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Legislative Council - Fifty-First Parliament, Third Session (51-3)
2009-06-17 Daily Xml
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Parliamentary Committees

SOCIAL DEVELOPMENT COMMITTEE: INQUIRY INTO BOGUS, UNREGISTERED AND DEREGISTERED HEALTH PRACTITIONERS

The Hon. I.K. HUNTER (17:22): I move:

That the final report of the committee, on an inquiry into bogus, unregistered and deregistered health practitioners, be noted.

Before providing an overview of the inquiry's findings and recommendations, it is necessary to define some of the key terminology used in this inquiry. In South Australia, as in other Australian jurisdictions, healthcare services are provided by a range of both registered and unregistered health practitioners. The term 'registered health practitioner' refers to a health practitioner registered under one of South Australia's health regulation acts. Examples include doctors, nurses and dentists—examples with which we will all be familiar. In contrast, the term 'unregistered health practitioner' refers to a health practitioner who is not registered under one of these acts. This includes, among others, naturopaths, herbalists, homeopaths, massage therapists, psychotherapists, counsellors, speech pathologists and a range of other complementary and allied health practitioners.

The inquiry also examined the conduct of deregistered health practitioners. For the purposes of this inquiry the term 'deregistered health practitioner' refers to a practitioner whose registration under the South Australian Health Registration Act has been cancelled or suspended as a result of disciplinary proceedings.

The committee commenced hearing public evidence on 17 March 2008 and completed its hearings on 16 February 2009. In total, 90 submissions were received, consisting of 73 written submissions and 17 oral presentations. Before going further, I take this opportunity to thank other members of the committee for their contribution: first, from the other place, Mr Adrian Pederick, Ms Lindsay Simmons and the Hon. Trish White. It should be noted that the Hon. Trish White was responsible for having this matter referred to the Social Development Committee for investigation. From this chamber I thank the Hons Dennis Hood and Stephen Wade. I also acknowledge the great work and thank the staff of the Social Development Committee for their contribution to our report.

But, most of all, on behalf of all committee members I thank those individuals who were prepared to provide intensely personal accounts as evidence to the inquiry, either through written submissions or by appearing in person before the committee. In many cases giving such evidence meant reliving an incredibly painful experience. This was not an easy thing to do but really deepened the committee's understanding of the issues before it.

ABS data over recent years has revealed a significant rise in the popularity of many unregulated therapies and treatments. Evidence shows that a great many health consumers are increasingly consulting unregistered health practitioners. From the outset, the committee agreed and acknowledged that many unregistered health practitioners perform an important and legitimate part of health servicing to consumers and that the majority are reputable. That noted, evidence presented to the inquiry suggested that some unregistered health practitioners are not of such good reputation.

The inquiry primarily concentrated on those unregistered practitioners who make extravagant claims they cannot substantiate and encourage unsuspecting consumers to spend significant amounts of money on so-called therapies that are, at best, ineffective and, at worst, dangerous. Such practitioners are often skilled at exploiting people's fears and creating a sense of hope based on deception. While some of these practitioners may be delusional, convinced that they are actually able to cure serious medical conditions, the evidence presented to the committee suggested that others are driven by greed and, in some cases, sexual gratification.

Although the committee received evidence of a number of instances of alleged misconduct, it is difficult to quantify the extent to which bogus, unregistered health practitioners operate in South Australia. Overall, the number of reported cases is low. However, the inquiry heard that shame and embarrassment often prevent individuals from coming forward. Moreover, in cases where an individual has died, it can be very difficult for a surviving partner or family member to pursue a complaint.

Notwithstanding these factors, the inquiry received evidence on a number of specific allegations of serious misconduct. These included an allegation that Mr Lubomir Batelka, an unregistered practitioner, claimed that he could provide a 50 per cent cure for cancer using ozone therapy, and had insisted that the patient sign a confidentiality form. Further, an allegation that Ms Elizabeth Goldway, an unregistered practitioner, had promised to cure a woman of her breast cancer dissuaded that woman from continuing with conventional medical treatment and required in excess of $5,000 in cash payments. The inquiry heard that this practitioner also displayed a prominent sign outside her premises that read, 'You don't have to die from cancer or any other sickness.'

Further, the committee heard an allegation that an unregistered massage therapist, Ms Elvira Brunt, had claimed, while massaging a man dying of bowel and liver cancer, that she could feel his tumours shrinking. The inquiry was also told of an unregistered practitioner, Ms Monika Milka, whose treatments, consisting of injecting small quantities of various substances and saline under the skin, resulted in at least six people suffering from skin abscesses and one person developing mycobacterial infection, a condition that is particularly difficult to treat.

The committee was shocked by the evidence presented to it. The evidence raised serious concerns about some unregistered practitioners whose training and qualifications, if any, are highly questionable and who make unsubstantiated claims about cures for cancer, or employ techniques and procedures that are unsupported by any credible evidence whatsoever. According to the evidence presented, the services of bogus health practitioners are commonly promoted by word of mouth. Quite often testimonials espousing the benefits of a particular therapy or product are put forward as a way of convincing consumers that a therapy will have benefit.

The inquiry also heard about bogus practitioners displaying dubious credentials, in some cases purchased directly from online universities. Indeed, as part of its investigation the committee sighted a number of websites that award academic degrees based on life experience and promise hassle-free delivery of bachelors, masters and doctorate-level degrees in a variety of subjects. Many of these websites use catchy slogans, such as 'Earn a degree for what you already know'. These websites assure prospective clients that volunteer activities, hobbies, military training, attendance at workshops and even independent reading, listening or writing are all considered legitimate qualifications by which a degree can be obtained.

