Senate Community Affairs Legislation Committee, , 21:05 to 38:26
Senators question the Professional Services Review (PSR) regarding its report drafting processes, legal staffing, and procedural fairness for medical practitioners.
Topics: Integrity, Health
Speakers: Speaker 9, Malcolm Roberts, Hon Anne Ruston, Hon Jenny McAllister, Dorinda Cox, Penny Shakespeare, Speaker 10
>> Thank you Minister. Um so just to to reiterate what I said and I will reiterate this again a million times. the coalition absolutely supports Australians getting access to timely and affordable primary health care. Um, and that that has never changed and will never change. Um, so I'm just keen to go back. All I'm trying to determine here is how you intend as a government to measure the success or failure of this 8.5 billion dollar initiative. So, Minister, maybe could you guarantee to me that the um the analysis or um that Miss Shakespeare outlined earlier in her contribution um will be completed and published and available to the Australian public prior to the next
>> I think the officials have set out the work that they intend to do. Um I don't have anything further to add to the timeline set out by Miss Shakespeare.
>> Yeah. Um, so can I just make it very very clear here, Minister, you are not prepared to put on the record today that an 8.5 billion dollar initiative um of your government that you're not prepared to guarantee that you will allow the public to see the measure of its success or failure prior to going to
yesterday the minister um put out a press release explaining the progress that has been made. I think you will see our government very regularly communicating about the progress that is being made under this initiative.
>> So I take that as a note.
>> Senator, you should not take it in that way at all. I can't be clearer. The minister speaks about this regularly. Uh data is in the public domain. uh our approach for 2030 is very clear. The uh expectations um about the policy initiatives we've adopted are in the impact analysis. Work is ongoing to deepen the way that we will evaluate the impact of this policy. Uh this is a policy we're very proud of, Senator, because Australians value Medicare. Labor built Medicare. It's our intention to strengthen it. Um, and you will continue to see this be a focus for
>> Thank you, uh, Senator Ruston. Uh, Senator PCO, uh, sorry, Senator Roberts.
>> Thank you, Chair. Could I have the professional services review scheme, >> Good morning.
>> Senator W from the Peter Professional Services
>> Thank you. At the December 2025 Senate estimates, Dr. You indicated that lawyers prepare the reports from the from the review scheme but the committee members review the reports. In what way does the PSR monitor the performance of the committee include if the committee has read the entire report and the material presented to it before signing it off?
Um, Senator, the committee diligently reads the draft reports and the final reports and we have uh staff who lies with the committee at various stages after the draft reports and the final reports have sent been sent to them. So should for any reason a committee member not do their duty and read in the draft report, the um legal officer in charge of that uh um giving service to that committee would firstly of course remind the committee members to to re review the report and if not they would then come to me but that's a theoretical possibility because I cannot recall that happening.
Okay, thank you. The PSR committee process is supposed to be a peerreview process performed by doctors. Why then don't the doctors write their own reports? If administrative support is needed, then why are lawyers drafting the reports instead of administrative or secretarial staff, which would come at a lower cost to the department? Because
the reports are incredibly important and we are passionate about according natural justice and procedural fairness to all practitioners under review. And it is my view that the best way to do that is to have the best qualified quality people writing those reports and reports of this nature would be best written by people who are very good at supporting doctors in providing their reports.
Best qualified to me would seem to be the doctors and then trimmed up or modified by the by the lawyers.
>> The lawyers are writing up what the doctors have formed a view about as part of that committee process as part of the hearing process. The concerns that they have put to the person under review the things that have come back. The lawyers are just putting it together. It is the doctor's concerns or the medical practitioners concerns. It is them who sign off on the report who approve the report. It is the peer review um committee members views.
>> Thank you. If it can be shown that a lawyer spends over 150 hours drafting a report, but a committee member only spends 7 to 10 hours reviewing the material and reading the report, is this truly considered by the PSR to be a legitimate peer review? Let's not take
into account any of the time that was spent in the hearing spent in the hearing in questioning the time that the committee members have turned to the matter throughout the process.
