By Marika Sboros
The Australian Health Practitioner Regulation Agency (AHPRA) is facing mass resignations from its medical boards nationally. Like the proverbial rats leaving a sinking ship, there have been more than 90% resignations in Tasmania alone.
The only states that don’t show significant resignations are New South Wales and Queensland. Both have declined to work under AHPRA’s jurisdiction.
A deluge of resignations have followed closely in the wake of the lifetime ban the agency slapped on orthopaedic surgeon Dr Gary Fettke in 2016. AHPRA does not want Fettke telling patients with diabetes not to eat sugar. He actively promotes low-carbohydrate, healthy-fats (LCHF) diets to reduce the risk of limb amputation for diabetes.
The resignations also follow the ongoing Senate Inquiry into AHPRA’s secretive medical complaints process. The inquiry heard details of endemic bullying and harassment of doctors in Australia’s medical profession. However, it seems to be Fettke’s ban, particularly that has made so many rats abandon AHPRA’s sinking ship in one go.
AHPRA’s three-yearly call for applications to fill vacancies now shows unusually large numbers since its inception in 2010. In Victoria, Tasmania, South Australia and Western Australia, there were 38 resignations out of 55 positions. Thus, at 69%, more than two-thirds of doctors in four states have jumped ship. In Tasmania, Fettke’s home state, there were 11 out of 12 positions are now vacant. That’s a whopping 92%.
AHPRA’s high attrition rate
In New South Wales, there have been three resignations for nine places and none in Queensland. Interestingly, AHPRA Nursing Board vacancies in Tasmania show a similarly high attrition rate. There have been eight resignations out of nine positions. That makes 19 resignations out of a possible 21 of both doctors and nurses.
AHPRA downplayed the numbers in response to my questions. It would only say that vacancies “become available as part of a scheduled cycle every three years”. AHPRA has refused to comment on reasons for so many vacancies. It also wouldn’t comment on the timing of calls for applications that close on March 20 or how it distributed these to members.
(Editor’s update: AHPRA replied again on March 21, insisting that there have been no mass resignations and the numbers are “not unusual”. It also claims to have “advertised widely to attract a wide field of applicants”.)
AHPRA has refused to answer all my emailed questions related to Fettke’s case, citing privacy rules. However, AHPRA has commented publicly at length on the case, always placing him in a negative light.
Before the ban, AHPRA investigated Fettke for more than two years after a complaint from an anonymous dietitian. Fettke is, however, certain that the dietitian is a member of the self-regulated Dietitians Association of Australia (DAA).
Advice to reduce sugar, processed carbs
In her complaint to AHPRA, the dietitian objected to Fettke telling patients with diabetes to reduce sugar and processed carbohydrates. Yet that advice is now part of mainstream dietary recommendations for diabetics.
DAA itself is under intense public scrutiny for compromising links with food industries and for the advice it dishes out. As with dietitians’ associations in other countries, DAA believes that dietitians are best-placed to dish out dietary advice to the public. Also like its sister organisations, it has a special antipathy towards doctors, such as Fettke, who give dietary advice that differs from industry-led dietary guidelines.
AHPRA appears to be actively working with dietitians against Fettke. In a public statement last year, the agency also spoke of the “expectation” that all doctors would give “appropriate” dietary advice.
Click here to read: Fettke: victim of a kangaroo court? Part 1
All that has added to global outrage at its action against Fettke. Legal experts have called AHPRA’s handling of the case against Fettke Kafkaesque and a real, live kangaroo court. Claire Deeks, enrolled barrister and solicitor of the High Court of New Zealand, said that Fettke was the victim of “gross injustice”.
Fettke gave a powerful submission to the Senate Inquiry into AHPRA’s complaints processes. He described bullying and harassment he experienced from doctor colleagues. He testified about the devastating effects of AHPRA’s investigation on him professionally and personally.
His wife, Belinda, initially became his “voice” and set up an I Support Gary Fettke Facebook Page to continue his views. Fettke has since bounced back from the initial shock of the ban and has now ignored it.
