The Legal Underpinnings of Medical Discipline in Common Law Jurisdictions.

Medical regulators have a responsibility to protect, promote, and maintain the health and safety of patients. Here, we compare and contrast the processes for addressing concerns about doctors in four countries with legal systems based on English common law: the UK, Australia, the United States, and Canada. The legal provisions underpinning each jurisdiction's disciplinary processes depict distinctive outlooks from the different authorities as each works toward the same goal. The initial stages of the investigation process are broadly similar in all of the jurisdictions examined. Each process, however, has subtle differences with regard to its comparators. Factors include how matters of discipline are framed, the constitution of disciplinary panels, and how the perceived independence of these panels all philosophically affect the public safety remit of each regulator. This work constitutes the first comparison of international regulatory frameworks for the profession of medicine.

Name Suppression Practices of New Zealand's Health Practitioners Disciplinary Tribunal 2004-2014.

Permanent name suppression decisions related to health practitioner disciplinary proceedings can result in debate across various interest groups, including practitioners, the public, the media and complainants themselves. However, there has been no analysis of name suppression patterns, principles and practices in New Zealand since the 2004 legislative reforms under the Health Practitioners Competence Assurance Act 2003 (NZ) provided for the combined regulation of 21 health professions and established the Health Practitioners Disciplinary Tribunal (HPDT) to hear and determine charges relating to those professions. This article reviews health practitioner name suppression debates within New Zealand in light of an exploratory descriptive analysis that was undertaken of 288 published decisions of the HPDT from 2004 to 2014. The study revealed that just under one-half of all cases involved a permanent name suppression application; amongst these, just over one-third were approved. Grounds cited for approving or declining name suppression varied and generally reflected established case law regarding naming principles and the Act's intent. While the public interest dominated as the most frequently cited reason to decline name suppression, the most frequent justification for granting name suppression was the health and wellbeing of various individuals. The findings have relevance for understanding current trends in name suppression, and whether there are changing practices or differences adopted between health practitioner groups.

New Zealand's Health Practitioners Disciplinary Tribunal: An Analysis of Decisions 2004-2014.

Established under New Zealand's Health Practitioners Competence Assurance Act 2003 in 2014, the Health Practitioners Disciplinary Tribunal (HPDT) hears and determines charges in relation to 21 health professions. Using publically available information, an exploratory descriptive analysis was conducted of 288 published HPDT decisions between 2004 and 2014 to assess the procedural factors (practitioner and hearing characteristics) and outcome factors (findings, penalties and appeals) relevant to these decisions. In particular, the study compared the two health practitioner groups (medical practitioners and nurses) with the highest number of decisions. The study found that nurses were significantly less likely to have legal representation or to lodge an appeal than medical practitioners, with nurses also more likely not to attend the hearing, have their registration cancelled and not receive permanent suppression. The study also revealed important characteristics of the decisions that are not contained in the summaries available on the HPDT website. These characteristics provide opportunities for future comparison across and within occupational groups. While relevant to health practitioners, lawyers, professional bodies, employers, educators and policy-makers, the findings also contribute to the international scholarship on professional discipline and tribunal decision-making.

It Doesn't Have to End in Disaster: A Case for Employment Compliance.

It only takes one unhappy or disgruntled person to create a legal nightmare for you. There's no need to take this gamble. All it takes is awareness, commitment and action on your part. Once you have your HR house in order and have implemented a sound HR program in your practice, you also can feel good about knowing you are giving your staff every protection due to them under the law and every opportunity to be happy and successful in your practice. For yourself, you will be minimizing your risks and protecting your most valuable asset--your practice. You also will have given yourself the gift of peace of mind.

DISCIPLINARY PROCEEDINGS AGAINST DOCTORS WHO ABUSE CONTROLLED SUBSTANCES.

This study examined 27 reports from disciplinary tribunals throughout Australia (save Tasmania where reports were not accessible) against medical practitioners who abused narcotic analgesics (often combined with other drugs of addiction) between 2010 and 2015. The reports revealed that 12 medical practitioners were in their 40s; five in their 30s; and one person still in their 20s. Although the majority were general practitioners (15 out of 27), other medical specialties were also represented. Self-administered pethidine was the most prevalent opioid (11 out of 27) and was the only drug used alone. Morphine was self-administered by six doctors; the same number used high doses of Panadeine Forte, codeine and codeine phosphate. Fentanyl was abused by five doctors. Surprisingly, fewer medical practitioners appear to use propofol, and similar opiates such as tramadol (Tramol) and/or oxycodone (Endone). The examination of cases suggests lack of consistency in the imposition of professional sanctions and penalties by the relevant tribunals. To remedy this problem, it is suggested that disciplinary tribunals should apply the test of proportionality in the form of "reasonable necessity" when deciding whether to remove or suspend the addicted medical practitioner from the Register.

"CAM-creep": medical practitioners, professional discipline and integrative medicine.