>> Thank you.
>> So hearing might take 8 days. It might take 50 or 60 hours. The prehering reading might take many many hours. The contemplation of what happened during the committee hearing might take the committee members many many hours to turn their mind to it.
Thank you. Over the past 3 years, as an average, what percentage of total services reviewed has the committee found the services provided by doctors to be inappropriate?
>> I'd have to take that on notice. That's
>> Thank you. This question is about general practitioners. The Royal Australian College of GPS recognizes 37 specific interest groups as sub specialties. If a GP is under review by the committee, is it correct that there is no legal requirement for the committee members to share the same subsp specialty? For example, if a GP practices solely in aerospace medicine, there's no legal requirement for the committee to have any experience in aerospace medicine because they all fall within the category of general practitioners. Why is there no sub specialty matching?
Um the subsp specialty matching is that uh the members of the committee are general practitioners but the PSR strives to uh find general practitioners who have experience in those matters. I can assure you that um some practitioners who are in craft groups that are exotic as you as you say um like myself I have particular special interests. Um we try to match those as much as we can but under the law a general practitioner can review a fellow general practitioner.
>> Okay. Thank you. Is it correct that the legislation allows just three committee members to decide what is unacceptable to the general body of general practitioners in deciding what the general body general practitioners find unacceptable? Do the committee members have to have any regard to any external resources or consideration of other doctors? Do the lawyers draft that part of the report as well about what the general body of the doctors think?
One of the things that we train committee members to do to absolutely and scrupulously give fairness to the practitioners under review is to try as much as possible to ask one question at a time to avoid the risk of the practitioner missing the opportunity to respond uh to any and all of the questions put to them. I'd be very grateful if you could just ask me the first couple and I'll go through them uh with you systematically. Is it correct
that the legislation allows just three committee members to decide what is unacceptable to the general body of practitioners?
circumstances where there could be additional panel members uh committee members appointed, but it is usually three.
>> Thank you. In deciding what the general body of general practitioners find unacceptable? Do the committee members have to have any regard to any external resources or consideration of other doctors?
>> The committee members have to regard to all the evidence before them so that they can
>> All the evidence before them. Yeah. So,
uh the committee members uh welcome from the practitioner any materials that they wish to submit as uh further evidence either before, during or after the
>> Thank you. Uh while PSR committee committees are intended to operate as expert peerreview bodies, concerns include the absence of a preciding judge, the lack of merits review, the inability to cross-examine the committee on what they believe to be the views of the general bodies, the downweing of significant evidence, limited engagement with defense submissions, and a lack of transparency. Why do PSR procedures deny these basic elements of procedural fairness and justice? And how does the PSI contend that the peerreview function is being properly exercised in their absence?
>> Could you ask those six points one at a time and I'll gladly uh respond to them.
>> they're intended to operate as expert peerreview bodies. Concerns include the absence of a presiding judge.
>> Well, um the process is a peer review process. So if somebody is trying to ask me whether I've trying to find out whether I've engaged in inappropriate practice then the best uh placed people to do that are my peers not a judge
>> and ultimately we are applying the the scheme as it is set out in the health insurance act senator. So that provides for a committee
>> that may be the problem. The lack of merits review.
>> Uh under the act there is no formal merits review. However, we try as much as we can to build fairness into this process by having multiple opportunities to respond and make submissions. Multiple opportunities.
>> The in excuse me, the inability to cross-examine the committee on what they believe to be the views of the general
bodies. The committee is there to make uh uh to ask questions and find out if the practitioner under review has engaged in inappropriate practice. It's not the committee that that is under review.
>> But the person under review can put forward their um information when they're answering the questions and the information that they would like the committee to consider and that will occur as part of the process.
>> The downweing of significant evidence.
>> What do you mean by that?
>> The as I said the downing of significant >> significant evidence being put cursorally or or or downgraded.
>> What significant evidence who's who's reviewed something cursorally or downgraded? I don't understand.
