March 2021

• Chair’s message 
• Medical Board of Australia news
  • Consultation
    • Endorsement of registration for acupuncture — consultation on revised registration standard closing soon 
  • Accreditation
    • Providing high quality education and training
  • Medical Board vacancies
    • Do you want to join the Tasmanian Medical Board?
• News and alerts
  • Registered health practitioners and students: What you need to know about COVID-19 vaccination
  • Are you on the pandemic response sub-register? Apply now if you want to keep practising
  • New accreditation committee to be established 
  • Methotrexate: prescribing and dispensing issues can be life-threatening
  • Podcast: Chief Health Officers Brett Sutton and Jeanette Young in the spotlight
• Medical regulation at work
  • Latest tribunal decisions published 
• Contacting the Board

Chair’s message 

Medical practitioners across Australia led our public health pandemic response. Now, as we begin the vaccine rollout, doctors and other health practitioners are again at the front line. With other National Boards, we have made a clear statement about what we expect of registered health practitioners in giving, receiving, advising on and sharing information about COVID-19 vaccines. The Board has confidence that medical practitioners will support the vaccination rollout, either by participating directly or by encouraging their patients to seek vaccination. We join the rest of the Australian community in thanks for your hard work over the past year, and going forward. 

Dr Anne Tonkin
Chair, Medical Board of Australia

Medical Board of Australia news

Consultation

Endorsement of registration for acupuncture — consultation on revised registration standard closing soon 

Do proposed changes to requirements for doctors practising acupuncture affect you? 

If you’re a medical practitioner and want to use the title ‘acupuncturist’, you need to have your registration endorsed by the Medical Board of Australia, or also be registered with the Chinese Medicine Board of Australia. 

We’re consulting on proposed changes to the Medical Board’s registration standard for Endorsement of registration for acupuncture for registered medical practitioners. 

There’s just a few days left to tell us what you think – our consultation closes on 5 April 2021.

Read more about these changes in the consultation paper on the Board’s website under Current consultations. The Board is keen to hear from practitioners, organisations and the community.

Written submissions can be emailed to medboardconsultation@ahpra.gov.au, marked: ‘Consultation on draft revised standard for acupuncture endorsement’.

Publication of submissions

The Board generally publishes submissions to consultations on its website to encourage discussion and inform the community and stakeholders, unless confidentiality is requested. For more detail, please refer to the section on submissions in the consultation paper.

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Accreditation

Providing high quality education and training

The Board has approved the following:

Medical school program of study

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Medical Board vacancies

Do you want to join the Tasmanian Medical Board?

Applications are welcome from registered medical practitioners in Tasmania to fill a vacancy on the Tasmanian Board of the Medical Board of Australia.

Applications close 16 April 2021.

More information is available on Ahpra’s Statutory appointments page.

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News and alerts

Registered health practitioners and students: What you need to know about COVID-19 vaccination 

The National Boards and Ahpra have published a joint statement to help registered health practitioners and students understand what’s expected of them in giving, receiving and advising on and sharing information about COVID-19 vaccination.

Registered health practitioners have led the remarkable public health response to the COVID-19 pandemic in Australia, and we commend them for this sustained public health response. As the national vaccination program gets underway, registered health practitioners and students remain critical to this success by: 

• being vaccinated against COVID-19 unless medically contraindicated
• being appropriately qualified and trained to administer COVID-19 vaccines if authorised, and
• providing accurate information and advice about COVID-19 vaccination including in social media and advertising.

The codes of conduct for each of the registered health professions explain the public health obligations of registered health practitioners, including participating in efforts to promote the health of the community and meeting obligations on disease prevention. There is no place for anti-vaccination messages in professional health practice, and any promotion of anti-vaccination claims, including on social media and in advertising, may result in regulatory action. See the National Boards’ Social media guidance and Guidelines for advertising a regulated health service for more information.

As part of the national vaccination program, practitioners authorised to administer COVID-19 vaccines must complete specific COVID-19 vaccination training, as required by Commonwealth, state and territory governments. Training in the handling and administration of COVID-19 vaccines protects the public by supporting the vaccination program to be rolled out safely.

All practitioners, including students on placement, must comply with local employer, health service or health department policies, procedures and guidelines on COVID-19 vaccinations.

For more information and the joint position statement, see the news item.

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Are you on the pandemic response sub-register? Apply now if you want to keep practising

In the early days of COVID-19 in Australia, we established a pandemic response sub-register as a temporary measure, to get more health practitioners into the health system quickly and safely to support the pandemic response. 

Formerly registered health practitioners who were properly qualified, competent and suitable were included. For doctors, this was practitioners who previously held general or specialist registration and had left the Register of practitioners or moved to non-practising registration in the past three years.

