Although 5 years ago, it is worth re-publishing that The Hon. A. Bressington stated she had been approached by a number of constituents on WorkCover, who have been required by their case manager to appear before Dr Doron Samuell, a fly-in “independent medical examiner” from New South Wales. Each has alleged that the behaviour of Dr Samuell was intimidating and bullying, that he inappropriately filmed meetings without seeking their permission, that there was yelling and finger-pointing, and that he behaved in a threatening manner towards the injured workers.
WorkCover insurance doctors – Dr Doron Samuell
Thursday, 24 June 2010, Page 427
SAMUELL, DR D.
The Hon. A. BRESSINGTON (14:43): I seek leave to make a brief explanation before asking the Minister for Industrial Relations questions concerning WorkCover.
The Hon. A. BRESSINGTON: Over the past two weeks I have been approached by a number of constituents on WorkCover, who have been required by their case manager to appear before Dr Doron Samuell, a fly-in independent medical examiner from New South Wales. Each has alleged that the behaviour of Dr Samuell was intimidating and bullying, that he inappropriately filmed meetings without seeking their permission, that there was yelling and finger-pointing, and that he behaved in a threatening manner towards the injured workers.
Extract from National Health and Medical Records Council, guidelines for standard of conduct
*It needs to be emphasised that the issue of symptom exaggeration and malingering primarily arises in the
context of litigation, compensation claims and contested cases rather than in the course of routine clinical
practice. Even in these settings, the practitioner must retain and convey empathy for the person to avoid the
risk of compounding suffering by being interviewed in an interrogatory fashion.
One constituent, diagnosed with post-traumatic stress disorder, reports cowering in a corner as Dr Samuell hurled abuse and pushed his finger into the worker’s chest. This was reportedly in response to the injured worker taking notes during the meeting. Another said that Dr Samuell filmed the meeting without asking permission, and then proceeded to interview him as though he were before the Gestapo. The wife of another injured worker, who attended the assessment, reports that Dr Samuell confused her husband by asking question after question and not giving him time to collect his thoughts to answer any question properly. When she tried to clarify one of Dr Samuell’s questions, she reports being told to be quiet because she was not even there.
As the minister would be aware, Dr Samuell is a fly-in, independent medical examiner who, as a group, were described as hired guns by Dr Andrew Lavender, President of the South Australian Branch of the Australian Medical Association in a recent Sunday Mail article. Dr Lavender went on to say in the article that they (claims managers) are trying to seek someone who, instead of giving an independent opinion, is getting the opinion that they (claims managers) want.
Of further concern is Dr Samuell’s reported involvement in the campaign to discredit Dr Louise Newman, a child trauma expert who, in 2004, was a joint author of a damning study showing the extent of mental illness in detention centres.
In an ABC online article on 10 February 2005, Dr Samuell was accused by Dr Newman of a campaign of harassment and personal vilification, seemingly sponsored by the department of immigration, if not the minister. In essence, Dr Samuell is again accused of being a hired gun for the government. My questions to the minister are:
1.How many injured workers has Dr Samuell been engaged to assess as an independent medical examiner?
2.How many of these injured workers had previously seen independent medical examiners for assessment?
3.How many of these injured workers were required by claims managers to see another independent medical examiner after seeing Dr Samuell?
4.How many complaints have been made to claims managers, WorkCover and the WorkCover Ombudsman concerning Dr Samuell’s conduct?
5.If, following the investigation, the minister considers the complaints to be with foundation, what action will the minister take to eliminate professional misconduct for certain IMEs and limit the number of independent assessments that injured workers are required to undergo?
The Hon. P. HOLLOWAY (Minister for Mineral Resources Development, Minister for Urban Development and Planning, Minister for Industrial Relations, Minister Assisting the Premier in Public Sector Management) (14:46): I thank the honourable member for her questions, and I note that she has a motion currently before this house. I propose to post some information when we debate that particular matter next week. The honourable member raised the issue of independent medical examiners sometime ago and I have been seeking information.
Perhaps I should say, first, that the honourable member has made allegations against one particular medical practitioner. In relation to that, I make two comments. First of all, I think that anyone who has issue with that should perhaps take those issues to the WorkCover Ombudsman.
The Hon. A. Bressington: I have.
The Hon. P. HOLLOWAY: And I am sure that they would be appropriately investigated. Secondly, in relation to any particular individual, as with all allegations made, they would need to be properly investigated before any conclusion should be drawn. In relation to the broader issue, the honourable member did raise it with a question a week or two ago. It is a matter which WorkCover has been examining and they will be making some changes in relation to what happens with the use of independent medical examiners.
Independent medical examinations are currently used to obtain independent evidence of a medical nature as and when needed to determine a claim, whether that be a claim for weekly payment or, less likely, cost of medical treatment. Independent medical examinations are intended to be impartial assessments providing independent medical opinion. They are arranged by the claims agent to assist in determining a worker’s medical status or to clarify issues relating to disability, capacity, treatment or recovery. All independent medical examiners must be registered specialists with the Medical Board of South Australia to conduct examinations in South Australia.
In relation to the interstate use, I am advised that WorkCover has a list of medical specialists who have agreed to provide independent medical examinations. Although its preferred, and generally common, for an independent medical examination to be conducted by one of the medical specialists on this list, it is not always possible or most appropriate to utilise their services.
