A GP has been banned from registering as a doctor for a year in Australia because of discriminatory behaviour toward an Indigenous doctor he accused of being a “fake Aboriginal” akin to “like a watered down bottle of Grange”.
The medical board described the decision as a “landmark outcome” as it is the first case to make reference to changes in the Australian Health Practitioner Regulation Agency (Ahpra) national law introduced last year to include a definition of cultural safety for Aboriginal and Torres Strait Islander people.
In the ACT Civil and Administrative Tribunal’s findings, the Canberra-based GP’s name was suppressed but the Indigenous doctor, Yuggera, Warangoo and Wiradjuri man associate professor Kristopher Rallah-Baker, made the unusual request that his name be published.
“It was important for me that this outcome wasn’t faceless, for people to see they won’t be brought down if they complain about racism,” Rallah-Baker said. “Racism in the healthcare system contributes to patient harm and premature death.”
The nation’s first Indigenous eye surgeon knows the consequences of racism all too well. He was inspired to become a doctor to stem the cycle that saw his grandmother orphaned at 12. “My nanna lost her own mother from pneumonia after refusing to see the white doctors for medical assistance. She was a member of the stolen generation.”
While still at the University of Newcastle medical school Rallah-Baker became one of the founding members of the Australian Indigenous Doctors’ Association, developed and managed the Indigenous Health Unit in the Logan-Beaudesert Health Service District, as well as developing the Deadly Ears Indigenous Hearing Health Program for Queensland, which has now been adopted as the National Indigenous Hearing Health Program by the federal government.
On 19 July 2022, the GP emailed Rallah-Baker’s ophthalmology practice, Sunshine Coast Ophthalmologists, with comments that had an “immediate, profound emotional toll” on the First Nations man, tribunal documents show.
According to the statement of facts agreed by both parties, the email read: “You are not full blood are you? Half? Quarter? One eight? Like a watered down bottle of Grange. Not the real thing. I have attached two photos of what real aboriginals look like just to remind you.”
The GP also went on to express his disaffection towards the Closing the Gap (CTG) pharmaceutical benefit scheme (PBS) co-payment program.
“To obtain a PBS subsidy for simple modified release paracetamol a patient MUST be aboriginal. This is not means tested. So rich dudes like you … could get your Panadol Osteo for absolutely NO CHARGE under the CTG legislation but my struggling old age pensioners with their osteoarthritis have to buy it at full cost.”
On 21 July, two days after the email was sent, Rallah-Baker notified the medical board of Australia (Ahpra) about the GP’s conduct and following an investigation, the board referred the matter to the ACT Civil and Administrative Tribunal because it reasonably believed that he had engaged in conduct that constituted professional misconduct.
The tribunal also considered the agreed facts that the GP has also failed to maintain a culturally safe practice when on the phone with an Ahpra investigator on 30 August 2022 the GP revealed that he had refused to write “CTG” on the script of a four-year-old whose father identified as Aboriginal.
The GP also made comments about Ahpra, including “Ahpra is a Gestapo”.
The GP’s legal representatives conceded his conduct was culturally unsafe, insulting and offensive. “However, he does not concede that that conduct was discriminatory on racial grounds ... First, because the person he sent the email to which contained the offensive comments was not a colleague. Secondly … the offending email was not generated in a workplace.”
According to the tribunal’s full decision, authored on behalf of the tribunal by senior member Thena Kyprianou, the GP issued an apology to Rallah-Baker and the Ahpra regulatory adviser he made subsequent comments to.
Kyprianou went on, “however, despite these concessions and issued apologies, we are not satisfied that the respondent has gained good insight into his conduct nor that he has shown genuine contrition for it”.
“Apart from the two apologies mentioned above, which were issued through his lawyers, no evidence has been presented to the Tribunal by the respondent supporting that he has taken any steps to gain insight into his conduct or expressing any remorse or contrition for his actions.”
The findings noted a psychiatrist’s report dated 30 June 2023 which described the GP “as having a personality with cognitive rigidity and a difficulty in understanding others’ emotional responses to his actions”.
The GP resigned in August 2022 and surrendered his registration on 13 September 2023. The tribunal ruled that in addition to a reprimand, it was necessary for the GP to be disqualified from applying for re-registration for 12 months “by way of general deterrence for the profession”.
‘Part of the solution to closing the gap’
Jayde Fuller, a Gomeroi woman and national director of Ahpra’s Aboriginal and Torres Strait Islander health strategy unit, said the outcome was “vindicating for Aboriginal and Torres Strait Islander Peoples whose experiences of racism in healthcare settings, as a consumer or practitioner are minimised or refuted entirely”.
Fuller said with Ahpra reforming the cultural safety of the complaints processes by actively recruiting First Nations staff to “handl[e] complaints involving us … we have a clear path forward to tackling racism in healthcare towards our people”.
Donna Burns, the CEO of the Australian Indigenous Doctors’ Association, said one of the best ways to improve cultural safety for First Nations patients was to increase the number of Aboriginal and Torres Strait Islander doctors. “However, we know that the doctors are exposed to these behaviours of racism.”
The latest medical training survey with data from 2022 found 55% of Aboriginal and Torres Strait Islander trainees had experienced or witnessed bullying, discrimination and harassment, which included racism, compared to 34% of all trainees nationally.
The same survey also found 29% of Indigenous trainees said they were considering leaving medicine, compared to 20% for non-Indigenous graduates.
“Cultural safety is clinical safety,” Burns said. “They can’t be decoupled. And holding people to account for culturally safe practice is not only a step towards eliminating racism, but an improvement in clinical care and therefore clinical outcomes.”
Rallah-Baker told Guardian Australia he hoped speaking out would encourage others. “There is still a lot of fear among Aboriginal and Torres Strait Islanders if they speak up against people in power or institutions in power, they will suffer the consequences.”