The Australian health watchdog has conceded it needs to "raise the bar" to protect patients from sexual misconduct, announcing it is seeking major changes to how health professionals are regulated in the wake of an ABC investigation.
The Australian Health Practitioner Regulation Agency (AHPRA) has also revealed it is investigating 933 sexual misconduct complaints, more than 400 of them aimed at doctors.
The reforms proposed by AHPRA include giving patients equal representation on key decision-making boards, which would reduce the influence of doctors, nurses, and other health professionals over the fate of their peers.
The planned overhaul comes one week after a six-month Four Corners investigation which exposed how Australia's system of health regulation allows doctors who have groped, dated, molested, or had sex with their patients to continue practising.
Four Corners found almost 500 health practitioners disciplined for sexual misconduct — all involving patients — and many of them were still able to work.
AHPRA chief executive Martin Fletcher told the ABC on Monday the agency needed to "raise the bar for patient safety".
He acknowledged victims were disappointed by the lack of support when they spoke out about serious misconduct by registered practitioners.
The agency will also start public consultation on existing criminal history standards and boost support to complainants.
Among the sanctioned doctors still able to practise were four convicted paedophiles and a convicted rapist, none of whom were featured in the Four Corners program.
"The reforms we're talking about here build on the work that we've done over the past five years to really strengthen our approach to dealing with these sexual misconduct cases," Mr Fletcher said.
"We want to build on that foundation work to make sure that everything is happening to keep the public safe."
Tom Monagle, who was sexually assaulted by a highly regarded Melbourne neurologist when he was 19, was cautiously optimistic about the proposed reforms.
"I think it's a good move by AHPRA. They've clearly undertaken to review their processes and acknowledged that things haven't been working so far," Mr Monagle said.
"The amendments and changes they've outlined do seem to be positive ones. But I am always reluctant to [give them] credit … until we see them in action and they had a positive outcome."
Andrew Churchyard sexually assaulted Mr Monagle under the guise of examination in 2016.
The neurologist continued to practise after Mr Monagle reported him to the police and AHPRA, but the medical board ordered Dr Churchyard to treat male patients under the supervision of a chaperone while he was under investigation.
Dr Churchyard allegedly assaulted another patient while under supervision. AHPRA commissioned a review and scrapped the use of mandatory chaperones in response to the scandal.
It later emerged that in 2007, years before Mr Monagle's sexual assault, the Medical Board of Victoria had ordered Dr Churchyard to attend further education after a similar complaint of an inappropriate examination from a different patient.
The neurologist died by suicide in 2016 before standing trial for indecent assault.
Mr Monagle said patients should be a priority for regulators.
"Patients coming first has to be the approach of any regulatory body overseeing doctors and their right to practice," Mr Monagle said.
Mr Fletcher has written to all state and territory health ministers jointly responsible for the laws governing AHPRA to lay out his blueprint for reform.
If these changes are passed in legislation, they will be among the most significant reforms for the regulator since it was created in 2010.
The Australian Medical Association (AMA), the peak representative body for practitioners, said it supported investigations and "robust regulatory action" against doctors who engaged in sexual misconduct.
"The AMA will consider any reforms proposed by AHPRA that help ensure complaints are investigated and dealt with promptly with fair, transparent and timely processes, which balance the rights of patients and health practitioners," AMA president Steve Robson said.
Included in AHPRA's suggested legislative amendments:
- The introduction of a charter of rights for patients who have experienced professional misconduct
- Another review of the complex national system of regulation which has led to inconsistent decision-making across states and territories
- Ensuring the reinstatement of practitioners be a public process in all jurisdictions, as it already is in NSW
- An overhaul of how agencies, such as police, work with the national regulator to "rapidly identify" practitioners who are at risk to the public
- The establishment of new shared governance arrangements with Aboriginal and Torres Strait Islander bodies to improve processes for those groups
As well as maintaining the national register, AHPRA is currently responsible for investigating complaints in all states and territories except NSW and Queensland.
Complaints in NSW are managed by the Health Care Complaints Commission (HCCC), and in Queensland co-managed with the Office of the Health Ombudsman (OHO).
AHPRA will encourage the HCCC and OHO to undertake similar work.
The agency investigates complaints on behalf of 15 professional boards, such as the Medical Board and Nursing and Midwifery Board.
Only independent tribunals can remove a practitioner's right to practise.