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1 ! "#$%&!!&#&%&!"#$$%"##$$ & ' ("" 15 July 2009 Ms Katy Gallagher ACT Minister for Health Chair Australian Health Workforce Ministerial Council C/- Dear Minister This submission is being furnished on behalf of the Council of Optometry Registration Authorities Inc (CORA). CORA would like to congratulate the Ministerial Council and the National Registration and Accreditation Scheme Project Team on attempting to draft such a wide sweeping legislation for all health professionals. The attached submission is offered as a constructive criticism of those aspects of The Health Practitioner Regulation National Law 2009 Bill B which CORA holds either a different philosophical approach or considers to be impractical in the manner and style in which the provisions are presently framed. There were some policy directions with which CORA expressed strong disapproval on the grounds that if included in national legislation, would potentially compromise the health and safety of the Australian public. Specifically, I refer to Clause 136 on the restrictions on prescription of optical appliances. The proposal to extend prescribing rights to orthoptists, yet exempt them statutory regulation, runs contrary to the due process registration and accreditation objectives expressed within the Intergovernmental Agreement. CORA appreciates having been given an opportunity to lodge this submission. Yours faithfully Dr Mark Feltham President CORA Inc '()' *'+,'--'. /'012 '--'+3

2 GENERAL COMMENTS 1. This submission arises out of a meeting of the above Council (CORA) and represents the majority opinion in each instance. Most optometrist registration boards are putting forward their own submissions, some being formulated after meetings with their Minister subsequent to the CORA meeting. These boards may argue issues which are an extension of comments in this document but time constraints meant that this new knowledge was not able to be put to a further meeting of CORA. 2. The specified time lines are very rigid throughout the document. Past experience shows that it would be very difficult for present Boards to carry out the functions required within these time constraints. Ensuring public safety could be compromised if timelines are too short. 3. In discussions with Health Department officers in the various jurisdictions regarding national registration and accreditation, there appear to be many issues where those departments are not making decisions while they await the drafts of national legislation. After the publication of the exposure draft of Bill B it would seem that there are issues for optometry, and probably other professions, which are not covered in the draft. The issues which CORA has identified as being absent from Bill B and which may well be included are: a. uniform schedules of drugs and poisons by optometrists prescribing across Australia b. the supply of optical appliances. (see s.136 below) c. uniform elements for the prescription of optical appliances It is hoped that issues such as these are to be included in Bill C or Regulations. 4. It would be regrettable if there is national registration but many slightly differing jurisdictional legislations regulating a health professional s behaviour when AHMAC has already agreed on various issues which are not included in the draft. Perhaps these will also be covered by Bill C or Regulations. Page 2 of 6

3 SPECIFIC COMMENTS s. 66 (1) Accreditation period Whereas the time period for general registration is set down as not more than twelve months (s. 64), there is no time period for accreditation of programs of study. This could lead on the one hand to open-ended accreditation resulting in non-incorporation of new knowledge, or on the other, to short periods of accreditation which would be onerous on the teaching institution. CORA recommends that a maximum time be set for re-accreditation. s.73 Professional indemnity insurance arrangements Existing professional indemnity insurance policies may not coincide with registration periods under the new legislation. CORA recommends an amendment to provide discretionary power to the Board to allow for transitional arrangements to be made. s Period of limited registration This clause will prohibit the registration of academics for longer than two years and will result in difficulties in the recruitment of overseas academics. CORA recommends that the time restriction be removed s. 96 (2) CrimTrac CORA recommends that allowance is made in the wording of this section to allow for alternate organisations and/or successors to be added to cover the event that CrimTrac ceases to operate. s. 97 (1) (a) (i) - Qualifications of new graduates Technically, successful completion a course of study does not constitute a qualification until the qualification is granted by the teaching institution, often at a graduation ceremony some time later. This time lapse has caused difficulties with at least one Board difficulties in granting initial registration in the past. CORA suggests that evidence of successful completion of a course of study in the form of a transcript of examination results or some other notification from the teaching institution would be sufficient. Page 3 of 6

