• PO Box 250, Corinda QLD 4075

2017 ASM: College Speakers

Roy Beran

Prof. Roy Beran

ACLM Council Member | Consultant Neurologist | 
Conjoint Associate Professor of Medicine, University of NSW |
Professor, School of Medicine, Griffith University, Gold Coast QLD

Abstract

Clinical Trials in Private Practice

Clinical trials of new agents enhance treatment options. Such trials are usually conducted in large tertiary referral centres, rather than the private practice setting. This paper reports the experiences of a private outpatient neurological clinic, which conducts such trials as part of its commitment to improve patient care.

Trials conducted in private practice give those patients access to novel treatments. They do not require referral to a tertiary institution, thereby maintaining continuity of care. The recruitment base is broader and may better reflect ‘real world’ practice.

The private practice setting generates different pressures and ethical expectations. This paper discusses these demands and how they are addressed and offers concepts which should be transposable and transportable to other private clinics and clinical environments. This should allow clinicians to offer their patients additional options and contribute to greater satisfaction by ensuring that those doctors remain at the forefront of therapeutics.

Biography

Roy is trained as a consultant neurologist and accredited sleep physician, in addition to working within legal medicine and aviation medicine. He is a Professor in the School of Medicine at Griffith University, Queensland, and Conjoint Associate Professor of Medicine at the University of New South Wales. He is a founding Fellow of the Australasian College of Legal Medicine, a Past President of the College, having stepped down in 2011, and is the Australian Governor and Secretary General of the Board of Governors of the World Association for Medical Law and an Honorary Fellow of the Faculty of Forensic & Legal Medicine of the Royal College of Physicians (London).

MBBS, MD, FRACP, FRACGP, Grad. Dip. Tertiary Ed., Grad. Dip. Further Ed., FAFPHM, FACLM, FRCP, FACBS, B Leg. S, MHL and FFFLM (Hon)

mike-oconnor-2

Prof. Mike O’Connor

ACLM Council Member | Chair Obstetrics & Gynaecology, School Of Medicine
Western Sydney University

Abstract

“Going to Grass” in Pregnancy

In the United States the use of marijuana for the control of nausea has been legalised in 29 States and Washington DC. One consequence of that is the increasing use of cannabis to control hyperemesis gravidarum especially in the first trimester of pregnancy.

Although deemed by many as harmless in terms of adverse fetal effects there is evidence that the use of marijuana in pregnancy is associated with maternal anaemia, low fetal birthweights and an increased risk of neonatal intensive care requirements. In the longer term there is evidence that cognitive function in the offspring is impaired: in particular reduced attention span, poorer visual memory and reduced impulse control. These may impact on a child’s learning and behaviour during school years.

In Australia we are facing a growing demand for medical marijuana to be legalised nationwide. The Federal Government has already enacted enabling legislation for chronically and seriously ill patients to access marijuana for the control of pain and nausea from chemotherapy [Narcotics Drugs Amendment Act 2016 (C’th)]. Children with drug-resistant epilepsy may also be eligible e.g. Access to Medicinal Cannabis Act 2016 (Vic) Victoria. This will require a doctor’s certificate as well as an import licence from the Therapeutic Goods Administration (where the drug is provided by overseas manufacturers).Local cultivation will also be facilitated by amendments to the Narcotics Drugs Act 1967 (C’th).

In NSW marijuana will only available for ‘end of life’ adult patients whereas in Queensland there will be no age restrictions but a doctor will need to certify its beneficial properties for conditions such as multiple sclerosis epilepsy, cancer and HIV/AIDS (Public Health (Medicinal Cannabis) Act 2016 (Qld). In Western Australia MM has been available from pharmacies under strict condition since November 2016.

If Australia follows in the wake of the US then it is possible that we will see the widespread use of cannabis as an anti-nauseant for pregnancy. The fetal consequences of that might be regrettable.

Biography

Mike O’Connor is Professor of O&G at Western Sydney University and a Visiting Obstetrician & Gynaecologist at The St George Hospital, Kogarah, and St George Private Hospital, where he is Chairman of the Patient Care and Clinical Review Committee. He is a Conjoint Senior Lecturer at UNSW in the Division of Women’s and Children’s Health and Lecturer at Sydney University.

From 1981-1983 he was Medical Superintendent at the Women’s Hospital (Crown St.) in Sydney.

For 6 years Mike O’Connor was a Federal Councillor of the Royal Australian & New Zealand College of Obstetricians & Gynaecologists, representing NSW and served as Vice President of the College from 2002-2004. His College work included the development of an Indigenous Health Worker training program in antenatal care, adult and neonatal resuscitation courses as well as courses on the management of sexual assault He established the Chapter of Military O&G in the RANZCOG and is its Chairman.

