8th International Conference on Medical Regulation

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8th International Conference on Medical Regulation

• Fitness to practice investigations a Block
  towards Professionalism
• Dr P S Makurira

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Overview

• Introduction
• Medical Professionalism
• Situation analysis
• Fitness to practice, Zimbabwe model,
• investigations
• health committee
• preliminary inquiries committee
• Education committee
• practice control committee,
• Challenges
• Conclusion

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Introduction

• The Medical and Dental Practitioners Council of
  Zimbabwe(MDPCZ) is mandated by an Act of
  Parliament(Health Professions Act Chapter 27.19)
  to register and regulate the medical and dental
  professions with the primary aim of enhancing the
  health of the population of Zimbabwe.
• MDPCZ operates through its standing committees
  namely Practice Control Education and Liaison
  Preliminary Inquiries Health and the Executive
  Committee

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Situation Analysis

• High inflation, weak currency, reduced earnings,
  high unemployment, reduced purchasing power
  parity
• High emigration of doctors, severe local human
  resource shortages, long working hours
• Unavailability of drugs and sundries, the HIV and
  AIDS challenge, drought and food shortages

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Situation analysis(cont)

• Determined and resilient professionals upholding
  the healthcare system to best ability
• Then September 15th 2008, a historic agreement,
  a brighter future with reversal of above
  anticipated

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Medical Professionalism

• Central to practice of medicine, unwritten
  contract with society
• Demands that patient interests be above those of
  the physician by setting and maintaining
  standards of competence and integrity and
  providing expert advice to society on
  health(International Medical Professionalism
  Project)

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Medical Professionalism

• MDPCZ core values are ethics, justice, continuous
  quality improvement and professionalism
• Translation of these values into practice is the
  challenge
• MDPCZ adopted(with the kind permission of the
  GMC) and adapted the GMC ethical guidelines

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Fitness to Practice

• Section 94 of the Health Professions Act(HPA)
  Chapter 27.19, defines an unfit practitioner as
• someone whose physical and mental health is not
  satisfactory
• the fact that he is not of good character and
  reputation
• the fact that his conduct in relation to his
  profession has at sometime been improper or
  disgraceful

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Fitness to practice(cont)

• Further, section 130 of HPA states -
• unfit to purchase, acquire, keep, use, prescribe,
  order, supply or possess any medicine
• been using a medicine or drug in contravention of
  any lawful enactment
• become addicted to or dependent upon the use of
  any medicine or drug

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1. Definition of Impairment

• An impaired physician is a doctor with a
  physical, mental or behavioural disorder that
  interferes with his ability to engage safely in
  professional activities(Association of Medical
  Councils of Africa-AMCOA).

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Investigations

• MDPCZ has a holistic approach to fitness to
  practice investigations premised on the
  interlinkages between the functions of the
  various committees
• Investigations are initiated on the basis of
  complaints or reports made to Council from any
  source public, press, colleagues ,etc

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Investigations(cont)

• Complaints with respect to failure to uphold
  ethical guidelines are referred to the
  Preliminary Inquiries Committee
• Concerns with respect to mental or physical
  health are referred to the Health Committee

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Investigations(cont)

• Statutory Instrument 93 of 1993 imposes a
  requirement on all health care professionals to
  report to MDPCZ any colleague who is allegedly
  impaired.

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Health Committee

• Investigates all cases of practitioners with
  physical or mental illness and evaluates their
  suitability to practice
• Major aim is to rehabilitate
• Specialised, experienced, multidisciplinary
  team invites different experts as necessary

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Health committee(cont)

• Commitment and dedication by the profession is
  humbling
• Makes recommendation to Practice Control
  Committee
• Surveillance is carried out till the committee is
  satisfied on the rehabilitation of the
  practitioner

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Referrals Jan-Aug 2008N42
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Preliminary Inquiries

• The Preliminary Inquiries Committee (PIC) will
  investigate all cases referred to it
• Composed of all specialities
• Has legal access to all documents and persons
  relevant to the enquiry

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Preliminary Inquiries

• Challenge with respect to a small community of
  practitioners who know each other
• Issues with respect to costs
• Refers appropriate cases to the executive
  committee for possible disciplinary action

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Interlinkages
COMPLAINT Public, patients, practitioners PCC
Executive Review of PIC reports
PIC Review of evidence, interviews, decision
reject or refer to EC,HC
Disciplinary Guilty or not guilty
Health committee
PCC
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Education and Liaison

• Primarily involved in validating foreign
  qualifications
• Considering the introduction of examinations for
  some foreign qualified doctors
• Continuous professional development(CPD) a
  regulatory requirement for licence to practice

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Practice Control

• Issues licenses for practice in Zimbabwe
• Reviews the scope of practice and determines the
  appropriate level
• May impose conditions e.g. to work in a group
  practice or under supervision in a designated
  health institution

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Challenges

• Poor reporting of errant and impaired
  practitioners
• Limitations with respect to ability to carry out
  various tests to detect and monitor illicit drug
  use
• Limited cooperation from some jurisdictions with
  respect to information exchange on errant
  practitioners

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Conclusion

• Zimbabwe has an integrated fitness to practice
  investigation system which relies on information
  and complaints from the public, patients, peers,
  the press and other sources.
• Its success is thanks to the incredible
  commitment by all levels of the profession
• The legal framework is very supportive and the
  major challenge is meeting the costs of a self
  regulatory, self financing MDPCZ

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Conclusion(cont)

• AMCOA should continue to develop generic
  templates for various protocols
• Strengthen information exchange between
  jurisdictions and harmonisation at regional,
  continental and global levels, the role of IAMRA,
  AMCOA and others
• Legal frameworks that have comparable generic
  elements

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References

• Health Professions Act Chapter 27.19
• Medical and Dental Practitioners Council of
  Zimbabwe database and committee reports
• Association of Medical Councils of Africa
  (AMCOA), Impaired Practitioner Protocol

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Contact details

• psmakurira_at_yahoo.com
• Makurira Memorial Clinic
• 07 Hofmeyer Street
• Masvingo, Zimbabwe
• 263 39 263460 263 11 413 801
• Medical and Dental Practitioners Council of
  Zimbabwe
• 8 Harvey Brown Avenue, Milton Park, Harare
• Zimbabwe
• 263 4 792195

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• I THANK YOU
• SIYABONGA
• TATENDA