4 s. 97 (1) (c) - Recency of practice The onus of proof should be on the applicant rather than the Board. CORA recommends that the wording of this section be changed so that the applicant provides this proof. The three year time-frame seems to be too limiting. CORA recommends the maximum time be extended substantially to allow for family leave and registrants returning after overseas study. s Conditions of registration CORA recommends that the word requirements should be substituted for the word conditions. s Restrictions on prescribing of optical appliances CORA is very concerned that not only should the prescribing of optical appliances be restricted, but so should the supply of optical appliances. Supply should only be on a valid prescription which must include, amongst other things, an expiry date. CORA recommends that national legislation should state that a valid prescription with an expiry date and written by a registered practitioner should be required before optical appliances are supplied. s prescribing contact lenses The supply of contact lenses by non-registered persons has been a major health concern, especially in relation to commercial sale of cosmetic contact lenses, which has led to loss of sight. Present South Australian and Tasmanian legislation restricts the supply of contact lenses to registered persons. CORA recommends that not only the prescribing of contact lenses be restricted but very strongly recommends that the supply of contact lenses be only on prescription with an expiry date and written by registered practitioners. s.136 Optometry Service Providers CORA recommends that the national legislation follow the South Australian legislation in stating that Optometry Service Providers also be regarded as natural persons so they can be covered by the legislation. Page 4 of 6

5 s.136 (1) (b) prescribing of spectacles by an orthoptist CORA would like to point out that orthoptists are mentioned in present Optometrists Acts in only three jurisdictions in Australia. CORA is concerned that the registering body for orthoptists is a private company which does not have any statements concerning public safety, public accountability, recency of practice, or code of conduct. The draft of Bill B also contains no Professional Indemnity Insurance provision for orthoptists, a requirement which is placed on every other individual covered by this draft Bill. CORA recommends that orthoptists be required to have Public Indemnity Insurance. There is concern that independent orthoptists be allowed to prescribe spectacles in a public facility and that their standard of prescribing may well be less than that by optometrists. CORA recommends that paragraph s.136 (1) (b) (i) and s.136 (1) (b) (ii) be joined by and rather than or. In the interest of public safety, CORA believes that orthoptists should only be able to prescribe spectacles after a patient has had an ocular health examination by an optometrist or ophthalmologist within the previous 6 months. This is a requirement in NSW Public Health (General) Regulation 2002 (Reg 20C). CORA recommends that s.136 (1) (b) (ii) end with and rather than or, and that s.136 (1) (b) (iii) be added which states, within 6 months of an ocular health examination conducted by an optometrist or a registered medical practitioner practising as an ophthalmologist. In the interests of public safety and accountability, CORA believes that a referral to an orthoptist needs to be written. Likewise, CORA believes that the term medical practitioner is too broad a term. CORA recommends that s.136 (1) (b) (ii) be replaced with under the supervision of, or on written referral from, a person registered in the optometry profession a registered medical practitioner acting as an ophthalmologist. s.136 (1) (c) prescribing by students There are concerns about the inexperience of students in prescribing. Registration and prescribing are two different issues. CORA recommends either that this section be deleted, or the words, signed off by a registered optometrist be added after appliance. Page 5 of 6

6 B s. 138 (b) - Certificate of Registration vs. Current Practicing Certificate The issuing of a new certificate of registration each year is costly. CORA recommends that only one Certificate of Registration be issued and that the current practice of Boards supplying an Annual Practicing Certificate for renewals of registration be utilized. s How a complaint is made Although verbal complaints should be able to be made, they should always be followed up with a written complaint to promote accuracy, transparency and accountability, and to lessen vexatious complaints. CORA recommends that verbal complaints always be followed up with a written and signed complaint with the complainant being given help as required. s. 155 (1) (d) - Impairment CORA is of the opinion that impairment is not a ground for complaint and this section should be deleted and impairment should be placed in a more suitable location e.g. in Section 3. s National Board to give notice of receipt of complaint CORA believes that this whole section requires a complete rewording because it seems to be impractical, unfair and convoluted. CORA supports the NSW Optometry Board s submission on this section. s.168 (6) (a) re-instatement of a suspended registrant In Victoria there was a case where there were grounds for a registered optometrist to be suspended immediately suspended, but the optometrist then produced evidence and asked for, and was granted, immediate reinstatement to the register. This section does not seem to allow the Board any flexibility to lift suspension in under three months if it is requested by the suspended person and subsequently found to be warranted. The suspended person is therefore placed at a considerable financial disadvantage. CORA recommends that the phrase or otherwise varied by the Board from time to time be added. Page 6 of 6

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