>> If there is significant evidence uh put before the committee, it's downgraded >> in terms of the the verdict.
>> I don't understand what you mean by
that. >> Okay. Limited engagement with
>> Senator. I would gladly take that on notice if it's clarified for me. I I I just don't quite understand. And I'm not in any way being disrespectful.
>> Okay. I can't understand um how you can't see that but because the words seem to be self-explanatory.
>> So are you >> word are you what do you are you suggesting that during a committee process a practitioner under review gives significant evidence and the committee then downgrades or chooses to ignore it.
Is that
>> Yeah. Senator I'm not aware of that
occurring. Limited engagement with defense submissions and a and a lack of
>> Limited engagement with defense submissions. Again, Senator, um, practitioners under review can make submissions. Those submissions are welcome and they are reviewed.
>> Okay, next question.
>> Senator Roberts, can I just interrupt you for one quick second? There are media in the room and I just need to give a short statement. The media have requested permission to film and take photos of proceedings and the committee has agreed to this. I remind the media that this permission can be revoked at any time. The media must follow the direction of secretariat staff. If a witness objects to filming, the committee will consider this request. The media are also reminded that they are not able to take images of senators or witnesses documents or of the audience. Media activity may not occur during suspensions or after the adjourment of proceedings. Copies of resolution three concerning the broadcasting of committee proceedings are available from the secretariat. My apologies. Um,
>> thank you, chair. >> A former PSR director has been found liable in the Queensland court for misfeasants in public office for failing to perform her statutory duties. Given these matters raised, why should the PSR's legislation, governance, and current office holders not be subject to a comprehensive independent review?
Senator, we did have a comprehensive review in 2023 called the Philip Review which made findings and we have um u acted on all of those findings including the uh appointment of associate directors to the scheme.
>> The um former director was found liable for making a decision without adequately considering sub submitted materials. Isn't that exactly what's still
No, Senator, we don't consider that to be happening. Sorry. >> No, Senator, we do not consider that to be happening.
>> You don't? Okay. What percentage of the department's budget is spent on the committee review process and how many cases per year go through a committee
>> I can't tell you the exact amount that
>> I can use chat GPT to answer that.
You'll have Richard McKenzie after
>> It might save us all a bit of time.
>> only if it's in super rational mode because other than that it just filled us garbage. So what percent? Can you take that on
>> hallucinate from time?
>> Um so
>> you have to be careful. >> It hallucinates from time to time. You have to be careful.
I woke up this morning, chat told me I was going to have a stress-free day. So, I think it was hallucinating. Um, I can't tell you exactly what percentage uh without notice of the budget is spent on committee hearings, but we can't take that on notice and give you an accurate reading. >> Thank you. >> The second part of your question was
>> how many cases per year go through a
year to year but it's approx we get approximately 100 to 120 cases per year referred to from uh Medicare which in turn represents about 30% of the cases that Medicare reviews and of those cases uh ballpark figure we approximately 10% get uh no further action under section 91 about 80% get an agree agreement with the director or the associate director under a section 92 and about 10% get referred to a committee. So maybe maybe 10 practitioners get referred to a
committee in a year. Thank you. And I need to put on the record that we're not debating whether or not the PSR should be there. The processes which I now understand are legislated. That's what the problem is for us. Uh and doctors very concerning. As a question, last question, chair. As a question on notice, please table a log of the hours spent on each of the draft and final reports by the PSR staff combined and each of the committee members for the last three years of PSR committee matters. It's expected that this log will table around 60 rows for each of the cases reviewed over that period.
>> Thank you notice.
>> Thank you very much for appearing. See you next time.
>> Thank you, Senator.
>> Thanks, Chair. Senator Roberts, um we'd all be interested in what Chat GBT had to say about those answers. Um we are now in a position to release um a couple of witnesses, the Australian Digital Health Agency and Professional Services Review. Uh thank you for coming to estimates and I'll hand the call over to Senator PCO.