Mike O’Connor was awarded the Gold Medal of the RCOG at the MRCOG exams in 1975 and in 1982 he was awarded the degree of Doctor of Medicine (Sydney University).He holds Diplomas in Diagnostic Ultrasound & Child Health .He is an active member of the ACLM, the ASCCP and the ASUM. He has a Master’s degree in Health Law from Sydney University and a Master’s degree in Forensic Medicine from Monash University. In 2009 he was created a Member of the Order of Australia in recognition of his longstanding work in Indigenous Health.

Sandra Johnson

Dr Sandra Johnson

ACLM Vice President Academic, Consultant Developmental Paediatrician

Abstract

Ethics of Therapeutics in Paediatrics

Paediatric practice demands that therapy, treatment and intervention performed in children be done in the best interests of the child. The discipline aims to provide a high standard of care that is child-centred and that takes the mental, social, emotional and physical needs of the child into account. Clear communication using child-specific language that is appropriate to the child’s developmental level of understanding is essential when instituting therapy and treatment. Paediatricians have a prime responsibility to promote and protect the well-being of children. This presentation will focus on ethical considerations when new drugs and therapies are being considered for use in children and when research is being done with children.

Biography

Dr Sandra Johnson is a developmental paediatrician who has been in private practice in Sydney for the past 26 years. She has been working in the field of Paediatrics since 1983 having worked the prior 3 years in general practice and adult Medicine. She is a Clinical Associate Professor in the Discipline of Paediatrics and Child Health of the University of Sydney Medical School and has held a clinical academic title since 1996. She did her training in Paediatrics at teaching hospitals in Cape Town, London, Toronto, Boston and Sydney. She is a Fellow of the Royal Australasian College of Physicians (FRACP), Fellow of the Royal College of Paediatrics and Child Health (FRCPCH) and Fellow of the Australasian College of Legal Medicine (FACLM). She has been a member of ACLM since 1997, was secretary for Council of ACLM from 2009-2013 and is currently VP Academic for the College. She has been a Council member for the Division of Paediatrics and Child Health of the Royal Australasian College of Physicians and she is a member of the University of Sydney Forensic Medicine Network. Sandra is the main author of “A clinical handbook on child development paediatrics” written for doctors and allied health professionals; she is the publisher and author of a book for parents “Your child’s development”; she has written a chapter in “Legal Medicine” (Editor:Beran) and she has written several peer reviewed journal articles. She enjoys writing and teaching topics related to paediatrics and legal medicine.

Donal Buchanan

Dr Donal Buchanan

ACLM President | Forensic Physician and Legal Practitioner

Abstract

Opiate Prescribing and Real Time Reporting

In recent years there has been a significant increase in the therapeutic use of orally ingested, longer acting opioids in many developed countries, including Australia. These longer acting and sustained release preparations result in less fluctuation of blood concentrations, leading to better control of chronic pain. A role that has emerged for these opioid preparations is the treatment of chronic non-malignant pain. In the USA, 95% of these preparations are prescribed for this purpose. A strong correlation exists between the extent of misuse of opioid medications and their licit availability. One such manifestation is ‘prescription shopping.’ Real time electronic monitoring and reporting of opioid prescriptions dispensed is an important tool to assist prescribers and pharmacists to meet their professional and legal obligations by providing real time information regarding a patient’s prescription history. This paper will review four cases where real time opioid prescription monitoring would have assisted in the effective management these patients’ chronic non-malignant pain.

Biography

Dr Don Buchanan has been a full time forensic medical officer in Queensland for 26 years, during which time he was director of state government medical officer services for 7 years. His duties have included the examination of sexual assault complainants, examination of deceased persons at death scenes, examination of drivers adversely affected by drugs or alcohol, advice to the coroner concerning the medial aspects of reportable deaths, forensic interpretation of injuries and the provision of medical services to sick and injured prisoners. He has given evidence in the various courts of Queensland and elsewhere on almost all aspects of clinical forensic medicine. He was educated at The Southport School and obtained his medical degree at the University of Queensland. He is a Fellow of the Australian College of General Practitioners and a Fellow of the Australasian College of Biomedical Scientists. He is also a Fellow of the Australasian College of Legal Medicine and is currently President of the College. He obtained a Master of Public Health from the University of Queensland in 1996. Dr Buchanan was awarded a Juris Doctor (a graduate law degree) from the University of Queensland in 2003 and admitted as a legal practitioner in the Supreme Court of Queensland in 2004. He is registered as a barrister through the Bar Association of Queensland. He has also completed a Master of Laws (Health Law) from the Queensland University of Technology. He has been a member of the Army Reserve since 1988 and has had two tours of duty to Afghanistan. He enjoys study and research, family, cycling and travel.

erwin_loh

Prof. Erwin Loh

Co-presented by Dr Jessica Dean

ACLM Vice President Administration | Chief Medical Officer, Monash Health | Clinical Professor, Monash University

Abstract

Pharmaceutical industry presence in health services – more than just free pens

Despite recent changes in attitudes, most hospitals continue to experience pharmaceutical industry presence. Despite evidence to the contrary, doctors believe they are able to effectively manage pharmaceutical sales representative interactions such that their own prescribing is not adversely impacted. Doctors also share a belief that small gifts and benefits are harmless. There may be significant financial burden associated with divestment of such sponsorship by hospitals. Change requires education and effective policies to manage industry relationships and conflicts of interest. Health services need to be proactive in transitioning financial and cultural reliance on industry sponsorship to other potentially less harmful sources.

