Independent Review of the Use of Chaperones to Protect Patients in Australia
Summary
The review was commissioned by the Medical Board of Australia (MBA) and the Australian Health Practitioner Regulation Agency (AHPRA) in August 2016, following a Melbourne case in which a neurologist facing criminal charges for indecent assault on a patient was permitted to continue practising for eight months subject to a chaperone condition, and indecently assaulted a further patient while a chaperone was present. The MBA and AHPRA asked the review to consider whether, and in what circumstances, it is appropriate to impose a chaperone condition on the registration of a health practitioner to protect patients while allegations of sexual misconduct are investigated, and to recommend whether changes to regulatory practice and the National Law are needed to better protect patients and the public.
The review was led by Professor Ron Paterson (University of Auckland; former New Zealand Health and Disability Commissioner and Parliamentary Ombudsman), with research and analytical support including from Juliette McHardy. It drew on 45 public submissions, facilitated consumer forums, meetings with regulators and senior officials from leading international regulators in the United Kingdom, Canada, the United States and New Zealand, and in-depth analysis of MBA case files, AHPRA data, policies and processes.
The review’s central findings are that chaperone conditions are of limited effectiveness in protecting patients; that they are inconsistent with the trust and informed consent underpinning the practitioner–patient relationship because patients are kept in the dark about why a chaperone is present; and that the term “chaperone” itself is paternalistic and outdated. Where a practitioner cannot be trusted to see patients without supervision, the appropriate response is generally suspension rather than supervised practice.
The review makes 28 recommendations. These include ending the use of mandated chaperones as an immediate action measure for allegations of sexual misconduct in favour of suspension or clear, transparent restrictions; replacing the term “chaperone” with “practice monitor” in the limited circumstances where supervised practice remains appropriate (for example, while a practitioner is returning from suspension); stronger communication with patients about any conditions on a practitioner’s registration; and amendments to the Health Practitioner Regulation National Law to support more consistent, patient-protective decision-making. The review’s recommendations were subsequently adopted by the MBA and AHPRA.