Background
The clinical care and governance failings at Bacchus Marsh Hospital (the Hospital), contributing to several perinatal stillbirths and deaths between 2013 and 2014, have been widely publicised. Former physiotherapist, Elizabeth Wilson is the latest of the total 43 practitioners investigated by Ahpra, to be the subject of disciplinary findings as a result of failings within the Hospital.
Between 2009 and 2015, Ms Wilson was the Director of Clinical Quality and Support Services at the Djerriwarrh Health Service (DjHS), of which the Hospital was a part. During her tenure, she retained her registration as a physiotherapist although did not oversee any clinical care of patients. Her role as Director of Clinical Quality and Support Services also did not require her to be a registered health practitioner.
The Physiotherapy Board of Australia (the Board) alleged that Ms Wilson failed to meet the standards of the physiotherapy profession, primarily as a result of her shared responsibility for clinical governance failings at the Hospital. There were 5 allegations in total:
- failed to ensure the effective investigation, management and analysis of incidents and in particular failed to take appropriate action to ensure that all perinatal deaths at DjHS were subject to appropriate clinical review.
- failed in her shared responsibility to take appropriate action to ensure that the DjHS had an organisational system that required clinical areas to identify their clinical risks and to ensure that there was relevant retraining and education of staff.
- failed to meet her shared responsibility to take appropriate action and to ensure that DjHS had clear booking and transfer criteria which was suitable to its capacity and failed to ensure those controls were utilised.
- failed to ensure that health service incident management polices reflected the department policy and clinical governance policy framework.
- did not undertake adequate formal reflective practice activity or training to identify gaps in her skills knowledge and ability, including undertaking adequate education in relation to competency in the review of adverse events and incident management.
The Tribunal was required to consider as a preliminary issue whether it was appropriate for Ms Wilson to be the subject of disciplinary proceedings, in the context of being registered physiotherapist carrying out an executive management and administrative role, which did not involve clinical care and or require health practitioner registration.
If satisfied she was the proper subject of disciplinary proceedings, then the Tribunal was to characterise her conduct and determine the appropriate disciplinary action.
Outcome
The Tribunal was satisfied that as a registered physiotherapist, Ms Wilson had health profession responsibilities that attracted disciplinary processes. This was primarily because the definition of ‘practice’ in the Physiotherapy Board of Australia Code of Practice extended beyond the provision of direct clinical care and included working in management or administrative roles.
It was accepted that a registered health practitioner occupying an executive or senior management role in a health service may be the subject of additional expectations and responsibilities through the professional standards set by the relevant Board.
The Tribunal acknowledged that Ms Wilson’s role was not one of clinical leadership, and whilst she had risk-management and quality and safety responsibilities, her responsibilities were wide ranging, and according to expert opinion, impossible to fulfil.
Ultimately, the Tribunal held that allegation 1 constituted professional misconduct and the remaining allegations were properly characterised as unprofessional conduct. Her main shortcoming was that whilst she had ensured risk management systems were in place, she had not recognised that clinical review discussions undertaken by relevant clinicians fell short of what was required.
Interestingly, the Tribunal refused to impose a 10-year disqualification period, despite prior agreement between the Board and Ms Wilson that this was the appropriate disciplinary action.
The Tribunal accepted that whilst Ms Wilson shared some of the responsibility for failures in clinical governance, her responsibility and relative culpability was not comparable to other cases, as her conduct was not at the same level of seriousness.
Ms Wilson’s case was distinguished from other cases related to the Hospital on the basis that she did not have responsibility or authority related to the direct clinical care of patients, and because she did not have authority to direct clinical leaders or question clinical assessments.
Further, she was instrumental in advocating for external review processes and investigations and the need for a properly resourced Quality and Safety Unit. She had also received external validation for her performance of her role, including advice that the DjHS had met clinical governance and quality and safety responsibility to the required standards.
Taking into account the above mitigating factors, the Tribunal reprimanded Ms Wilson and disqualified her from re-applying for registration for a period of 2 years.
Implications
The case is a timely reminder for registered practitioners in an executive management and/or administrative role that ensuring appropriate clinical governance is fundamental to meet their professional obligations, and extends to the identification of clinical risks and clinical review of adverse outcomes in compliance with relevant standards and policy.
We recommend that those in executive management roles review their continuing professional development plan, and ensure that they complete and remain up to date with relevant courses related to clinical governance.
To read the decision in Physiotherapy Board of Australia v Wilson (Review and Regulation) [2022] VCAT 881, click here.
