Health Policy Perspective
- On January 12, 2021
- January / February 2021
Health policy perspective
Whilst the pandemic took precedence in 2020, there was a flurry of policy activity towards the end of the year and in early 2021.
AMA (NSW) has been busy formulating policy responses to a number of Government inquiries. Here is a breakdown of several health-related issues being examined in more detail by Parliamentary Committees and the AMA (NSW) response to these inquiries*.
MANDATORY DISEASE TESTING
The Standing Committee on Law and Justice in the NSW Legislative Council established an inquiry into the Mandatory Disease Testing Bill 2020 in late November.
The Bill proposes to establish a scheme whereby a person can be ordered to provide a blood sample for testing if, by deliberate action, the person’s blood has come into contact with a health, emergency and public sector worker, and the worker is at risk of contracting a blood-borne disease as a result.
The Bill would allow law enforcement officers to use ‘reasonable force’ to assist in taking blood. It also comes with a penalty of 100 units or imprisonment for 12 months (or both) for failing to comply with a mandatory testing order.
It’s not the first time AMA (NSW) has been asked to participate in policy formulation on this issue.
AMA (NSW) acknowledges that the impact of potentially serious blood borne viruses (BBVs) such as Hepatitis B, Hepatitis C and HIV continues to be an issue of public health significance. We also recognise that because such infections can be serious, emergency services personnel are deeply concerned about the risk to themselves.
However, AMA (NSW) has repeatedly stressed that the rationale for mandatory testing of people whose body fluids may come into contact with emergency or public sector workers is not evidence-based.
Clinical evidence shows that the risk of Hepatitis B, Hepatitis C and HIV transmission from a known positive source through blood and saliva to unbroken skin and skin-to-skin contact is zero.
There have been no cases of saliva being a transmission route for HIV in Australia.
We also highlight that the standard workplace procedure is to treat all blood and bodily fluids as potentially infectious.
So in circumstances where a risk assessment has determined there is a risk of transmission of BBVs, emergency services personnel would be advised to follow potential bloodborne virus exposure management protocols.
AMA (NSW) strongly supports emergency services workers have access to immediate assessment, counselling and management by a health care professional after exposure to potentially infectious bodily fluids.
Testing of the source person (whether that be mandatory or voluntary) should not change the management of a potential blood-borne virus exposure.
This is especially important given that testing for HIV and other BBVs has a window period during which an infection cannot be detected.
A negative result is not conclusive. If significant exposure such as a needle stick injury or blood splash to broken skin, mouth or eyes has occurred, it is critical that Post Exposure Prophylaxis (PEP) treatment is commenced no later than 72 hours following exposure.
Given that testing and results should not change the protocol that should be followed in cases where significant exposure has occurred, and that testing of the source person should not be considered conclusive, AMA (NSW) does not support mandatory testing as an effective, reliable and necessary legislative reform.
AMA (NSW) acknowledges the stress emergency services personnel experience following exposure to blood and bodily fluids and potential for transmission of BBVs. It is vital that emergency services personnel are given prompt assessment, counselling and management by a health care professional.
AMA (NSW) highlights that mandatory testing presents significant practical and ethical challenges.
Informed consent is part of doctors’ duty of care to patients and is necessary before performing any medical procedure. Under NSW Health’s Your Health Rights and Responsibilities, patients have the right to withhold consent.
There are other practical issues for attending health professionals should the source person not consent to testing and ‘reasonable force’ must be used – how is this applied and what risks does this pose for medical staff?
Mandatory testing also removes the source person’s autonomy over their health information. Medical professionals are very protective and vigilant about the privacy of health information of patients. Furthermore, mandatory testing contributes to the stigma and discrimination of people living with HIV, Hepatitis B and C. This has the downstream effect of limiting the ability of health services to engage people at risk or living with blood borne viruses.
Lastly, AMA (NSW) is concerned that the Bill applies to children between 14 and 18. The risk of infection from minors in this age group is extremely low – there were only three infections among children in this age group in the previous year.
Mandatory testing will not necessarily reduce stress for emergency services personnel who are exposed to a person’s blood or other bodily fluids.
Should exposure occur, emergency services personnel should follow procedures for management of a potential blood-borne virus exposure.
Based on this, AMA (NSW) does not conclude that the benefits of mandatory disease testing to emergency services personnel outweighs the extreme impact on the rights of the source person to consent to medical tests and disclosure of their health information.
CHILD PROTECTION AND SOCIAL SERVICES SYSTEM
The number of children ‘lost in the system’ is increasing year on year. In 2019, more than 77,000 children assessed by the Department of Communities and Justice to be at risk of significant harm were not followed up. That is a 41% increase from four years ago.
The Joint Committee on Children and Young People launched an inquiry into how the current child protection and social services system responds to these vulnerable children and their families.
The Committee is reviewing the respective roles and responsibilities of health, education, police, justice and social services and is assessing optimum evidence-based prevention and early intervention responses for vulnerable children and families.
The availability and adequacy of current funding for prevention and early intervention services will also be considered.
AMA (NSW) is advocating for investment in specialised training for evaluation and management when child abuse or neglect is suspected, particularly for vulnerable populations including Aboriginal and Torres Strait Islander children, children from CALD backgrounds and children with disabilities.
Cooperation and coordination between medical practitioners in different disciplines and medical practitioners and experts in other professions is important in effective prevention and management of child abuse and neglect, as such AMA (NSW) endorses an integrated strategy and response.
COERCIVE CONTROL IN DOMESTIC RELATIONSHIPS
The NSW Government established a Parliamentary Joint Select Committee to hold a public inquiry to examine coercive control.
The Discussion Paper details key issues to inform their consideration of legislative reform and what can be done to improve how the justice system addresses it.
As many frontline health workers are involved in responding to people involved in domestic and family violence, AMA (NSW) will be looking at training and service delivery in the health sector to individuals subject to coercive control and other education and awareness measures, as well as note-taking for legal purposes and the role of medical practitioners to provide documentation for criminal proceedings.
THE CRIMES LEGISLATION (OFFENCES AGAINST PREGNANT WOMEN) BILL
Premier Gladys Berejiklian and Attorney General Mark Speakman released an Exposure Draft Bill for public consultation on a suite of reforms to recognise the loss of an unborn child as a result of a third-party criminal act.
The draft bill makes good on the Premier’s pledge look at this legislation in the 2019 election campaign after abortion law reform was finalised.
AMA (NSW) will be looking at the proposed legislation in relation to issues associated with personhood.
A balance needs to be reached between protecting the rights of women and doctors and being able to hold people who would harm women to the point they lose pregnancies to account.
AMA (NSW) notes that a new bill from the Government would not be the same as previous ones introduced by Reverend Fred Nile and as such would consider it on its merits.
*Please note that at the time of writing AMA (NSW) was still finalising its submissions to these inquiries. To read our submissions in full, please follow the Parliament of NSW - https://www.parliament.nsw.gov.au/committees/inquiries/Pages/inquiries.aspx.