The purchase price for these degrees varies and usually depends on whether an undergraduate bachelor degree or postgraduate degree is sought. Special package deals are also offered. For example, on one website the committee sighted, customers were able to purchase a high school diploma, a bachelor's degree and a master's degree for a combined discounted price of just over $US1,000. For an additional fee an academic transcript was thrown in for that price.

The committee also heard evidence about an expanding number of practitioners who now use the title 'Doctor'. The committee is concerned that the use of this title by some practitioners may give the impression that they hold medical qualifications when this is not the case. It can, and no doubt does, cause confusion to health consumers. The committee is certainly of the view that those individuals who use the title 'Doctor' need to be mindful of the context in which it is used, and ensure that the broader community is not misled in any way.

While most of the submissions received by the committee accepted the need for some type of regulatory reform, how this should be pursued was a point of considerable difference. The committee grappled long and hard with the difficult question of whether tighter regulatory measures should be established to deal with unregistered health practitioners and, if so, what type of regulation would be the most appropriate. The committee considered a number of regulatory models ranging from self-regulation at one end of the continuum to reservation of title and whole of practice at the other. The committee has recognised that each regulatory model has its strengths and weaknesses.

After weighing up the pros and cons of a broad range of regulatory options the committee has decided, as the inquiry's main recommendation, to call on the state government to introduce new legislation to better regulate the broad range of unregistered health practitioners providing services in this state. In doing so, the committee has recommended that the government should closely examine other regulatory models introduced in interstate jurisdictions.

In particular, the committee considers that there is merit in the development and implementation of a code of conduct similar to that which exists in New South Wales. It also considers that there is merit in establishing a statutory registration scheme for Chinese medicine practitioners, acupuncturists and Chinese herbal dispensers similar to that which has been introduced in Victoria.

The committee is also calling on South Australia's Health and Community Services Complaints Commissioner to take a much tougher approach in publicly naming dodgy unregistered health practitioners. The committee understands that the decision to issue a public health warning in relation to an individual practitioner should not be made lightly, nor should it occur without procedural fairness being afforded to the individual concerned. However, once those matters have been attended to, action to publicly identify individuals who exploit or represent a risk to the health of consumers should be taken. To that end, the committee has resolved to call on the Health and Community Services Complaints Commissioner to report back on the progress made in dealing with complaints about unregistered health practitioners.

In total, the committee's report contains 21 recommendations. This includes recommendations calling on the state government to:

better educate health consumers so they are able to differentiate between credible health claims and those that are exaggerated;

ensure that all health practitioners display only legitimate and properly accredited qualifications in their workplaces; and

urge the commonwealth government to strengthen the capacity of the Australian Taxation Office to clamp down on potential tax evasion by dubious health practitioners.

As mentioned earlier, the committee was also required to examine the practices of deregistered health practitioners; that is, those practitioners whose registration under a South Australian health registration act has been cancelled or suspended as a result of disciplinary hearings.

The committee notes that health practitioners who have been deregistered are not necessarily bogus and in and of themselves do not necessarily pose problems to health consumers. However, the committee heard evidence of instances in which health practitioners had been deregistered for unethical or unprofessional conduct but who had subsequently rebadged themselves so as to be able to practise in an unregulated area of health care. For example, the committee heard of a case involving a psychiatrist who, after being deregistered, had established a practice as a counsellor. In another case, a deregistered general practitioner set up practice as a nutritionist.

The committee is of the strong view that any registered health practitioner who has been deregistered on disciplinary grounds should not be able to set up practice in another area of health care without appropriate review. To this end, the committee has recommended that the government consider legislative amendments to all relevant health legislation to ensure that in such instances deregistered health practitioners are unable to establish themselves under a different title in an unregulated area of health care.

In summing up, the provision of health care services is not something that should be undertaken lightly. Yet for too long we have allowed anyone to practise in unregulated areas of health care without any proper checks and balances—no checks on competencies, safety training or occupational health and safety competency.

It grieves me and it makes me very upset to read today on the Adelaidenow website that a young baby has died at a clinic of Ms Elvira Brunt, one of the persons of interest in our report. There is scant information available at this stage. I do not want to jump to any conclusions until the proper investigations have been completed. However, it concerns me greatly. I also do not want to compound the grief of the parents of the poor child, so I will refrain from commenting further at this stage. However, it is time that the situation that currently exists is changed.

The committee certainly considers that it is important that people who are seriously ill are supported and given hope, but the committee is clear that they should not be given false hope by shonks and rip-off merchants. Bogus practitioners who make claims of curing cancer or other terminal illnesses are particularly insidious.

As harrowing as this inquiry was, the committee was pleased to have the opportunity to thoroughly investigate this area and to put forward recommendations that it feels will better safeguard the public while strengthening community confidence in the health care system.

Finally, the recommendations put forward by the committee should not be seen by legitimate unregistered health practitioners an as infringement of any kind. They need not fear the committee's recommendations. Rather, what has been proposed by the committee is a series of measures to reduce the likelihood of charlatans and shonks setting up practice and passing themselves off as trained health professionals.

Debate adjourned on motion of Hon. B.V. Finnigan.

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