MIPS Review summer 2013-2014 by Medical Indemnity Protection Society

MIPS

Review SUMMER 2013 - 2014

MIPS Photo Competition

Winner of the YOUR13 photo competition! Ruthy Hernandez

Life is like a wave, you canâ&#x20AC;&#x2122;t change the way it breaks, just the way you ride it See pages 8 and 9 for some of the best of the comp

2 | MIPS Review | SUMMER 2013 – 2014

Managing Director’s report

adverse implications. This has previously occurred in respect of insurance and medical indemnity insurance in Australia. The 30 June 2013 Annual Accounts of medical defence organisation owned medical indemnity insurers demonstrated that MIPS Insurance again showed the highest Australian Prudential Regulation Authority (APRA) prudential capital requirement (solvency) ratio of that medical indemnity insurer group. As 2013 draws to a close it is timely to reflect on some of the core features that underpin MIPS’ approach to providing security and service to members.

Financial Security

A Prudential Capital Requirement ratio of 1 is required by APRA to ensure that insurers hold additional capital so they can, in general terms, weather a range of unexpected adverse outcomes. The prudential capital requirement ratio calculated for MIPS Insurance was 4.43 times that required by APRA as at 30 June this year. At the time of writing that ratio has further improved.

Financial security of a medical indemnity provider is paramount. Medical indemnity claims can take many years (sometimes decades) to finalise. During that time the financial health of an organisation may be very different to when the cover was purchased.

The protection of MIPS members is further strengthened by significant additional (to MIPS Insurance) capital reserves held by the parent entity, MIPS.

In the event that an indemnity provider later did not or could not meet its obligations there could be significant

MIPS Insurance also reserves for claims liabilities at a higher probability of sufficiency (highest in medical

indemnity sector for operating insurers according to recent years’ annual reports), than that required by accounting and regulatory standards. But for this prudence in reserving an even higher than stated net asset position would be shown in the MIPS annual accounts. The annual accounts also show that MIPS runs a very efficient organisation ensuring a high percentage of the subscriptions members pay are available to meet claims and provide members with the other benefits of MIPS membership.

Doctors for Doctors All MIPS clinico-legal advisers and claims file managers are experienced clinicians from a range of craft groups. We believe that expert colleagues are best placed to assist members in the first instance. They also help facilitate interaction between members and the legal defence experts that MIPS appoints and ensure those legal experts fully understand the clinical issues and relevant medical expert reports. MIPS’ external panel legal firms in each jurisdiction ensure that MIPS’ members receive expert, independent and local assistance.

Inside Managing Director’s report. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Health Practitioners in the media. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Newer, more sustainable member cards for MIPS members. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 RACGP - Quality health records in Australian primary healthcare: a guide.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Increasing complaints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 YOUR13 photography competition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Understanding Informed Consent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Being a Good Samaritan.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Death – the Final Complication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 mips.com.au . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SUMMER 2013 – 2014

The MIPS Group is also unique in that the Chairman of MIPS, Chairman of MIPS Insurance and the MIPS MD/ MIPSi CEO are each AHPRA registered health professionals.

Fairness and Equity Each year MIPS’ external consulting actuaries review claims experience for all members/membership categories as well as considering other costs when advising ground up subscription pricing recommendations for the new membership year. Our pricing aims to ensure prudent, fair, equitable and stable pricing for members. The MIPS subscription fee is calculated using complex membership system algorithms. The subscription calculation for each member of MIPS reflects their individual risk profile and includes

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consideration of current and prior years’ practise, practise jurisdiction, retroactive cover date and other factors. In this way MIPS can ensure that it applies individual as well as craft group equity and fairness and that cross subsidisation between individuals and craft groups is avoided.

ensure that they have made appropriate and adequate arrangements for cover for their patients and ensure that they have clearly advised those arrangements to patients. Special care should be taken in respect of emergency cover and also follow up of test results during the festive season.

Our pricing methodology also means that two members practising in the same State and craft group (perhaps even in the same practice group), will be charged different subscriptions unless all their other risk factors are also the same.

