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Monday, 18 June 2012
Page: 3488


Senator BACK (Western AustraliaDeputy Opposition Whip in the Senate) (19:39): As my colleague Senator Fierravanti-Wells quite correctly noted in her speech on this bill, the Health Insurance Amendment (Professional Services Review) Bill 2012, professional services review was the subject of a Senate inquiry and I thank my colleagues, led by Senator Rachel Siewert, for the Senate allowing us to undertake an investigation. I am pleased to record that the legislation we are considering this evening picks up on many of the issues which were the subject of concern to the committee and which appear in the report and, to some extent, in the coalition senators' report.

It is an absolute undertaking that the expenditure of public moneys, on this occasion through the Medicare system and through the Pharmaceutical Benefits Scheme, should be the subject of the highest level of audit and probity and that, if there is an occasion when a member of the medical profession or kindred professions is in default under this scheme and has been in some way defrauding the taxpayers of Australia, they should be dealt with in the harshest possible way. However, the representations made to me and other Senate colleagues which led to the PSR review and inquiry being undertaken illustrated that there were deficiencies and that there clearly was unfairness occurring. I will reflect on those issues for a couple of moments.

The first point I would make relates particularly to doctors in rural and regional areas of Australia, where their workloads are often very high, where they often do not have the support of colleagues and where they are therefore placed in a position of having no option but to have high caseloads. It was of concern that too many instances were occurring in which doctors who appeared out on the right-hand end of the normal or bell curve—in other words, that end of the curve where there would appear to have been a high degree of client consultation and therefore overcharging—were being unfairly discriminated against or were being unfairly targeted. I have been assured, as a result of the inquiry we held and as a result of questions asked in Senate estimates only in the last month, that if that practice occurred in the past then it has certainly ceased. In fairness to the then director, he would argue that that had not been the case. But the evidence before the committee was that those who were very high in their caseloads, those who were perhaps in positions where they had no option but to see large numbers of patients, did appear to actually attract the attention of, firstly, the Medicare officers responsible in this area and, subsequently, the Director of Professional Services Review. That is an area that I believe this place needs to continue to examine to ensure that doctors who are legitimate as to the workloads they undertake—and therefore as to the incomes they generate under the Medicare system and subsequently under the PBS—have adequate opportunity to explain that situation before they find themselves either the subjects of allegation or indeed in default.

The second area I want to alert the Senate to is the process of panel membership—those who will judge doctors or allied health professionals in this area. It is absolutely essential that, firstly, they are competent to assess their peers on whom they are sitting in judgment. They would argue perhaps that they are not sitting in judgment and that they are only putting advice to the director, but it is one and the same to somebody who is the subject of such investigation. The panel members must be drawn from a wide group of professionals who, first of all, are actively practising—I would suggest actively practising full-time—and who can assess the doctors on the capacities for which they are before the panel.

I can recall an instance in which a doctor who was not a cardiac specialist and who had a very prolonged series of interviews with a patient in consideration of some psychological affairs became cognisant of the fact that this person appeared to have a cardiac condition. They immediately referred that person to a cardiologist, who in fact undertook treatment and was able to save the life of that person. The psychologist was then the subject of an adverse inquiry by the PSR because they had not undertaken an electrocardiogram of that patient. That is unconscionable and should never, ever have gone to a full assessment by a panel. In fact, in his evidence, that doctor produced documentation from the cardiologist supporting the argument that his excellence as a clinician probably saved the life of the patient. I know that is only one isolated case, but it did seem to keep coming up in our inquiry.

The points I would make are these. Panel members (a) have to be drawn from a wide background and (b) have to be themselves engaged in the profession actively—and, I would say, professionally—full time. If I could just advert back for one moment to those from rural and regional areas, I would plead that those panel members should at least, if not currently in rural and regional practice, have had experience themselves in rural and regional practice so that they understand the constraints and the pressures on their peers whom they might be judging.

Coming back to my support of Senator Fierravanti-Wells and the legislation: where there is corruption or fraud, it must obviously be rooted out. The other point I would make relates to specialties—an area that we identified in the inquiry. With the evolution of medicine, there are new specialties emerging. Once again, it comes back to panel membership.

I make this point in conclusion about the whole question of the past—and I believe it is picked up in the legislation—in which somebody who had been the subject of an adverse report could only appeal on the legalities of the mechanism of which they were the subject but they could not appeal based on the medical facts. As a person who has been a member of a somewhat kindred profession, I believe that is medically nonsense. It is incompetence. In fact, should there be a challenge, it should be possible for the person who has been the subject of an adverse report, with their solicitor and through their solicitor, to challenge not only the legality of the process which has led them to where they are but also the medical facts upon which decisions have been made.

In conclusion, I have to say to you that the current and newly appointed Director of the Professional Services Review is, I believe, a person of enormous integrity—not that I reflect on those of the past, but I do understand and know this person. I for one believe that we will see in his stewardship of this new legislation a complete change—hopefully very, very harsh on those who genuinely are in default but at the same time understanding of those whose case should be the subject of meritorious study before it goes on to the more harsh legal constraints.