Medical Council

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After several years of controversy, and both praise and blame for his willingness to perform high-risk surgeries, neurosurgeon Charlie Teo has been subject to practice restrictions by a special committee of the Medical Council of New South Wales. So how does the process of restricting doctors’ medical practice work? And what did this mean for Teo?

How are health practitioners regulated in Australia?

• Health practitioner regulators in Australia aren’t generally empowered to make punitive decisions about health professionals’ conduct.
• Instead, Australia’s health practitioner regulations (the so-called “national law”) require decision-makers to exercise their powers to protect patients.
• As the Australian Health Practitioners Regulation Agency (AHPRA) acknowledges, requirements to protect the public may sometimes result in “a determination that is harsher on the practitioner than if punishment were the sole purpose”.

What happened in the Teo case?

• In late 2022, proceedings commenced against Teo via two complaints by the New South Wales Health Care Complaints Commission (HCCC).
• Tragically, neither patient regained consciousness after the operations and both patients died – one just ten days after.
• The HCCC alleged Teo had engaged in two categories of this wrongdoing: conduct below the standard reasonably expected of a doctor of his training and experience, and unethical conduct.

What were the findings and consequences for Teo?

• Though the committee is not legally bound to apply the rules of evidence applied in criminal courts, it decided, broadly for procedural fairness reasons, to receive and consider all of Teo’s unchallenged evidence.
• In a decision of more than 100 pages, the committee found Teo guilty of unsatisfactory professional conduct.
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What about patient autonomy or clinical freedom?

• Here, the committee had to balance the practitioner’s right to practise medicine against the paramount consideration of patient health and safety and against the patient’s right to exercise autonomy.
• a surgeon does not have a licence to undertake any conceivable procedure even with the agreement or acquiescence of the patient.

Is medical regulation strict in Australia and NSW?

• Many reviews and academic studies find the national law to be fair and appropriate, or not strict enough.
• However, some scholars and representative groups including the Australian Medical Association (AMA) find some aspects are too strict and unsympathetic to practitioners.
• But a potted history of NSW medical history showcases how successive medical scandals have tended to drive strong regulatory reform.

What next for Teo?

Teo may appeal the orders of the committee to the NSW Civil and Administrative Tribunal or seek a review of the conditions. But as the conditions are not subject to an end date, it appears they will otherwise continue indefinitely.

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• But while it is acknowledged New Zealand has under-invested in health infrastructure, more damaging has been the under-investment in people.
• This lack of planning for the future health workforce is directly responsible for the staffing shortages now being experienced.
• Ideally this would include a budget that invests in training more – and more diverse – New Zealand doctors.

Relentless demand

• We know the demand for more doctors is relentless – fuelled by a growing and ageing population.
• At the same time, we have an ageing medical workforce, with many doctors planning to retire in the next decade.
• To sustain this modest growth each year, we will need to increase the total medical workforce by 590 annually.
• Last year, 1,232 IMGs were registered to practice here, reflecting the high demand for doctors not being met through local training and retention.

Our missing GPs

• There are particular problems in the less wealthy regions, and in particular specialities such as general practice.
• GPs are the backbone of the health system, with 90% of health consultations occurring in primary care.
• Yet while we have increased the number of doctors by 5,000 over the past ten years, the number of GPs has only increased by 260.

Investing in training

• In both countries, research showed doctors tended to stay and work in the area where they trained.
• The new medical schools are located in regions with high needs and recruitment difficulties.
• This should be just the start, with ongoing commitments to increase student numbers in line with the growing medical workforce.

• The IMC issued a five-year renewal of the accreditation of the undergraduate medicine programme, which is valid until November 2026.
• President of RCSI Bahrain, Professor Sameer Otoom commented, With our accreditation standards and a world-renowned curriculum, RCSI Bahrain graduates attain a level of knowledge and clinical experience to compete for rewarding career opportunities worldwide, as well as supporting the development of national healthcare programmes in the Gulf Countries.
• RCSI Bahrain is a constituent university of RCSI, which was established in Dublin, Ireland, in 1784.
• RCSI Bahrain, an independent private university, opened its doors to a cohort of 28 medical students in 2004.