During the Christmas and New Year break MIPS will operate with normal business hours and all members will still have access to our 24-hour ClinicoLegal Support.

Holiday Season Practice Arrangements Members who will not be working normal practise hours or taking time off over the holiday season will need to

Hopefully, for those who are able to take a break, the stress that is generated during the lead up to taking time off from work (and then from matters waiting on return) will be better than balanced by the benefit of their break!

During the Christmas and New Year break MIPS will operate with normal business hours and all members will still have access to our 24-hour Clinico-Legal Support Happy Holidays to all our MIPS members. We hope you have a safe and relaxing summer wherever you are. See you in 2014.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . mips.com.au

4 | MIPS Review | SUMMER 2013 – 2014

Health Practitioners in the media Over the years many health practitioners including MIPS members have provided healthcare advice through television, radio and various other forms of media. MIPS occasionally receives enquiries from members who wish to participate in such activities about their cover. Despite the surge in use of social media in addition to traditional forms of media there is no change in professional obligations. Healthcare advice must still be provided with the same degree of professional diligence, care and caution. Requirements of the Medical or Dental Board The Medical Board has proposed a social media policy which has been circulated for consultation. It contains guidelines that apply equally to all practitioners whether participating in general or social media. Professional standards must be maintained and healthcare practitioners must be aware of the consequences of their professional advice and actions. The principles are articulated by AHPRA in the codes of conduct for both medical and dental practitioners. Important expectations include compliance with advertising, privacy and confidentiality requirements and presenting information in an unbiased, evidence informed context while at all times avoiding making unsubstantiated claims. It is also important to consider that any comment, statement or other material that is provided may end up and remain in the public domain.

MIPS’ position Providing general advice of a healthcare nature (rather than specific healthcare advice to a patient) via the many forms of media is not the provision of healthcare as defined at 13.4 in the MIPS Members’ Medical Indemnity Insurance Policy. However in the event of a non medical indemnity complaint, investigation or claim arising from such activity members may approach MIPS for assistance under MIPS Protections where the matter arises out of a member’s professional activities.

MIPS recommends you: • should have the appropriate recognised qualifications, training and experience for the health conditions, services and treatments on which you comment • maintain an appropriate membership category • provide only accurate current information • familiarise yourself with Board codes and guidelines • advise your audience that anyone with a health concern should see a GP as soon as possible • provide an appropriate disclaimer Please refer any queries to 1800 061 113 or info@mips.com.au

MIPS members (intending to promulgate their views in the media) should be familiar with the guide to online professionalism published by the AMA and medical students associations of Australia and New Zealand.

mips.com.au . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SUMMER 2013 – 2014

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Newer, more sustainable member cards for MIPS members

Most of our members will have received a new membership card in the past few weeks. In previous years, MIPS has issued its members with a laminated card each year. In 2013, this card has been reworked to a thicker, more durable option that can be kept by ongoing members for the next five years eliminating the need for a new card every year. Your new card: • is produced at the same cost as the previous card • is made of Teslin plastic which is easily recyclable and nontoxic making it an environmentally friendly alternative to traditional PVC products (like your credit card) • can be disposed of in your residential recycling • is manufactured in Australia

By now, most MIPS members should have received their new membership card.

Dr John Citizen

M900012345

Some members will not receive a card, such as student members from international universities and some members with run-off cover.

Joined 07/13

If you have not received a member card yet, you may contact MIPS on 1800 061 113 or info@mips.com.au. Cards are distributed monthly and typically arrive within the first two weeks of each month.

Quality health records in Australian primary healthcare: a guide The Royal Australian College of General Practitioners (RACGP) recently launched the Quality health records in Australian primary healthcare: a guide (the Guide). The Guide, sets out common expectations on quality health records which form the basis of appropriate, safe, high quality healthcare. Quality health records are crucial for patients to receive safe and effective care, continuity of care and optimal health outcomes. Health professionals should ensure the information they record in health records is complete, consistent, legible, accurate, relevant, accessible and timely.

