Michelle Lensink

Physiotherapy Practice Bill

The Hon. J.M.A. LENSINK: It gives me great pleasure to speak on the second reading. At the outset, I declare an interest, as I am a registered physiotherapist, even though I no longer practise. (Tuesday, 24 May 2005)

The Hon. J.M.A. LENSINK: It gives me great pleasure to speak on the second reading. At the outset, I declare an interest, as I am a registered physiotherapist, even though I no longer practise. This is one of a tranche of bills in response to national competition policy and the fulfilment of agreements. I understand that it has been under review for some time. In following the debate in the other place, and particularly the reports from the government that accompany it, I am beginning to find the parroting of particular phrases a little tedious, as the government keeps stating that it is about more transparent mechanisms and the protection of the public, almost in some way implying that consumers need to have very strong measures to protect them from professionals.

As I stated in my speech in respect of the podiatrists bill, it is hammered into all students from day one that, when they lay their hands on and provide treatment to clients, they need to be very cautious about what they do and that they need to bear that in mind at all times. I want to put that point on the record, because the professional schools at the universities do a very good job of informing all students of their responsibilities. Indeed, I believe that all professions, bar a few recalcitrants, also bear that in mind at all times, and they provide a great service to the people of this state.

I will not go through all the provisions, because they are all pretty much identical. However, I make the point that I do not believe that it is necessarily a good thing that bills relating to professionals are identical in almost every way. Indeed, the government got itself into quite a bit of hot water a couple of years ago when it proposed that all the professions should be rolled into the same act. As I said at that time, as a physiotherapist I would not know what a podiatrist does on a day-to-day basis, and I am sure that the reverse would be true in that a podiatrist would not know what a physiotherapist does on a day-to-day basis. Therefore, they would not be in a position to judge whether or not their practice was appropriate.I have been in email contact with both the chair of the Physiotherapist Registration Board, Emeritus Professor Ruth Grant, and the President of the Physiotherapy Association, Ms Jo Bills, and I am very grateful for the advice and information they have provided to me in my coming to a landing on different aspects of the bill.

A number of outstanding issues have been referred to in the debate, and in particular by the Hon. Dean Brown, our shadow health spokesperson, which I will run through. First and foremost, the amendment which was lost in the Assembly would have increased the representation on the board to provide physiotherapists with a majority. I filed those amendments this afternoon. I checked whether the govern¬ment had similar amendments on file, as I had been advised that the government intended to do so, but I could not find them in my folder. It remains to be seen whether the govern¬ment has identical amendments on file.

In response to my email in relation to this issue, the chair of the board, Professor Ruth Grant, said:

It has been a cause of real concern to the Board, and if not addressed will mean that this will be the only Physiotherapists Board in Australia not to have a majority of physiotherapists on it. The Board has been informed that it is now the Government's intention to put an amendment to the Legislative Council to right this matter.

The APA (Australian Physiotherapists Association) had an identical view. There is also an outstanding issue about mutual recognition. I would have thought that that would be a natural thing to be examined in a bill which is triggered by the competition rules in that physios who, for instance, travel with teams into South Australia but are not registered here but are registered in their own jurisdiction should be allowed to practise without having to go through the onerous task of re-registering in South Australia—that may apply to sporting teams, dance groups and so forth. Can the government advise the opposition of what action it is taking in that direction? It has been suggested that this issue will be addressed in the regulations. The groups with whom I have spoken accept that it may well be addressed in the regulations, but they would in some ways prefer it to be addressed in the act. So, I would like some clear indication from the government as to exactly where that situation is at, otherwise I will move the opposition's amendment in relation to that issue.

A related issue about which the board and the association did not take the same position was that the association believes that the word `education' should be included within the definition of physiotherapy. In fact, the board stated:

The Board considers this to be adequately covered by the interpretation/definition of physiotherapy in the Bill. The Board has always seen physiotherapy as encompassing practice, teaching and learning, research and management, with careers in each of these or a combination of them sitting within the definition.

The physio association takes a slightly different view in that it is concerned that, for instance, someone who is involved in education (that is, the teaching of other physio students or physio graduates) may be disadvantaged in relation to the understanding of whether they have actually practised and will be forced to requalify after five years if they do not perform what we call `hands on' work. Again, I ask the government whether it could examine that issue for us and provide a commitment that physios who might be involved in teaching but do not have their own clients will not be disadvantaged because of some sort of misunderstanding that these issues are not inextricably linked.

Further, the question was raised about visiting lecturers and whether, if they come to South Australia to provide workshops and so on, which may include a clinical component, they will be covered under the government's draft. I under¬stand that this is to go into the regulations.

The issue of registration of students is well understood as being a standard part of the need to protect clients. Another issue raised was in relation to section 36 in respect of limited practice. The profession has good reason to be concerned that this may be misused in situations of work force shortages. In all health professions we are facing work force shortages. Presently a lot of students do not practice in South Australia, which has changed from when I graduated, because the vast majority stayed in South Australia and then may have travelled overseas after a couple of years experience but then came back. I understand now that more than 50 per cent leave South Australia on graduation.

We have a problem in this state of which we need to be mindful. It has been suggested that this clause may be put to use only in cases such as on the Pitjantjatjara lands where, if there is no physiotherapy practising, a physio trains someone else. The profession is very concerned and would like an assurance, which I now seek from the government, that this clause will only ever be activated under extenuating circum¬stances. The physio association wrote to the government on 1 September last year, as follows:

The removal of restrictions on practice raises concerns about the opportunity for unqualified persons to provide therapy or services that might present a danger to consumers. For example, in the interest of public safety the use of electromedical equipment should be restricted to properly trained and qualified registered health professionals bound by at least a code of conduct and preferably by an act of parliament. The Australian Physiotherapy Association has found it necessary to approve formal guidelines for `the clinical use of electrophysical agents' to guide physiotherapists in their effective use and to ensure the safety of consumers'.

There is a further issue of concern that the profession would like to clarify, which again comes under the protection of clients. Some people may have had cause to have physiother¬apy treatment at some stage, and it is part of our practice and part of the undergraduate training in South Australia to perform spinal manipulations. We were warned that there is a one in a million chance (or similar odds) of actually killing somebody by rupturing their vertebral artery, and in our early days it was something that we performed very gingerly. In these days of litigation and insurance problems, the profession has suggested that perhaps some form of declaration might be required so that, if a practitioner's insurance does not cover cerebral vertebral manipulation, it would at least send a flag to the board to alert it to the fact that it might be an issue. I would like a comment from the government in that regard. If, as it says, this is there to protect clients from any untoward practice that may take place, that is a very important issue.

We have seen in the legislation in relation to insurance claims that have come out that they are looking at profession¬al guidelines and so forth, and this may well become quite an important issue in the future. I am not aware of any claims, but it is wise to look at this before the horse bolts, so to speak. With those comments I will seek some response from the government in committee. If I do not see those amend¬ments to the board composition, I will certainly move for that to occur and will also consider moving an amendment that addresses the issue of mutual recognition for interstate teams and so forth unless I receive an assurance that it is being addressed.

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