The sub-register for medical practitioners is closing on 5 April 2021. 

Practitioners do not need to do anything to remove themselves from the sub-register as it will automatically close and they will either revert to non-practising registration (if this is what they had before going on the sub-register) or drop off the register all together.

If you wish to continue practising, you can apply through a special pathway which is open until 11.59pm on 5 April 2021. If you miss the deadline, you will no longer hold registration (or revert to non-practising registration if this is what you held before) and will need to apply through the standard registration process required by the Board.

Thanks to the 3,359 medical practitioners who were part of the more than 34,736 health practitioners from eight professions who opted to stay on the pandemic response sub-register. 

For more information on the sub-register, visit the pandemic sub-register page. 

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New accreditation committee to be established 

Ahpra will establish a new, independently chaired committee to consider key accreditation issues, in response to a new policy direction from the Health Council.

The new committee will have broad stakeholder membership to give independent and expert advice on accreditation reform issues to Ahpra’s Agency Management Committee. The new committee will replace Ahpra’s Accreditation Advisory Committee set up in 2020.

The Independent Review of Accreditation Systems (ASR) Final Report, Australia’s health workforce: strengthening the education foundation, recommended that Health Ministers issue the policy direction. 

Ahpra and the National Boards welcomed the policy direction, which requires Ahpra, the National Boards and accreditation authorities to consider the new committee’s advice when exercising their functions under the National Law.

Under the policy direction, Ahpra, National Boards and accreditation authorities must document the outcome of their consideration of the new committee’s advice in meeting minutes, communiqués or other relevant formats. 

Ahpra and National Boards will continue to work collaboratively with accreditation authorities through the Accreditation Liaison Group and the Health Professions Accreditation Collaborative Forum. 

The policy direction can be viewed on the Ahpra website.

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Methotrexate: prescribing and dispensing issues can be life-threatening

The Medical and Pharmacy Boards have published a reminder on methotrexate dosing. We have included case studies from coronial proceedings which illustrate the dangers of incorrect prescribing, dispensing and administration of methotrexate. 

Background 

Methotrexate is an anti-inflammatory drug. It is also a cytotoxic used in cancer chemotherapy.  

Methotrexate is used as a weekly dose as one of the mainstays of treatment of rheumatoid arthritis and psoriasis, with a dose range of 7.5 - 30mg per week. It can provide long term clinical benefit for patients with inflammatory arthritis, but has potentially fatal side effects, particularly bone marrow suppression, if given daily by mistake.

Prescribing, dispensing and administration errors continue to lead to daily instead of weekly dosing of oral methotrexate, with sometimes avoidable fatal outcomes. 

Case study 1

Mr DL, aged 66, was visiting his daughter and son-in-law in Perth in 2009 when he developed an exacerbation of arthritis in his hands and feet, and was taken by his daughter to her general practitioner. The general practitioner diagnosed rheumatoid arthritis, and prescribed methotrexate at an incorrect high dosage (5mg daily for five days followed by 10mg daily for seven days).  

The community pharmacist noted the high dose but dispensed the methotrexate after trying to contact the prescriber, and after informing the patient’s son-in-law that weekly dosing was more appropriate. The patient took the methotrexate at the prescribed dosage for four days and developed abdominal pain, vomiting and polyuria. He returned to the general practitioner who diagnosed a urinary tract infection and prescribed antibiotics.

Over the next four days, the patient’s symptoms persisted and he developed diarrhoea and mouth ulcers. He was admitted to hospital, where he was found to have a very low white cell count and a chest X-ray showed old apical tuberculosis. He was treated for septicaemia, tuberculosis and gastrointestinal bleeding, but developed multi-organ failure and eventually died. Review in hospital indicated that he had polyarticular tophaceous gout rather than rheumatoid arthritis, so that the methotrexate was not indicated in the first place.

The coroner considered the responsibilities of prescribing doctors and dispensing pharmacists when the type or dosage of a medication on a prescription appears to the pharmacist to be incorrect. He noted that, ‘pharmacists are expected to play a crucial checking role in ensuring, as far as possible, that patients receive appropriate medicine.’

He also found that: ‘the cause of the failure was an inexplicably incompetent error by a suitably qualified general practitioner, which … had been identified but not effectively corrected by an apparently competent pharmacist for reasons that cannot now be ascertained.’

Case study 2

Mr IG, aged 77, lived independently despite a number of chronic medical conditions, including severe chronic kidney disease (estimated Glomerular Filtration Rate (eGFR) of 11), chronic obstructive pulmonary disease and mild cardiac failure.  

The patient’s general practitioner prescribed methotrexate to treat a flare-up of psoriasis.  No blood tests were checked before prescribing a daily dose of methotrexate.  