Biography

Professor Erwin Loh is Chief Medical Officer at Monash Health, Victoria’s largest health service. In this role, he has executive accountability for the professional governance of over 2,000 doctors, which includes the medical workforce and education, research governance across clinical and translational research, and the implementation of the electronic medical record. Prior to this he was the Deputy Chief Medical Officer at the Peter MacCallum Cancer Centre. Before that he worked full-time as a lawyer at Sparke Helmore, and has trained in psychiatry. He has a medical degree from the University of Melbourne, and a law degree with honours from Monash University. He also has an MBA, a Master of Health Service Management, and a PhD with his thesis examining doctors in senior hospital management. He is Fellow of the Royal Australasian College of Medical Administrators, Australasian College of Health Service Management, Australian Institute of Company Directors and Australasian College of Legal Medicine. He is an alumnus of the Williamson Community Leadership Program, the Department of Health Executive LINK program, and the Institute of Healthcare Improvement Executive Healthcare Improvement Academy, and is a Lean Six Sigma Certified Lean Champion. He has been Board Director of the Australian Medical Association (Victoria), Law Institute of Victoria, Royal Australasian College of Medical Administrators, and is a current Board Director and Vice President of the Australasian College of Legal Medicine. He is an adjunct Clinical Professor at Monash University where he teaches health law and health services management, and is involved in research exploring medical leadership and health services management. He is a member of the Consultative Council for Clinical Trials Research and is also Jurisdictional Coordinator of Training for the Royal Australasian College of Administrators training program in Victoria. He has been an invited speaker of local and international conferences, published articles and book chapters on health law and medical management, and supervises doctoral students.

Alexander Holden-web

Dr Alexander Holden

MACLM | Lecturer in Dental Ethics, Law and Professionalism, School of Dentistry, The University of Sydney

Abstract

Tooth Whitening

Tooth whitening or bleaching is a divisive and controversial intervention with regards to professional remit and scope of practice. The dental profession is of the belief that the intervention is a professional procedure whilst non-qualified practitioners feel it is a legitimate addition to a cosmetic, beautifying armamentarium. This presentation will begin by considering and contrasting the differing legislative pharmaceutical  frameworks relating to tooth whitening/bleaching  within the jurisdictions of the United Kingdom, Australia and New Zealand. The consequences of these differing positions on dentistry’s professionalism and the social contract will then be examined.

Biography

Dr Alexander Holden is a lecturer in dental ethics, law and professionalism at the University of Sydney. Having qualified in dentistry at the University of Sheffield in the UK, Alexander gained masters degrees in law and dental public health whilst working in private and public clinical practice. He has extensive experience acting as a dental expert in clinical negligence and personal injury claims and publishes regularly on the subject of ethics and law in dentistry. Alexander also holds membership to the University of Sydney Human Research Ethics Committee and is an honorary associate with the University of Sydney’s Centre for Values, Ethics and Law in Medicine.

BDS MDPH LLM MJDF RCS (Eng) MACLM

Maria Dudycz-web

Dr Maria Dudycz

FACLM

Abstract

The Law and Ethics of Sterilisation of Disabled Persons: Challenges in Adopting a Therapeutic Approach Consistent with Human Rights Legislation

In the early 20th Century and underlying some thinking today is the Eugenics programs to forcibly sterilise “undesirable” populations. Shifting views to enshrine international Human Rights treaties, supporting the protection of disabled persons from inappropriate medical treatment, into Australian legislation, has seen a prohibition on sterilisation of disabled persons unless it is in their “best interests”; essentially for therapeutic purposes. In Victoria, sterilisation only occurs with the authority of VCAT. However, ethical challenges arise regarding what amounts to “best interest”. While therapeutic reasons for sterilisation should be the paramount consideration enabling disabled persons to receive equal treatment to all others in society, applications pursuant to the Guardianship Act 1986 (Vic) often arise from carers for convenience in managing menstrual cycles, to prevent pregnancy, to prevent sexual assault etc. Does the persistence of historical eugenic thinking permeate ongoing applications and “ethical” decision making to sterilise disabled persons in Australia?

Biography

Dr Dudycz has a long standing history with the College, becoming a Fellow in 1998, then soon after Chairing the Victorian Division of the College until 2003, serving a term on Council in 1999 and lecturing on the Expert Witness Training Program. Dr Dudycz has both an MBBS (hons) and LLB (hons) from the University of Melbourne and has worked for 15 years as a Senior Member of the Victorian Civil and Administrative Tribunal.

MB BS(Hons), LL.B(Hons), FACLM

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