Characteristics and predictors of regulatory immediate action imposed on registered health practitioners in Australia: A retrospective cohort study

Abstract

Objective: Immediate action is an emergency power available to Australian health practitioner regulatory boards to protect the public. The aim of this study was to better understand the frequency, determinants and characteristics of immediate action use in Australia. Methods: This was a retrospective cohort study of 11 200 health practitioners named in notifications to the Australian Health Practitioner Regulation Agency (AHPRA) between January 2011 and December 2013. All cases were followed until December 2016 to determine their final outcome. Results: Of 13 939 finalised notifications, 3.7% involved immediate action and 9.7% resulted in restrictive final action. Among notifications where restrictive final action was taken, 79% did not involve prior immediate action. Among notifications where immediate action was taken, 48% did not result in restrictive final action. Compared with notifications from the public, the odds of immediate action were higher for notifications lodged by employers (mandatory notifications OR = 21.3, 95% CI 13.7-33.2; non-mandatory notifications OR = 10.9, 95% CI 6.7-17.8) and by other health practitioners (mandatory notifications OR = 11.6, 95% CI 7.6-17.8). Odds of immediate action were also higher if the notification was regulator-initiated (OR = 11.6, 95% CI 7.6-17.8), lodged by an external agency such as the police (OR = 11.8, 95% CI 7.7-18.1) or was a self-notification by the health practitioner themselves (OR = 9.4, 95% CI 5.5-16.0). The odds of immediate action were higher for notifications about substance abuse (OR = 9.9, 95% CI 6.9-14.2) and sexual misconduct (OR = 5.3, 95% CI 3.5-8.3) than for notifications about communication and clinical care. Conclusions: Health practitioner regulatory boards in Australia rarely used immediate action as a regulatory tool, but were more likely to do so in response to mandatory notifications or notifications pertaining to substance abuse or sexual misconduct. What is known about this topic: Health practitioner regulatory boards protect the public from harm and maintain quality and standards of health care. Where the perceived risk to public safety is high, boards may suspend or restrict the practice of health practitioners before an investigation has concluded. What does this paper add?: This paper is the first study in Australia, and the largest internationally, to examine the frequency, characteristics and predictors of the use of immediate action by health regulatory boards. Although immediate action is rarely used, it is most commonly employed in response to mandatory notifications or notifications pertaining to substance abuse or sexual misconduct. What are the implications for practitioners?: Immediate action is a vital regulatory tool. Failing to immediately sanction a health practitioner may expose the public to preventable harm, whereas imposing immediate action where allegations are unfounded can irreparably damage a health practitioner's career. We hope that this study will assist boards to balance the interests of the public with those of health practitioners.