The Guide: • is designed to assist health professionals working in the Australian primary healthcare sector to produce, manage and use high-quality health records. It is important to note that the Guide is not designed to impose new professional obligations over and above recognised best practice. • covers electronic, paper-based and hybrid health record systems and in each section describes core principles, tips for compliance and clinical examples to illustrate application in day-to-day clinical practice. • is now available on the RACGP website.

For further information, please send an email to qualitycare@racgp.org.au or call the College’s First Contact team on 1800 331 626. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . mips.com.au

6 | MIPS Review | SUMMER 2013 – 2014

5000

Increasing complaints 4000 3000 2000 1000 0

ACT

QLD

2010/11

TAS

2011/12

AHPRA annual report released

• 2733 notifications were closed:

The 2012/13 National Scheme Annual Report has been released. The national scheme brings together fourteen healthcare professions in a national regulatory framework designed to deliver a more robust system to ensure public safety.

Stage at closure

The 2012/13 results are in line with MIPS’ own experience in recent years. MIPS workshops and online units reinforce the importance of risk education to minimise complaints and/or avoid or mitigate adverse outcomes. Considerable resources are devoted to avoiding adverse outcomes and managing complaints.

• 4709 voluntary notifications to the board - an increase of 18% • 54% of all notifications in respect of 16% of all practitioners • 4.2% of the medical practitioner registrant base involved in a complaint

Sub NSW Total Total

2012/13

Total 2,733

2500

2,200

2000 1500 1000 407

500

Assessment

Health or performance assessment

Investigation

Panel hearing

Tribunal hearing

• In 90% of cases that were closed the Board assessed that no further action was required • Immediate action was taken by the Medical Board in 147 matters – 31 suspensions, 4 surrenders of registration, 71 conditions imposed on registration and 21 undertakings. 1500

Other matters • Consideration of introducing a revalidation process to 1200 ensure all doctors who are on the register remain fit and competent to practice 900 • The Board agreed it will provide funding for external health programs for medical practitioners and medical students. 600 Further work will be done in 2013/14 to establish a model or models for the external health programs. • 300 A Medical Board CPD Audit Working Party is to be established.

Medical Practitioner 5000 4000 3000 2000

1000 0

3000

Some key results from the medical and dental board reports are as follows:

AHPRA Notifications - Medical

VIC

ACT

QLD

2010/11 ACT

QLD

2010/11

TAS

2011/12

VIC

TAS

2011/12

VIC

Sub NSW Total Total

2012/13

Sub NSW Total Total

2012/13

NB (The NSW notifications are not managed by the Board and AHPRA) 3000 2500

Total 2,733

MIPS workshops and online units reinforce the importance of risk education to minimise complaints. 2,200

2000 1500 1000 500

407

64 45 17 0 mips.com.au . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Health or performance assessment Assessment

3000

SUMMER 2013 – 2014

Total 2,733

2500

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2,200

2000 1500 1000 407

500

Assessment

Health or performance assessment

Investigation

Panel hearing

Tribunal hearing

AHPRA Notifications - Dental • 1052 voluntary notifications representing 4.4% of the registrant base: Dental Practitioner 1500 1200 900 600

Mandatory reports • 30% of all reports concerned medical practitioners, (221 to 299) • There was an increase in the number of mandatory reports requiring further investigation • 21 out of 54 reports concerning sexual misconduct involved medical practitioners • 18 out of 59 reports concerning alcohol and drug use involved medical practitioners • 194 reports concerning departure from standards by medical practitioners. Mandatory notifications received by profession and jurisdiction (including NSW data)

300

0 ACT

QLD

2010/11

TAS

2011/12

VIC

Sub NSW Total Total

2012/13

• 1075 notifications were closed in 2012/13, with 76% closed at the assessment stage, 21 closed after a panel or tribunal hearing with the remaining 102 closed after an investigation and 5 related to health or performance assessment. • There were 196 complaints in relation to advertising. Other matters • A review of the scope of practice registration standard continues with revised guidelines released for consultation. • It is noted that a taskforce has been established to review current activity on dental advertising which is not compliant with the National Law and advertising guidelines. • The Board has committed to starting an audit process of dental practitioners to determine compliance with the professional indemnity insurance, CPD and criminal history registration standards. Students • 45 notifications involving students, 15 were medical students Main reasons for Health Professional notifications • 53% regarding conduct of health professionals • 8% concerned health of health professionals • 38% concerned performance of health professionals For more information on our workshops, visit mips.com.au/workshops Resources ahpra.gov.au/ medicalboard.gov.au/ dentalboard.gov.au/ Refer to policies, codes and guidelines.

