 28 are your legal obligations as a health practitioner to notify Council in two particular circumstances.

First, if you have good reason to believe a colleague is suffering from a health condition (including substance abuse or addictions) which could affect their ability to deliver patient care or place colleagues at risk, you must notify the Council.

Second, if you employ a practitioner who is dismissed or resigns from their job for reasons relating to competence, you must notify the Council.

In these situations you are legally required under sections 45 and 34 respectively of the Health Practitioners Competence Assurance Act 2003 (the Act) to give the Council written notice of health or competence issues.

Do I have other professional obligations to inform Council?

Yes, as indicated in the guidance notes for both standards 27 and 28.

Your professional obligations are to:

• seek medical advice if your own or a colleague’s personal or health issues may be a risk to your patients or colleagues
• inform the Dental Council if you suspect or know that your mental or physical health may be a risk to patients or colleagues
• inform the Council if you know or suspect that your own competence or conduct, or the competence or conduct of a colleague, may be a risk to patients or colleagues.

Although the intent of these standards is clear—to ensure people are protected from any risk from health, competence or conduct issues—acting on your concerns is not always easy.

What should I do?

The overriding principle is public welfare. Sometimes it helps to apply the “daughter test” to help you decide how to proceed. Ask yourself if you would be happy for the practitioner to treat a relative or close friend. If the answer is “no”, then you should let us know.

If a practitioner is suffering from a physical or mental health issue, they are likely to be going through a stressful period. This is a time when expressing your concerns to the practitioner involved, offering advice and giving collegial support are more important than ever. Your professional association may be able to offer support and guidance through the process.

Doctors Health Advisory Service is a national network that provides collegial support and arranges counselling for dentists and other health professionals with health problems and stress. The DHAS is a personal advisory service for practitioners and students. If requested, appropriate referral for treatment, or other support can be arranged.

You could also seek personal help and advice from your GP, a counsellor or an employee service such as EAP.

What happens when I do notify the Council?

Here are some things to know and remember, about what happens if you do notify the Council of your concerns:

• Notifications need to be in writing (or email).
• Council’s policy is full transparency so anonymous phone calls are not helpful.
• When a serious concern is received in writing about a practitioner the Council will act on that concern.
• Fairness principles mean an informant’s written notification of concerns will be disclosed to the practitioner, allowing them an opportunity to comment.
• You should objectively include the basis for the notification.
• It is inappropriate for you to actively seek further evidence of concerns and it is unacceptable to create situations to entrap practitioners.

Council will follow up with the appropriate inquiries in a timely fashion. This includes considering the possibility that the notification could be frivolous or vexatious. A report is provided to Council as a foundation for a decision on what, if anything, should be done. Council may seek further information before deciding what, if any, action to take. Fairness and privacy issues mean that the notifying practitioner may not receive immediate or full feedback on any actions taken by Council.

Council’s processes are designed to be supportive and educational. A fundamental tenet of the Act is that concerns about competence are addressed through education and remediation of the practitioner, wherever possible. Where issues affect a practitioner’s health the Council will again endeavor to work with a practitioner to balance an ability of a practitioner to work safely, with the public interest of safety.

Options available to Council when considering a notification include seeking assurance that any concerns have been addressed, independent assessment and advice about a practitioner’s health, a competence review, or referral to a professional conduct committee if concerns around conduct are apparent. In the situation where a risk of harm to the public is apparent then it may be necessary, in the interim, to alter a scope of practice or introduce supervision or mentoring.