Considerations for doctors fulfilling the role of administrators.
Doctors fulfilling largely administrative functions remain answerable to their registration board and can be disciplined for unsatisfactory professional conduct while carrying out administrative functions.
In 2009, the Queensland Health Practitioners Tribunal will hear a matter involving allegations of unsatisfactory professional conduct deriving from allegations against one of the, then, most senior medical administrators in the state. Queensland's former chief health officer is defending allegations that decisions he made in an administrative capacity amount to unsatisfactory professional conduct in his dual role as a medical practitioner.
The role of chief health officer is unique in most (if not all) states and territories in that it is mandatory for applicants to have current registration as a medical practitioner. There are many other administrative roles in the public and private health sectors that require registration as a health practitioner (and, of course, the necessary qualifications).
The Tribunal may first be asked to determine whether as a matter of law if you are both a doctor and a manager/ administrator, you are answerable to the standards of your profession. Authority in other states and in the United Kingdom1 suggests the clear answer to this is yes.
Presumably, the Tribunal will be guided by the decision of the United Kingdom Privy Council case of Roylance2.
Roylance, a medical practitioner, challenged a finding that he was guilty of serious professional misconduct for failing to ban an operation upon a baby, and for failing, for several years, to deal with the excessively high infant mortality rate of two cardiac surgeons.
Roylance was a medical administrator who also held specialist registration in the field of radiology. At the material times, he was District General Manager of the Bristol and Weston Health Authority and later Executive Officer of the United Bristol Healthcare NHS Trust. In that role, Roylance was responsible for nine hospitals and some 6,500 staff.
Between August 1990 and March 1994, Roylance received information, including by way of complaint in writing, from a number of medical practitioners to the effect that the mortality rate for infants undergoing open heart surgery was tragically high. Despite receiving consistent information that the mortality rate was above average and unacceptable, he did nothing to address it.
In these circumstances, the committee held that a charge of serious professional misconduct was established.
Roylance accepted that he owed a common law duty to patients in hospitals under his supervision, but argued that his duty was as an administrator not as a medical practitioner. That argument was rejected by the committee and its decision was upheld by the Privy Council.
One principle reinforced by Roylance is that 'certain behaviour may constitute professional misconduct ... although it does not occur within the actual course of carrying on of the person's professional practice.' (at 331)
The judges recognised that applications of the principle inevitably require judgments of fact, circumstances and degree, but they were satisfied that Roylance had a duty of care towards patients in his hospital system as a medical practitioner as well as a civil servant. His duty as a practitioner 'did not disappear when he took on the [administrative] appointment, but continued to co-exist with it.'
In considering Roylance, it must be remembered that the standard of proof was the criminal standard. The Queensland Health Practitioners Tribunal will apply the standard of reasonable satisfaction or the 'Briginshaw'3 standard.
The challenge for medical administrators is of course the tightrope they walk between financial viability and fulfilling the demands of providing a health service in the 21st century.
To take steps to minimise the exposure to complaints and disciplinary processes, medical administrators may consider:
- Ensuring there is a well published complaints process at their facility.
- Acting upon and/or responding to complaints with due regard to elements of urgency and risk to the public.
- Investigating complaints and/or referring them for investigation through formal government protocols as soon as possible.
- Following up on investigations to obtain updates and/or re-assess urgency if more information is received.
- Understanding and using emergency powers such as suspending staff where serious complaints are made in order to maintain the status quo (ie they are on full pay), ensure a rapid investigation and protection of the public.
- Obtaining legal advice when there is uncertainty in relation to investigations, natural justice and acting on emergency powers.
- Getting opinions from colleagues when matters are outside the administrator's field of speciality or former field of practice.
The biggest risk for medical administrators is inaction. In an era where the public is more familiar with their entitlement to complain and instigate investigation, hindsight dictates that the best response for medical administrators is to ensure timely investigation and assessment of complaints.
1. Roylance v General Medical Council  1 AC 311
2. See also Reyes v. Dental Board of South Australia  SASC 239. There is also a publication of the General Medical Council entitle 'Management for Doctors' that is of some assistance.
3. Briginshaw v Briginshaw  60 CLR 336
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