250 200 150 100 50 ACT NT QLD

TAS

Dental Practitioner

VIC WA 2013 NSW 2013 2012 Sub Total Total Total

Medical Practitioner

Notify MIPS Members should immediately notify MIPS if contacted by AHPRA about a voluntary notification or mandatory report. MIPS can provide advice and assistance to ensure a professional, prompt and appropriate reply is provided. Unfortunately there have been many instances where practitioners have chosen to manage complaints by themselves; the issues have not been properly addressed and AHPRA’s concerns have escalated. How to manage complaints • Always notify MIPS in a timely manner preferably before the open disclosure process • Show empathy and do not be defensive. You can say ‘sorry’. Concentrate on the issues raised by the patient • Comply with any relevant policies, procedures and reporting requirements, subject to advice from your employer/MIPS • Make sure patient healthcare is continuing appropriately • Always refer a draft of any proposed response to MIPS before sending.

8 | MIPS Review | SUMMER 2013 â&#x20AC;&#x201C; 2014

YOUR13 photography competition One of our most successful competitions to date was the YOUR13 photo competition. Thank you to all our members who entered their favourite photos of 2013. They were spectacular! What a year it has been! It was great to see such a large number of budding photographers amongst our members. The competition which ran from 11 September 2013 ended at midnight on 24 November 2013 and here are the lucky winner and runners up. The winner was chosen based on the number of votes received for each photo and a few of you campaigned strong. The winner has been displayed on the cover of this newsletter and will have the opportunity to promote their work on the MIPS Facebook page and will receive a 78cm x 53cm canvas print of their photo. Both runners up will also receive a canvas print of their photo.

RUNNERS UP

Stephanie Seow On a cliffside Cappadocia, Turkey 325 votes

Nick Laidler Curves In All The Right Places - The Oldest Bridge in Australia

Amy Thomson A piece of summer in winter. Beijingâ&#x20AC;&#x2122;s Summer Palace

Lukas Marchant Banff National Park

mips.com.au . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . mips.com.au . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SUMMER 2013 â&#x20AC;&#x201C; 2014

Parvathy Mural Beautiful Marysville recovering after Black Saturday bushfires

Frank Scheelings Bullers Albatross taken in New Zealand

Cathy Cowan Having a whale of a time on the The Gold Coast

Campbell Watson 3 young monks. Kopan Monastery Nepal

Joshua Rajaratnam The pathway to shelter

Neil Liddle Waterfall Borneo

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10 | MIPS Review | SUMMER 2013 – 2014

Understanding Informed Consent by Dr Gerard Clausen

The term informed consent is universally used to describe a significant part of the process in providing healthcare to the public. As a complaint, the lack of consent to treatment is a recurring theme in many dental cases, varying from a simple extraction to extensive periodontic reconstruction. In nearly every case the major concerns expressed are: • The full range of treatment options was not presented • The limitations/constraints of the chosen treatment were not explained • The total cost of treatment was not clarified and • The potential subsequent complications and cost of rectification were not explained. If we consider the endodontic treatment of a heavily restored molar tooth in light of the above comments, it becomes apparent that the process of informed consent involves a thorough explanation and discussion with the patient prior to the initiation of treatment. Treatment options should also be on the top of your list of things to discuss with your patient. It varies from case to case, but it is not essential that all molar teeth be retained. It may be that the unopposed, non-functional molar could be extracted without any untoward effects. In other cases, retention of the tooth in question may be more critical.

