Health professionals being investigated for sexual misconduct will no longer be allowed to continue working accompanied by a chaperone, after a review by Australia’s medical regulator found the measure was outdated, paternalistic and did not improve public safety.
The independent review of the use of chaperones, commissioned the Medical Board of Australia and the Australian Health Practitioner Regulation Agency (Ahpra), found there were better ways to keep patients safe while a practitioner was under investigation.
These included placing gender-based restrictions on health professionals, restricting patient contact, or suspending the doctor’s right to practise.
The review was sparked by the case of senior neurologist Dr Andrew Churchyard, who took his own life last year while awaiting a criminal trial in Victoria for charges of sexual assault against patients. He was allowed to continue practising while being investigated on the condition he be monitored by a chaperone.
Churchyard was only suspended by the medical board in February last year after another patient alleged that Churchyard had indecently assaulted him behind a pulled curtain while a chaperone was present.
An international expert on health law and patient safety, Prof Ron Paterson, led the review and found many other reported examples of practitioners breaching chaperone conditions.
“Predatory practitioners who have come to view patients as sexual objects may not be deterred by a safety mechanism that still leaves the practitioner in control,” he found.
“The mandated chaperone system keeps patients in the dark. They do not know why a chaperone is required. This is the most significant flaw in the current system. Even the word ‘chaperone’ is inappropriate – patients find it old-fashioned and paternalistic.”
In January 2017, 48 health practitioners, including 39 doctors, were subject to a chaperone condition. Nine other health practitioners were subject to a chaperone condition including three nurses, two physiotherapists, two chiropractors, a dentist and a Chinese medicine practitioner. Only one of the chaperone-restricted practitioners was female, a nurse.
Twenty general practitioners, two psychiatrists, two neurologists, one dermatologist, one ophthalmologist and 13 medical practitioners without specialist registration were among the doctors with chaperones. Overseas-trained doctors, who comprise 33% of the medical workforce in Australia, comprised 59% of the doctors subject to a chaperone condition.
The review found chaperones were inappropriate for some medical specialities including psychiatry, where patients might be unsettled by trusting an additional person in the room with private information. It was inappropriate for a staff member to be a chaperone to someone under investigation, the review also found, given power imbalances that occur.
The 28 recommendations made by Paterson have been accepted by the medical board and Ahpra. They include establishing a specialist team to improve handling of sexual misconduct complaints, and strengthening monitoring of doctors while providing more information to patients in the exceptional cases when chaperone conditions may be appropriate.
The Ahpra chief executive, Martin Fletcher, said the report made it clear to regulators, courts and legislators about how to strengthen public protection and keep the system fair to practitioners.
“A range of legislative amendments are already under way and, in the meantime, we are making changes that will better protect and inform patients,” he said.
Using chaperones as an interim step to protect patients is common regulatory practice internationally. The changes to Australian regulations will make Australia one of the toughest responders to sexual assault allegations in health professions in the world.