The dispensing pharmacist noted that the daily dose prescribed by the general practitioner was potentially dangerous and phoned him to convey her extreme concern. The general practitioner assured her that he had checked the dose and that it was correct. Although not reassured, the pharmacist felt obliged to dispense the medicine in accordance with the prescription.  

Over the next few days, Mr IG developed serious symptoms of methotrexate toxicity including a skin rash, ulcers, pallor and fever. This was on the background of serious chronic medical conditions in which the use of methotrexate was contraindicated.

Mr IG was admitted to hospital, where he required haemodialysis for renal failure, and developed methotrexate-related erosive skin rash and sepsis. He died after 11 days in hospital.

Again, the coroner identified important issues about the relationship between the prescribing doctor and dispensing pharmacist. The coroner noted that it was of particular interest, ‘whether pharmacists needed to be empowered in their dealings with medical practitioners, and if so, how to facilitate it.’

What can be done?

Prescribing errors and dispensing errors can be made by otherwise competent practitioners. The medical and pharmacy professions need to work together to reduce the risk of serious outcomes by communicating concerns with each other about prescribing, dispensing or administration of medication.

We encourage doctors to prioritise calls from pharmacists with questions about prescriptions, particularly of methotrexate and other drugs with potentially serious consequences of overdosing.

Pharmacists are trained in pharmacology and therapeutics and act as an important safety net for prescribers and, most importantly, patients.

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Podcast: Chief Health Officers Brett Sutton and Jeanette Young in the spotlight

Ahpra’s Taking care podcast series has a new episode. Victoria’s Chief Health Officer, Adjunct Professor Brett Sutton, and Queensland’s Chief Health Officer, Dr Jeannette Young, talk to host Susan Biggar about their very personal experiences of leading during a pandemic, how they coped, and the impact on them and their families.

Ahpra releases a new Taking care episode fortnightly, discussing current topics and the latest issues affecting safe healthcare in Australia. You can access these on the Ahpra website, or listen and subscribe on Spotify, Apple Podcasts and by searching ‘Taking care’ in your podcast player.

Other recent episodes include:

• Diversity in the Australian health workforce, with Dr Dinesh Palipana, doctor, lawyer and disability advocate and Dr Susan O’Dwyer, medical practitioner member on the Medical Board of Australia and medical administrator 
• Through the eyes of a remote GP, with Dr Katie Gault who works in the Kimberley, WA
• The future of telehealth, perspectives from a physiotherapist, a consumer and a GP
• Responsible advertising by regulated health services.

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Medical regulation at work

Latest tribunal decisions have been published online

There are important lessons for registered medical practitioners from tribunal decisions. The Medical Board of Australia refers the most serious concerns about medical practitioners to tribunals in each state and territory. The following decisions were published recently:

• the Victorian Civil and Administrative Tribunal has reprimanded a medical practitioner and disqualified him for applying for registration for fourteen months after he inappropriately prescribed medications and was dishonest with the Medical Board (Medical Board of Australia v Islam)
• the Tasmanian Health Practitioners’ Tribunal suspended a medical practitioner who had a relationship with a patient (Medical Board of Australia v Thompson, Paul David).

Publication of panel, court and tribunal decisions 

Ahpra, on behalf of the 15 National Boards, publishes a record of panel, court and tribunal decisions about registered health practitioners. 

When investigating a notification, the Board may refer a medical practitioner to a health panel hearing, or a performance and professional standards panel hearing. Under the National Law, panel hearings are not open to the public. Ahpra publishes a record of panel hearing decisions made since July 2010. Practitioners’ names are not published, consistent with the National Law. 

Summaries of tribunal and court cases are published on the Court and tribunal decisions page of the Ahpra website. The Board and Ahpra sometimes choose not to publish summaries, for example about cases involving practitioners with impairment.

In New South Wales and Queensland, different arrangements are in place. More information is available on Ahpra’s website on the Concerned about a practitioner? page.

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Contacting the Board

• The Medical Board of Australia and Ahpra can be contacted by phone on 1300 419 495.
• For more information, see the Medical Board of Australia website and the Ahpra website.
• Lodge an enquiry form through the website under Contact us at the bottom of every web page.
• Mail correspondence can be addressed to: Dr Anne Tonkin, Chair, Medical Board of Australia, GPO Box 9958, Melbourne, VIC 3001.

More information

Please note: Practitioners are responsible for keeping up to date with the Board’s expectations about their professional obligations. The Board publishes standards, codes and guidelines as well as alerts in its newsletter. If you unsubscribe from this newsletter you are still required to keep up to date with information published on the Board’s website.

Comment on the Board newsletter is welcome and should be sent to newsletters@ahpra.gov.au.

For registration enquiries or contact detail changes, call the Ahpra customer service team on 1300 419 495 (from within Australia).

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