The second focus area in this clinical scenario is frank and thorough discussion about potential complications. Endodontic instruments can fracture, canals can be calcified and difficult to locate or instruments and previous interventions may compromise the expected outcome. These concerns must be conveyed to the patient. Finally, as well as clinical management, discussion around financial matters must be clear and transparent. If the tooth in question needs a core foundation and crown after endodontic treatment this should be explained and the costs involved outlined prior to treatment. In several cases patients have asserted that the option of endodontic treatment would have been refused if they had known about the additional restorative cost involved. In

such matters the financial aspect of treatment and incomplete disclosure thereof has a direct effect on the treatment chosen by the patient. Obtaining informed consent is a process that involves more than just presenting treatment options or signing a form. It is the careful explanation of treatment and the consequences thereof, in a manner that the patient understands and accepts. At the end of that process it is also imperative that the clinical notes incorporate the questions raised, any discussion relating to the treatment and consent provided by the patient regarding the chosen treatment. In recording the process always bear in mind the potential view “if it isn’t written, it didn’t happen”.

It is the careful explanation of treatment and the consequences thereof, in a manner that the patient understands and accepts

A further consideration would be whether to remove and subsequently replace the tooth. This may be a very appropriate choice when dealing with a vital site but the combined endodontic and restorative prognosis for the tooth in question is poor. These issues need to be discussed with the patient so that the choices and their advantages and disadvantages are understood. Simply presenting an ‘option list’ to the patient and allowing the patient to choose does not constitute informed consent.

SUMMER 2013 – 2014

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Being a Good Samaritan

The provision of healthcare to people in need of urgent medical attention in instances following motor vehicle accidents, at sporting events or during air travel can all be classified as Good Samaritan acts. These occurrences can take place both within and outside Australia.

Should you refuse assistance you may open yourself to complaint and even Board investigation. In 2012, a case in Western Australia involved a doctor who refused to treat a sick infant who was not his regular patient. As a result of this, the doctor was reprimanded and fined by the Board.

For incidents in Australia there is legislation surrounding the protection of Good Samaritans.

Should you have a complaint made against you and you are investigated by a Board in relation to your conduct in such circumstances, your actions will be judged in accordance with these codes.

This is how the Australian Medical Board protects the intentions of a Good Samaritan:

Board Code of conduct for medical and dental practitioners Apart from any ethical duty, members are reminded that the codes of conduct state at 2.5 Treatment in emergencies: Treating patients in emergencies requires practitioners to consider a range of issues, in addition to the provision of best care. Good medical practice involves offering assistance in an emergency that takes account of the practitioner’s own safety, skills, the availability of other options and the impact on any other patients under the practitioner’s care, and continuing to provide that assistance until your services are no longer required.

The Good Samaritan defence As a result of tort reform in the mid2000s there is individual State (not including Tasmania) and Territory legislation concerning personal injury in emergency situations. The protection does vary so consider your local jurisdiction for specific details. However in general terms if you were acting in good faith, acting without recklessness, exercised reasonable care and were not drug or alcohol affected, you are not likely to be considered negligent if there is an adverse outcome and it is alleged a better outcome should have been achieved.

MIPS cover Good Samaritan acts are covered in all countries except the USA or countries where US law applies. The following outlines basic principles that will be considered in determining whether an event can be classified as Good Samaritan in nature: • there should be no expectation that the member is available or would be available to provide health services; and • the Good Samaritan act is provided in a voluntary manner; and • any such assistance is in relation to unexpected and unanticipated events. Should you be involved in a Good Samaritan act please outline its circumstances to a MIPS clinico-legal adviser on 1800 021 223 for further advice. In summary • Consider your ethical and code of conduct requirements • Advise MIPS of any involvement in a Good Samaritan act • MIPS insurance does not cover incidents within the USA or where US law applies.

