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Monday, 23 November 2009
Page: 8591


Senator SIEWERT (5:56 PM) —by leave—I move Green amendments (1) and (2) on sheet 5963 together:

 (1)   Schedule 1, item 2, page 3 (line 32), omit “If”, substitute “Subject to section 129AADA, if”.

(2)    Schedule 1, item 2, page 6 (after line 7), after section 129AAD, insert:

129 AADA  Additional requirements for personal clinical records

When section applies

         (1)    This section applies if, in relation to a decision under section 129AAD to require a person to produce or copy a document or an extract of any document:

              (a)    the Medicare Australia CEO; or

              (b)    the medical practitioner referred to in paragraph 129AAD(1)(b);

knows or believes on reasonable grounds that the document, extract or copy contains clinical details relating to an individual.

What happens

         (2)    Any decision to require the person to produce or copy the document or an extract of the document:

              (a)    may only be made by the CEO; and 

              (b)    must be made with oversight by qualified medical advisers.

         (3)    Before requiring the person to produce or copy the document or an extract of the document, the CEO must cause a Privacy Impact Assessment to be prepared, which must address:

              (a)    whether there is any other way to obtain the information being sought; and

              (b)    whether the requirement to produce the document is in the public interest; and

              (c)    whether the information being sought could be gained using de-identified records without undermining the integrity of the audit process.

         (4)    Before requiring the person to produce or copy the document or an extract of the document, the CEO must take all reasonable steps to advise the individual, or the individual’s representative, that his or her personal clinical records are to be accessed for the purpose of a compliance audit.

         (5)    If the individual, or the individual’s representative, objects to the use of the individual’s personal clinical records:

              (a)    the individual, or the individual’s representative, must be given the opportunity to provide reasons for that objection; and

              (b)    the CEO must review the decision to seek information by requiring the person to produce or copy the document or an extract of the document; and

              (c)    if the CEO decides to proceed to require the person to produce or copy the document or an extract of the document—the patient must be provided with written reasons for that decision.

I will try to be quick, as I did talk about these amendments in my speech on the second reading. Our concern is about making sure that patient confidentiality is maintained. The first amendment is fairly simple. It removes the word ‘if’ and replaces it with ‘Subject to section 129AADA, if’, which is contained in amendment (2). This means that the CEO should indicate the additional requirements for clinical and patient records. These additional requirements for patient records include defining reasonable concerns in order to investigate and having oversight of, as I articulated earlier, the medical advisers, not just the bureaucrats. It provides alternative ways to get the information. It deals with the public interest and the identification of records. It deals with advising individuals that their records are about to be used in an audit. I understand there is a debate about whether they should be told because there are issues around privacy for the medical practitioner. However, when we reviewed those issues, on balance we came down on the side of the patients and believed patients had a right to know that their records were being accessed. It deals with a case where a patient objects to their records being assessed. These issues relate to amendments (1) and (2) and I did articulate the reasons for these in my speech on the second reading.