Tightened recruitment processes to reduce fraud
The Australian healthcare industry has certainly seen its share of drama in the arena of fraud and falsified qualifications over the past 15 years. From the classic case of negligent Bundaberg “surgeon” Jayant Patel nicknamed “Dr Death” for his malpractice uncovered in 2005; to Dusan Milosevic, a former member of Serbia’s secret service who was jailed in 2011 for posing as a psychologist in Melbourne – and many others. Despite these precedents, risks in recruitment procedures continue to affect healthcare providers today; threatening financial and reputational exposure, whilst potentially endangering the vulnerable they serve.
More recently in an incredible case of ID fraud, Shyram Acharya stole the identity of UK doctor, Sarong Chitale, between 2003 and 2014 in order to work at six NSW hospitals. While working together as medical interns in India, Archarya obtained medical registration and other Commonwealth documents (such as a passport) to fraudulently pose as Dr Chitale.
An independent inquiry report revealed that time pressures and staff shortages led to the failure to cross-check medical qualifications and pick up inconsistencies between Acharya’s resume and references. These would likely to have raised alarm bells to question his application and possibly detect the fraud.
The inquiry just finalised in April 2019 concluded that there has since been an improved recruitment process introduced within NSW Health, which included tightened requirements for the registration of international medical graduates. The inquiry claims that anyone who was fraudulently registered between 2003 and 2008 would not have survived the more stringent rules relating to registration that have been applied in NSW from 2008.
The Role of AHPRA
The Australian Health Practitioner Regulation Agency (AHPRA) plays an important role in the tightened health practitioner licencing requirements and mandatory obligations for employers.
In order to practice in the healthcare industry in Australia, practitioners must first apply for registration (to confirm that they hold a current licence) via AHPRA, and registration must be renewed annually. Once registration is approved, the practitioner appears on the online AHPRA Register of Practitioners that same day. If registration is not renewed, the practitioner will appear on the register as expired.
Restrictions and conditions can be placed on registrations to protect the public. For example these conditions can be applied for disciplinary reasons brought about by a National Board who have concluded that the practitioner has departed from accepted professional standards.
As per AHPRA guidelines, it is an employer’s responsibility to check the certification of a practitioner via the register prior to employment. As a minimum, companies should check the register annually, although monitoring consistently throughout the year is recommended.
Employers (along with education providers and health practitioners) must also meet mandatory notification obligations such as notifying AHPRA if they have formed a reasonable belief that a registered health practitioner has behaved in a way that constitutes notifiable conduct. Valid reasons are outlined on the AHPRA website.
Online registers for validating medical credentials
Online registers (such as that maintained by AHPRA) are developed by professional and regulatory bodies, regularly maintained and provide a transparent and simple means for healthcare employers to remain vigilant in validating the credentials of practitioners and preventing risk to the public.
Registers to assist employers with hiring only licensed health practitioners form the basis for several checks PeopleCheck has recently introduced to minimise risks for our clients. Undertaken in addition to background checks, PeopleCheck can now provide a “one stop shop” for clients within the healthcare industry, offering:
- AHPRA Check: A search of the Australian Health Practitioner Regulation Agency’s (AHPRA) Register of Practitioners for the candidate’s name. Information returned includes confirmation of registration status, registration expiry, registration type and endorsements, along with any notations, conditions, undertakings and reprimands issued on behalf of the Agency.
- ASORC Check: A search of a register of Rehabilitation Counsellors accredited with the Australian Society of Rehabilitation Counsellors (ASORC) for the candidate’s listing.
- ESSA Check: A search of a register of Exercise and Sports Science practitioners accredited with Exercise and Sports Science Australia (ESSA) for the candidate’s listing.
International Background Checks
It is also important to remember that sometimes Australian background checks do not cover all bases. The case of fake gynaecologist Raffael Di Paolo reveals the importance of undertaking international background checks where relevant to the candidate’s background, particularly where medical credentials are claimed from overseas institutes.
Di Paolo posed as a gynecologist, obstetrician and fertility expert in Australia for an entire decade from 2004, despite never having gained tertiary qualifications. During his “career”, women were subject to invasive internal examinations and, amongst other things, were injected with unknown substances. Di Paolo had a history of lying on an international scale, avoiding jail time in Italy in 2006, and when his registration was questioned by AHPRA, Di Paolo forged Italian medical qualifications.
Background Checks for the full picture
Although consistently checking an authorised register such as AHPRA’s Register of Practitioners is an effective tool in weeding out fake health practitioners, some of these horrific fraudulent cases emphasise the importance of undertaking a suite of background checks to expose any gaps in an individual’s history, especially one who is going to treat patients and potentially perform medical procedures.
As seen in a recent judgement (Health Ombudsman v Armstrong [2018] QCAT 382) by the Queensland Civil and Administrative Tribunal (QCAT), authorities take non-disclosure of relevant information (such as criminal proceedings) in the AHPRA registration process seriously and it can amount to “unprofessional conduct”. However, in addition to checking registration with AHPRA, some healthcare providers are opting to undertake further, independent checks to confirm a candidate’s background (rather than relying on the registration process to reveal candidate disclosures), which only further minimises their risks.
A recent article on the disturbing case of disgraced obstetrician and gynaecologist Dr Emil Swaky Gayed also makes the point that “hospital staff should not rely too heavily on the registration and disciplinary systems to provide oversight and impose conditions or correction of performance. There remains a significant level of responsibility on all health practitioners, managers and colleagues to proactively manage clinical risk and the safety and quality of health care at the local level, within their own teams and among those they work with.”
To this end, register-based checks can be undertaken in conjunction with other checks that aim to obtain a full picture of the candidate and identify any hidden skeletons.
- A police check for working with vulnerable persons (including the mandatory ID check) will confirm the candidate’s identity and identify any disclosable court outcomes that may be relevant to the role;
- Qualification verifications direct with the awarding institute will validate credentials; and
- Employment verifications will provide insight into the candidate where misconduct may be unreported or behaviour blurs the line between reportable and not.
Traditionally, background checking in the healthcare industry has had a narrow focus of police checks and working with children checks, particularly with 3-yearly police checks required under the Aged Care Act 1997. It is encouraging to see an emerging trend towards healthcare providers seeing the benefit of additional checks, even where they may not be mandated by regulators.
Background checking in the spotlight
Despite the case studies and constant call for further tightening of recruitment procedures, mandatory background checks are not yet reflected across the entire Australian healthcare industry.
According to an ABC News article, a report released by the Australian College of Nursing (ACN) revealed that healthcare is under the spotlight to have unregulated workers (those who are not registered practitioners across the primary, acute and aged care sectors) subject to some sort of standard, as at present they do not even require a police check prior to working in healthcare facilities.
ACN Chief Executive, Kylie Ward, has called for healthcare workers to be admitted to a register that would require satisfaction of minimum training, police checks and annual/biannual renewal of registration, similar to registered nurses. As the common sense approach of background checking all employees with access to the vulnerable (practitioner or not) gets tabled, we will need to watch this space.
Not coincidentally, the Royal Commission into Aged Care Quality & Safety is currently in progress and due to provide an interim report by 31 October 2019 and a final report by 30 April 2020. Here’s hoping stringent processes and standards are developed across all parts of this crucial sector as a result of the findings…as well as issues such as fair pay and staff ratio laws!
The information contained in this post is the opinion of PeopleCheck Pty Ltd and does not form the basis of legal advice.