12 | MIPS Review | SUMMER 2013 – 2014

Death – the Final Complication By Dr Nichola Davis, MIPS clinico-legal adviser

Most junior doctors will tell you that signing their first death certificate is one of the most surreal experiences in their career. This duty appears to be one of the last remaining bastions exclusive to medical practitioners yet it barely rates a mention in most medical school curricula. Usually the first time a recent graduate sees a death certificate is when they are handed a blank one by a nurse who says, “Fill this out”. A Medical Certificate of Cause of Death (MCCD) more commonly recognised as a ‘death certificate’ is a legally required record of a person’s passing (although apparently no one has seen Bin Laden’s). The certificate is usually required immediately following a death by family members in order to proceed with funeral arrangements. As a result MIPS members are often urgently called upon to consider their position. The format of Australian death certificates varies slightly in each state and is beyond the scope of this article however all Australian certificates are based on the World Health Organisation framework in order that international mortality statistics can be collated. Medical practitioners have a legal, ethical and moral duty to ensure the accuracy of such death certificates for the following reasons: • Statistical and Public Health reasons • Legal/Financial ramifications. (Heath Ledger’s $10 million life insurance was disputed for a number of reasons connected with the cause of death written by a medical practitioner on his death certificate.) • Family history ramifications • To safeguard against crime and the inappropriate disposal of bodies. ‘I am not sure of the cause of death but the family want me to write a Death Certificate’ is a common clinico-legal enquiry received by MIPS. Each situation is very different, however it is appropriate for a practitioner to write a death certificate if he/she is ‘comfortably satisfied’ as to the cause of death and

the circumstances of a person’s death do not constitute a ‘reportable death’. (See Figure I). It should be noted that if a person’s death is reported to the Coroner, a death certificate should not be issued. In general, a death must be reported to a coroner in the following instances (although what constitutes a ‘reportable death’ varies by jurisdiction): • Where the person died unexpectedly and the cause of death is unknown • Where the person died in a violent or unnatural manner • Where the person died during or as a result of an anaesthetic • Where the person was ‘held in care’ or in custody immediately before they died • Where a doctor has been unable to sign a death certificate giving the cause of death • Where the identity of the person who has died is not known MIPS’ experience is that practitioners are uncomfortable writing a death certificate if they have not seen the patient for some time. Whilst this is understandable it is not always justified. In most States there is no requirement for the deceased to have recently attended the practitioner (exceptions are in the ACT where a certificate can be issued if a person has attended any medical practitioner within three months and NSW where this time period is six months). Similarly members are often surprised to be informed that a Death Certificate can in fact be issued by a practitioner who has never seen the patient or the body. It is of course vital that the practitioner who writes a certificate has an opinion regarding the probable cause of death and this may be obtained through perusal of the medical record or discussion with other treating medical practitioners. Many members who have been contacted while on vacation to supply a certificate for a faithful patient who has

Further information: Aust. Bureau of Statistics – A booklet for the guidance of medical practitioners in completing medical certificates of cause of death 2001 School of Population Health UQ Handbook for doctors on cause-of-death certification

passed away can now use the ‘electronic death certificate’ available on the Department of Births, Deaths and Marriages websites in Victoria. As well as being easily accessible this should increase accuracy and the standardisation of certificates. If a member is unsure whether to write a certificate, MIPS suggests that the practitioner should call the local Coronial Registrar or Office of the State Coroner in their state to discuss their knowledge of the patient’s medical history and their position. If a medical practitioner still wishes to decline issuing a certificate then as always MIPS recommends thorough documentation of that decision. In a situation where a coroner is investigating a reported death, members often receive a request for notes or a report. MIPS advice would be to promptly comply with this request and advise MIPS of the circumstances and any potential involvement. Members are sometimes disappointed to hear that they can’t charge the coroner for this service! However as a treating practitioner a member is entitled to a copy of a coroner’s report. Lastly it is important to remember that although government organisations such as the state Coroner and the Public Trustee have the legal right to obtain patient information; all practitioners should still treat a deceased patient’s medical records with confidentiality. Family may request access to the records and this should only be permitted if they have the permission of the Executor of the Estate. It may sound obvious but certificates should not be issued when the patient is still alive! This can lead to all sorts of complications. On one occasion a junior doctor eager to please an organised family, queried whether he could issue a certificate now for a patient who was clearly terminal. Some clinico-legal calls to our 24 hour support line are easier to answer than others; but we are always pleased when members contact us!

Photo courtesy of General Practice Registrars Australia