This article examines the problem of applying disciplinary standards to the practice of integrative medicine. The article examines the structure of the National Law and discusses examples of when medical practitioners have been found to have breached professional standards because of their use of complementary and alternative medicine. The article argues there is a danger in medical practitioners who move away from the principles of evidence-based practice and informed consent in their adoption of integrative medicine. The authors posit a concept of "CAM-creep", situations where practitioners abandon medical professional standards in favour of ones from complementary and alternative medicine.

Quality indicators for initial licensure and discipline in nursing laws in South Korea and North Carolina.

BACKGROUND: The Korean regulatory framework of nursing licensure reflects that of the USA, but its content differs in some of the powers related to quality assurance. AIM: This article compares regulatory quality indicators and describes core standards in nursing regulations that are related to both initial licensure and discipline for three groups: the National Council of State Boards of Nursing, the North Carolina and the South of Korea. METHODS: A descriptive, comparative law design is used to examine the differences and similarities in the quality indicators and core standards found in three documents: the National Council of State Boards of Nursing Model Act, the North Carolina Nursing Practice Act and the Korean Medical Service Act for registered nurses. RESULTS: The findings indicate that ten quality indicators and two standards appear in study objects. Although most of the quality indicators are common to all documents, some differences are found in terms of the scope of criminal background checks and the range of grounds for disciplinary action. LIMITATIONS: These findings cannot be generalized in the USA because although the North Carolina nursing act was selected as an example of US nursing laws, nursing laws differ somewhat across states. CONCLUSIONS: This comparative study shows a clear opportunity to develop indicators that acknowledge the important areas of competence and good moral character and how they can improve patient safety in Korea. IMPLICATIONS FOR NURSING AND HEALTH POLICY: This study provides recommendations for Korean nursing legislative redesign and pointers for other jurisdictions to consider.

What to do if you are referred to the NMC.

If you are subject to an investigation by a professional regulator, you need to be informed about the process and act quickly. This article outlines the process and offers some advice on how best to navigate it.

A new beginning for health complaints in Queensland: the Health Ombudsman Act 2013 (QLD).

The Queensland Government has recently passed the Health Ombudsman Act 2013 (Qld) which will render Queensland a co-regulatory jurisdiction for the purpose of complaints in relation to all regulated health practitioners. The Act also establishes a single entry complaints management system which will apply not only to regulated health practitioners but also unregulated practitioners and health service facilities and organisations. This column considers the legislatively created positions and processes aimed at strengthening the capacity of the health complaints system to protect the public, ensure safe and competent practice, maintain high standards of service delivery and public confidence in both the practitioners and the system.

Handling restraining orders in a health-related facility.

Having an effective restraining order policy in place, besides contributing to professionalizing the image of the security department, provides greater protection for victims and staff while lessening your organization's liability, according to the authors, who present a primer in managing such orders.

Analysis of legal cases for prevention of elder abuse: decisions from New Zealand.

Elder abuse is a universal concern and is gaining greater public and professional attention. This increased concern to protect elders is internationally evident in policy reform, multidisciplinary research and education. Yet neglect in care settings continues. This research responds by contributing to the international effort to promote humane care for elders who are in a position of dependence, particularly in residential facilities. The legal cases that result from some complaints by aggrieved elders and their advocates may offer insights that are relevant for prevention. While the law is often viewed merely as a system of control, it may also be a resource for learning, particularly in the context of abuse prevention. Although the analysis references New Zealand law, the discussion may have broader application by indicating factors that precede, or trigger, unacceptable conduct. By understanding what went wrong and why, we may decrease the likelihood of future incidents. Also, understanding the legal ramifications may have a deterrent effect. Many advocates and activists have asked how we can ensure that abuses do not recur; some answers may lie within the legal cases themselves. How may recent legal cases be used to prevent mistreatment of elders in residential facilities? This question is applied to select decisions of New Zealand's Health and Disability Commissioner, Human Rights Review Tribunal and Health Practitioners Disciplinary Tribunal. While each body has distinct functions, relevant factors identified within the cases may reveal information that is of interest to elderly people and their advocates, caregivers, health educators and professional registration bodies. The research is timely in light of New Zealand's Review of Elder Abuse and Neglect Prevention Services in New Zealand (Department of Child Youth and Family Services, 2004) and New Zealand's Positive Ageing Strategy (Office of Senior Citizens, 2001). This article incorporates current debates regarding the use and analysis of legal cases and suggests that such analyses offer learning opportunities.

Access to enforcement and disciplinary data: information practices of state health professional regulatory boards of dentistry, medicine and nursing.

This article describes a study of public access to enforcement and disciplinary information provided by the websites of health professional regulatory boards. The study explored the current state of transparency by specifically examining the availability of disciplinary data on the websites of state boards of medicine, nursing and dentistry. Web sites were reviewed regarding availability of enforcement and disciplinary data on the aforementioned state boards in each of the 50 states and the District of Columbia. The study found that there is more information about individual practitioners available from the boards than ever before. On the other hand, there has not been a comparable increase in information about the administrative practices and the work of the boards. Increased availability of this information would allow public administration and policy researchers to develop performance indicators of state boards and assist in improving policy decisions and allocation of resources.