From 1 July 2010 any medical specialist registered with the Medical Board of South Australia can conduct an independent medical examination in South Australia. Sometimes a specialist practising interstate is the most suitable candidate in terms of their speciality or their availability. In other words, while any medical specialist as of 1 July will be able to conduct an independent medical examination, there will still be some situations where a specialist practising interstate may be required, because of the particular condition or the availability of suitable local specialists. Some of the areas of speciality where interstate independent medical examiners have been used, I am advised, include rheumatology, general surgeon, physician, occupational medicine, orthopaedic surgeon, and psychiatry.
It is important to note that the cost of an independent medical examination is gazetted in the WorkCover SA medical fee schedule, and all independent medical examiners must abide by these fees. WorkCover has a list of contracted providers, in accordance with section 53 part 2 of the Workers Compensation and Rehabilitation Act, who have agreed to provide these examinations.
As I explained earlier, WorkCover has reviewed its contracting processes for independent medical examiners, and its contracting arrangements will change from umbrella contracts to contracting providers on an individual case basis. This will remove the current list format of contracted providers, and WorkCover’s nominated list of approved experts will become any medical specialist, other than a general practitioner, who is registered with the Medical Board of South Australia. So, this is an inclusive rather than exclusive approach that helps remove potential barriers in assessing independent medical examiners. Contracts will therefore be entered into with specialists on an individual basis for their acceptance following a referral letter
I also indicate that of course the changes that were made by this parliament to WorkCover several years ago introduced medical panels. Referrals to the medical panels since 1 April 2009, from both registered employers through Employers Mutual and self-insurers, have been progressively increasing. The medical panel selection process is transparent and equitable.
The Governor appoints legally qualified medical practitioners to the medical panel on the recommendation of the minister. Nominations come from a selection committee, which includes employee and employer stakeholders and others from the medical field.
The Convenor of Medical Panels SA convenes panels to answer medical questions from the list of medical practitioners so appointed. The mix of specialties depends on the medical questions referred.
WorkCover with Employers Mutual have taken steps to broaden the approach and to evaluate when a referral to Medical Panels SA is a better option than the past practice of seeking further medical reports from an independent medical examiner or a treating doctor.
We hope that this will lead to a change in practices over time, and so, if there is any truth to the type of allegation made by the honourable member, we hope this is one way in which that will be mitigated.
A doctor who is on the medical panel can be used as an independent medical examiner. However, if they have seen the injured worker previously, or been involved with their treatment, then a conflict of interest is declared and managed by the appropriate party, whether Employers Mutual or Medical Panels SA.
So the matters raised by the honourable member I have taken up with WorkCover. As I say, as a result of some work that has been undertaken by WorkCover there will be some changes such as I have announced now, and also we will endeavour to ensure that the use of the medical panels will mitigate against any of the types of abuses that have been alleged by the honourable member. In relation to the particular case that she raised, I think the appropriate way for that to be examined would be through the Ombudsman, but I will see if I can obtain any further information on that matter and bring that back to the council.
The Hon. A. BRESSINGTON (14:54): I have a supplementary question. Will the minister also try to get a commitment from WorkCover, since they are so willing to change their policies, that they will also limit the number of independent medical examinations that an injured worker is required to undergo?
The Hon. P. HOLLOWAY (Minister for Mineral Resources Development, Minister for Urban Development and Planning, Minister for Industrial Relations, Minister Assisting the Premier in Public Sector Management) (14:54): The problem would be that if you do need an expert from interstate because the specialty is so narrow that there is only a handful of people here and that they may therefore be conflicted, because they have already seen the person or in some way they are not available, then it would be dangerous to put a limit on it.
Obviously, I expect that WorkCover will adopt practices to reduce that. Certainly, the measures it has already announced will, I hope, see a reduction in the number of interstate medical examinations. That is the whole point of the exercise, and we would expect to see that happen. Whether putting a cap on it is sensible is another matter but I would certainly expect to see the number of interstate independent medical examinations reduced. That is the whole purpose of the exercise.
The Hon. A. BRESSINGTON (14:55): I would like to clarify this because I think the minister misunderstood my supplementary question. I am not asking about limiting the number of fly-ins: I am asking about limiting the number of actual independent medical examinations that an injured worker is required to undergo now. Can we put a cap on it? Does the minister think that perhaps 50 independent medical assessments is a bit too many?
The Hon. P. HOLLOWAY (Minister for Mineral Resources Development, Minister for Urban Development and Planning, Minister for Industrial Relations, Minister Assisting the Premier in Public Sector Management) (14:56): Of course that would be the case. One would hope that if the medical panels are functioning correctly—and certainly the advice I have received suggests that they have been making a big difference—then, in relation to the assessment processes of WorkCover, one would think that, apart from a case progressing over a period of time, in most cases one such examination would be desirable.
Unless there is an ongoing issue that needs future reference, it is hard to believe that the number of examinations that the honourable member is talking about is desirable. If there is any evidence that that is continuing then I would be concerned about it, and I would hope that WorkCover would be concerned as well.
May I take this opportunity to say that a new chief executive of WorkCover, Mr Rob Thompson, has been appointed in the last week or so. He is a former acting head of WorkCover in New South Wales, and he is a person with great experience in this field. As he becomes familiar with the operations in South Australia, one would expect that he will take action to ensure not only that the treatment of injured workers is reduced, in terms of over-examination, but that the scheme is efficient. Repeated medical examinations, if they do occur, are not in anyone’s interest—neither for the economic cost of the scheme nor for the wellbeing of workers—so, obviously, we would like to see them reduced, and I am sure that will be the objective of the changes that are made.
(*)reference: National Health and Medical Records Council
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