Roman Hasil and the Whanganui DHB - Health and Disability ...
Roman Hasil and the Whanganui DHB - Health and Disability ...
Roman Hasil and the Whanganui DHB - Health and Disability ...
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Opinion 07HDC03504<br />
supervisee where he or she has good reason to believe that <strong>the</strong>y are competent to carry<br />
out <strong>the</strong> delegated tasks. The supervisee should be encouraged to seek assistance if he or<br />
she feels out of <strong>the</strong>ir depth. The supervisor needs to be available to provide assistance as<br />
required. 49<br />
A critical issue in cases involving clinical supervision is whe<strong>the</strong>r <strong>the</strong> supervisor acted<br />
reasonably in relying on <strong>the</strong> supervisee acting in <strong>the</strong> role assigned. In deciding this issue,<br />
several factors are considered, including <strong>the</strong> supervisee’s experience <strong>and</strong> <strong>the</strong> supervisor’s<br />
knowledge of <strong>the</strong>ir skills <strong>and</strong> experience. 50<br />
One variant of clinical supervision is <strong>the</strong> supervision of a medical officer by a specialist<br />
within a service. 51 The supervisory relationship between a specialist/Clinical Director <strong>and</strong><br />
a medical officer within a mental health service was discussed in Director of Proceedings<br />
v O’Flynn. 52 In considering <strong>the</strong> adequacy of <strong>the</strong> supervision, <strong>the</strong> Tribunal adopted <strong>the</strong><br />
objective test referred to by Venning J in McKenzie v Medical Practitioners Disciplinary<br />
Tribunal. 53 The Tribunal indicated that specialist/clinical director Dr O’Flynn was not<br />
required to provide close supervision. In <strong>the</strong> absence of any specific knowledge of <strong>the</strong><br />
medical officer’s shortcomings, <strong>the</strong> specialist/Clinical Director is entitled to expect <strong>the</strong><br />
medical officer to conduct himself to a st<strong>and</strong>ard commensurate with his qualifications<br />
<strong>and</strong> experience as a senior member of <strong>the</strong> medical staff.<br />
If <strong>the</strong> person responsible for delegating clinical responsibilities in a service has worked<br />
closely with a medical officer, <strong>and</strong> is confident that <strong>the</strong> medical officer can act in <strong>the</strong> role<br />
assigned, it would usually be reasonable for <strong>the</strong> specialist to rely on <strong>the</strong> medical officer to<br />
act independently, in effect as a specialist. 54 I accept that <strong>the</strong>re are medical officers who<br />
are well able to act independently, in effect as specialists. However, if a medical officer’s<br />
competence is in doubt, or not known to <strong>the</strong> supervisor, closer supervision is required.<br />
Effective clinical supervision is critical for safe health care. One of <strong>the</strong> essential checks<br />
within <strong>the</strong> system will be lost if <strong>the</strong> requirement for supervision is “watered down”. A<br />
49 There has been a tremendous change in nature of <strong>the</strong> medical workforce <strong>and</strong> hospital medicine in <strong>the</strong><br />
past 20 years, which is undermining <strong>the</strong> traditional model of supervision. The supervisors may not be<br />
familiar with <strong>the</strong> supervisee’s level of competence. Concomitantly, <strong>the</strong> supervisee may not recognise<br />
<strong>the</strong>ir own limitations due to <strong>the</strong>ir lack of experience.<br />
50 McKenzie v Medical Practitioners Disciplinary Tribunal [2004] NZAR 47 (HC).<br />
51 A medical officer, previously known as a medical officer special scale (MOSS), falls between <strong>the</strong><br />
cracks in relation to <strong>the</strong> professional colleges. Professional colleges have a role in relation to <strong>the</strong>ir<br />
fellows <strong>and</strong> trainees. For example, <strong>the</strong>re is generally a requirement for formal supervision as part of<br />
registrar training programmes.<br />
52 Director of Proceedings v O’Flynn, Medical Practitioners Disciplinary Tribunal, 291/03/110D, 15<br />
July 2004.<br />
53 McKenzie v Medical Practitioners Disciplinary Tribunal [2004] NZAR 47 (HC), para 562–563.<br />
54 Director of Proceedings v O’Flynn, Medical Practitioners Disciplinary Tribunal, 291/03/110D, 15<br />
July 2004.<br />
February 2008 75