Posts for September 2017

The Erosion of the Professions

Tuesday, September 26, 2017 4:00pm

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To protect the community, it is unlawful to practice as a lawyer or a doctor without having the appropriate qualifications and certifications.

Lawyers and doctors must complete years of study and work in heavily regulated environments so that the community can have trust and confidence in them to deliver services to the high standard expected for such specialised services. However, recent decisions by the State Government indicate a relaxation of these standards.

Lawyers are concerned about the adverse consequences of non-lawyers preparing documents like contracts and trust deeds. 

In the medical profession, services that have been traditionally the domain of doctors are now the subject of active encouragement, by government, to be undertaken by allied health professionals. Medical certificates are now being issued by nurses and pharmacists. Live-virus vaccines are being administered by pharmacists. 

I now understand the State government has organised for three nurses to be trained to perform colonoscopies after 12 months of training.

It is unclear the degree of supervision that would be expected by a trained colonoscopy surgeon or physician when these nurses eventually undertake colonoscopy procedures. Should a surgeon be expected to accept responsibility for a surgical procedure undertaken by a nurse? Why is this being considered where there is no shortage of surgeons to perform the task?

Colonoscopies are highly skilled procedures. Perforation of the bowel is an ever-present risk and the consequences can be severe. A trained surgeon can deal with that immediately. It also requires a highly trained and experienced eye to detect subtle premalignant changes.

How is a nurse expected to have that skill? If a polyp is found, does the nurse attempt to surgically treat it or call in a medical specialist? Must the patient undergo a second procedure for the removal?

Then comes an important legal issue. What if something goes wrong and you are seeking compensation?

Under the law, the standard applied by a court in determining whether a defendant has acted with due care and skill is by reference to what could reasonably be expected of a person professing that skill. We need to have a very good understanding of the skill that is being professed by these nurses. 

Are they professing the same skill as a suitably trained specialist doctor in the field or, if not, could the Government potentially use, as a defence in a negligence claim in the public health system, that the level of skill exercised was appropriate for a nurse (being less than of a surgeon) and that the claim should fail no matter how dire the consequences?  

Nurses perform a vital function but professional standards must be maintained to ensure that only those with the appropriate level of training and expertise can perform the work of medical specialists. The State Government approach of breaking down years of experience and training into “tasks” and ignoring expertise and accreditation raises serious legal and medical questions for the community. 

 

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