Nutrition’s central role in health
However, he only did so after asking AHPRA to clarify the ban in detail. To date, AHPRA has not responded. As a result, Fettke continues to talk to patients about nutrition and to give presentations by invitation at conferences abroad.
— Alan Watson (@DietHeartNews) March 16, 2017
“If you don’t tell people that sound nutrition has a central role in their health, you are failing in your duty of care,” Fettke says.
He also says that he only ever talks to patients about the concepts of eating to prevent the worst complications of diabetes. And, of course, he only dispenses evidence-based advice. He does not give meal plans, he says. And when speaking to patients about nutrition, he usually uses the analogy of the right fuel in a vehicle’s engine.
Thus, the issue revolves around what AHPRA and Fettke consider the “right” or “appropriate” fuel.
The right fuel
“The fuel we have recommended for the past 40 years clearly isn’t working,” Fettke says. “I see patients every week who have to have bits of their anatomy amputated. I can’t wait for AHPRA to catch up with the science.”
“There is no question that your car will run more efficiently if you use the right fuel. After all, you wouldn’t put a little diesel in the petrol.”
Real food, by definition, is low-carb, healthy-fat, Fettke says. He tells patients to avoid sugar and highly processed foods and not to be afraid of healthy fats. If they need further information, he refers them to dietitians trained in optimum nutrition.
He dismisses out-of-hand the criticism of conflict of interest (COI) for referring patients to the Nutrition for Life dietitians’ clinic. He and Belinda set up the clinic in 2014 at significant personal expense: Aus$700,000.
The clinic is nothing more than the common “vertical integration”, which many doctors practise, Fettke says. For example, doctors routinely employ physiotherapists and dietitians in their own practices. They also refer to radiology and pathology services, for which they receive kickbacks.
Since he set up the clinic, Fettke has been one of 88 referring doctors, in 28 out of 1100 clients. “That’s hardly over-servicing,” he sys.
He and his wife have not profited at all from the clinic. “We are proud of the vested interest we have in our community’s health. And we receive no financial gain from this healthcare model,” Belinda told me.
Fettke remains a mentor to the dietitians, but only from an educational viewpoint, she says. As a matter of course, he has always declared his COI to patients.
Why are the rats abandoning ship right now?
Last year, Fettke attempted to resolve the impasse by meeting the Chair of AHPRA’s Medical Board, Dr Andrew Mulcahy, accompanied by Belinda. However, Mulcahy refused to allow Belinda to be present. Probably not all that surprisingly, the meeting proved fruitless.
Fettke has firm opinions on AHPRA and why the rats are abandoning the sinking ship. “Those who serve on AHPRA’s medical board have good intentions but the process is fatally flawed,” he said.
AHPRA’s website shows that board members must spend a day each month attending meetings. They must also read 1000 documents to prepare for these meetings. For that, they are paid $627 monthly.
AHPRA receives 10,000 notifications (complaints) annually, of which 53% are related to medicine. AHPRA also has 180 investigators considering complaints. Of those, 42 have some health background, 23 have nursing backgrounds and only four have some degree of medical background. The rest are community workers. That’s from a supplementary report, which AHPRA CEO Dr Martin Fletcher submitted to the Senate Inquiry last year.
Thus, investigators without legal qualifications are interpreting and implementing National Law. “Anecdotally, I think it’s fair to say that this system is fatally flawed,” Fettke says.
Heart of darkness
The Senate Inquiry has shone a light straight into the darkness of AHPRA’s secretive processes, he says. It found that these contradict all principles of natural justice.
Fettke and his wife have not referred publicly to medical board members by name. However, it’s easy enough for anyone to find the names on a public register. It is likely that these doctors are feeling increasingly uncomfortable in the Senate Inquiry’s very bright, very public spotlight.
Of course, that raises the question of why the rats are only now abandoning the sinking ship. After all, board members have participated for years in processes that Fettke says manifestly contradict principles of natural justice.
Fettke has openly stated his view of AHPRA:
“I respect the police and common law for processes which lawmakers developed over hundreds of years. They have tested these processes under natural justice.
“I don’t respect AHPRA for the exact opposite reasons.”
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