Dr Volker Hitzeroth, Medicolegal Consultant at Medical Protection says there's more to be done in order to make the ordeal of being involved in a protracted HPCSA investigation does not have a devastating affect on the wellbeing of those on the receiving end of a complaint.
In a recent Medical Brief column, we discussed a recent case where Medical Protection represented a member in the Gauteng High Court, Pretoria, regarding a HPCSA complaint alleging unprofessional conduct. The complaint was brought against our member in 2008, yet the HPCSA had still not commenced proceedings. The court ordered that the complaint against the practitioner be permanently set aside and that all existing disciplinary proceedings related to the complaint be terminated.
The judge described the case as a “tale of institutional inefficiency, demonstrating the traumatic and adverse prejudicial impact on the well-being of a professional medical practitioner accused of unproven misconduct”.
Unfortunately, cases like this, where members feel they are caught in a seemingly never-ending HPCSA process are not uncommon.
A recent survey conducted by Medical Protection highlights the impact that an HPCSA investigation can have on a doctors’ mental wellbeing, and shows how the stress of being investigated by the regulator is compounded by the length of the process.
Of the 204 doctors who participated in the survey, having faced an investigation in the last five years, 61% felt the investigation had a detrimental impact on their mental wellbeing and 83% said it caused stress and anxiety. 71% went on to say that the length of the process impacted on their mental wellbeing most.
It should be added that these sentiments are not exclusive to the HPCSA process. We have conducted similar surveys in other jurisdictions where we support members with regulatory investigations. Being under investigation by any professional regulator for a period of time takes its toll on the practitioners involved – including on their confidence, personal lives and relationships.
For some the investigation, regardless of the outcome, has even resulted in practitioners considering their future in healthcare. In our survey nearly one in five (19%) considered leaving the medical profession or leaving to practise in a different country because of their HPCSA investigation.
While delays of over a decade are hard to excuse, we do recognise that the HPCSA, just like many other regulators around the world, are bound by statutory obligations which can cause delays to the process. Making changes to the regulatory framework is something the HPCSA and the Department of Health could consider to help facilitate faster resolution of cases.
There are however other steps the HPCSA could also consider outside of making changes to the regulatory framework, which admittedly could take some time. The HPCSA has indeed already established some measures to help speed up their process, and while this is welcome, we hope more can be done.
For example, the regulator could encourage alternative complaints resolution processes within health establishments, such as mediation, which would allow patients to work with the healthcare provider and resolve complaints locally and promptly. This would enable quicker resolution for patients and practitioners, and also reduce the number of minor complaints directed to the HPCSA so it can focus on the most serious allegations and protecting the public.
Delays to the process are not the only cause of stress to practitioners. 81% cited the initial, unexpected notification of the investigation as impacting on their mental wellbeing and 41% said the tone of communications from HPCSA affected them most.
In the last month we have had constructive engagement with HPCSA colleagues, and we have made several suggestions in these areas.
For example, the HPCSA could undertake a review of its communications to practitioners, to ensure the tone is more compassionate and acknowledge that notification of an investigation into their professional conduct, and the process which may follow, may prove stressful.
The HPCSA could also look at changes professional regulators in other jurisdictions have rolled out following similar feedback about the shock and fear that often comes with receiving an initial notification of an investigation. For example, the United Kingdom’s General Medical Council has recently, following a pilot project, rolled out initial contact by phone prior to a letter being sent. It has also committed to not sending an initial notification on a Friday when access to legal and wellbeing support may be more limited.
We also believe it would reduce stress around unknown timeframes and lack of communication, if the practitioner under investigation is informed how long the process should take and when they can expect updates.
These may seem like simple measures, but such relatively small changes could mean much to the practitioner on the receiving end of a potentially career changing – and sometimes life changing – letter.
Clearly there is much that can be done, and we are keen to continue our dialogue with the HPCSA and share our international experience, to help develop some of the ideas discussed above.
Being investigated by any regulator will never be pleasant, but we believe it could be a swifter, more palatable and less stressful experience and we are absolutely committed to helping to bring about positive change for our members and the healthcare profession as a whole.