Australian Doctor Australian Doctor 17th November 2017

RACHEL WORSLEY A DOCTOR has lost a nine- month legal fight to keep practising after she claimed she was unfairly suspended under the NSW Medical Council’s emergency pow- ers. Dr Denise Jane Lee, a radiologist based in Syd- ney, was banned after being charged with stalking her former partner, his new girl- friend and the girlfriend’s parents through text mes- sages and emails. The criminal allegations, which Dr Lee denies, were unrelated to her clinical work and she was no threat to patients. But in February, the coun- cil suspended her by using its section 150 “public interest” emergency powers. It stated that she posed a “significant risk and had acted in ways that damage the standing of the medical profession”. In September, Dr Lee suc- Newspix Radiologist loses 9-month fight In Brief Staff writers Change in the air for COPD inhaler guidelines Dr Lee denies the criminal allegations, which are unrelated to her clinical work. cessfully appealed to the NSW Civil and Adminis- trative Tribunal to lift the suspension so she could fund her living expenses and defence of criminal charges. The tribunal said Dr Lee was entitled to the presump- tion of innocence, ruling that her competence as a radiologist was not an issue and there was “no real risk to patients or the public”. But the NSW Court of Appeal reinstated the sus- pension, finding that only the medical council, not the tribunal, had the power to lift the suspension. “The [medical] council is best placed to assess whether the interim measure of suspend- ing the registration should remain in place, having regard to the health and safety of the public,” the court said. The ruling stressed that the tribunal could only overturn the medical coun- cil’s suspension if the case related to a point of law. Dr Lee was immediately suspended again after the court’s ruling was handed down last week. PBS restrictions on COPD inhalers may be eased to align with the Lung Fdoundation’s COPD-X guidelines. The guidance recommends fixed-dose combination inhalers of long-acting muscarinic antagonists (LAMA) and LABAs for patients who remain symptomatic despite monotherapy with either. The Pharmaceutical Benefits Advisory Committee recommends removing the current requirement to stabilise patients on both individual monotherapy inhalers before initiating the combinations. It also recommends an increased restriction to authority required (streamlined) for inhaled corticosteroid/ LABA inhalers to counter high rates of initiation. Doctors denied presumption of innocence Comment Rachel Worsley THE ruling in the Dr Denise Lee case is significant. Medical boards use their emergency powers to suspend doctors to protect the public from potential harm while serious concerns about an individual’s practice are properly investigated. At least that is the general idea. Yet the use of those powers in NSW have been controversial. Medical defence organisations argue that the powers are so broad that doctors can be unfairly banned from practising, even when they present no immediate threat to public safety. The legislation underpinning section 150 of the National Law in NSW says a suspension can be instituted for the protection of a person or people, and also when it is deemed “in the public interest”. Obviously public interest has a very broad definition and can mean many different things to different people. This has all been made explicit in Dr Lee’s case. Her lawyers argued that the alleged criminal behaviour doesn’t pose an immediate threat to public safety. When the original ban on her practice was briefly lifted, it was done so because the NSW Civil and Administrative Tribunal said Dr Lee had not been convicted of the charges, and she was entitled to a presumption of innocence. The tribunal also noted that Dr Lee’s medical competence was not at issue. In throwing out that determination, the appeal court has made it clear that doctors in NSW have severely limited rights to appeal if they are suspended by the medical council under emergency powers. Put simply, the appeal court said there is no independent avenue for doctors to appeal the use of these powers — unless it relates to a point of law. In other words, the facts of the case are irrelevant. Given that under these emergency powers suspensions can run for months — in Dr Lee’s case more than eight months — their use has a profound impact on a doctor’s ability to continue earning a living. There is a twist, though. This situation is no longer unique to NSW. Following amendments to the National Law earlier this year, the powers to suspend doctors on the basis of “public interest” (rather than immediate threat to the public) are now in effect across all states and territories except SA and WA. However these states are expected to pass their own laws to effect the changes. MDOs such as Avant have previously expressed concerns that the public interest powers in NSW are no longer being employed only in exceptional circumstances. “These powers are being used as a matter of course in an investigation when there’s a complaint made,” Avant head of advocacy Georgie Haysom said. The question is whether this starts to happen in other states and whether there are similar limitations on doctors’ ability to get justice if they believe they are being misused. Slip, Slop, Slap a success PUBLIC health campaigns on skin cancer prevention have resulted in a sharp decline in melanoma rates among people born after 1980, research from Cancer Council Queensland shows. Melanoma incidence continues to be high among people over 60, however it has declined in younger age groups, according to figures from 1995-2014. Modest Minister Hunt says May budget will be remembered as a ‘foundational moment’ GEIR O’ROURKE Health Minister Greg Hunt is impressed with his work thus far. HEALTH minister Greg Hunt says his first budget in the portfolio will one day be seen as a “foundational moment” in the history of Australia’s health system. Writing in the Medical Journal of Australia, Mr Hunt argues that his achievements since taking over from Sussan Ley in January have laid the groundwork for “long-term, generational change”. Among what he cites as his major victories is “returning indexation of the Medicare rebate”, without mentioning that it was his government which took it away in the first place. Most GPs are also aware that the Medicare windfall has yet to happen — the 50c expected increase to a level B consult only occurs next July, while the increases for MBS care plans will not occur until 2020. But the minister says the financial boost “makes it easier to bulk-bill and reduces patients’ out-of-pocket expenses”. “The budget handed down in May 2017 reset the health agenda,” he declared. “I believe it will come to represent a foundational moment in building a health system for 21st century Australia, anchored on our www.australiandoctor.com.au commitment to universal healthcare based on free public hospital care, affordable medical services and affordable medicines.” Mr Hunt identified private health insurance, mental health, sport and aged care as his top priorities for next year. Primary care and hospitals, under his “wave three” reforms, will be his focus in 2019. Health Care Homes, which Mr Hunt’s predecessor once described as the biggest reform to general practice since the advent of Medicare, rated a mention near the bottom of the MJA essay. EpiPen shortage advice A SHORTAGE of EpiPen Jr 150µg autoinjectors is expected to be resolved by late November, according to manufacturer Mylan Australia. An emergency supply of EpiPen Jr products is being made available via pharmacies to patients whose EpiPens are about to expire, the company says. MJA 2017; online. 17 November 2017 | Australian Doctor | 3

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