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medico-legalGuardianship Tribunal proceedings – the role of the medicalpractitioner by Melanie SheaThe Guardianship Tribunal (Tribunal) exercises protective jurisdictionfor people over the age of 16 living with a decision making disability.The Tribunal determines applications for the appointment ofguardians and financial managers and can provide substitutedconsent to medical or dental treatments. Further, the Tribunaloversees procedures for appointing enduring guardians.In most cases medical practitioners maybecome involved in Tribunal proceedingswhere:n They have a patient who is the subjectof an application in the Tribunal andthe doctor has been asked to reporton the decision making ability of thepatient; orn They have been asked, either by afamily member or by the subject of aTribunal order, to conduct a medicaltreatment and there are concernsabout consent to the treatment; orn They have concerns about the abilityof a patient to manage their ownaffairs.Applications in the TribunalIn applications for guardianship theTribunal may decide to appoint a privateguardian (a family member or willingfriend) or the Public Guardian. Guardiansare appointed for adults who areincapable of making their own decisionsabout their lifestyle. Medical treatmentdecisions are included in applications forguardianship.In applications for a financial manager,the Tribunal may decide to appoint aprivate financial manager (family orwilling friend) or the NSW Trustee wherethey decide a person is incapable ofmaking their own decisions about theirfinances.Pursuant to either of theseapplications, the Tribunal may contacta doctor requesting a report attestingto the decision making ability of apatient. While this is not a subpoena,4 I THE NSW DOCTOR I MARCH 2011the report should be completed in areasonable time and certainly before thecommencement of the hearing. Doctorsmay not be able to charge for preparinga report so be mindful of the amountof time spent. In the first instance thedoctor should contact their patientand advise that they have been askedto make a report. While consent is notnecessary for the report to be provided,and may be difficult to get if there arecapacity concerns, it is prudent to have adocumented discussion with the patientabout the report. The Tribunal requiresthat the person making the applicationserve a copy of the application on thesubject person and the subject of therequested report must be aware of theapplication.In circumstances where doctors treatseveral members of the same familythey may have concerns where anotherfamily member is making an applicationfor guardianship. Doctors must make aclinical judgment as to the contents ofthe report and not become embroiled infamily disputes. Any conflict of interestmust be clearly outlined in the reportto the Tribunal. Importantly, regardlessof which family members are patients,the doctor must ensure to maintainconfidentiality of the subject of the reportand must communicate directly withthe Tribunal rather than other familymembers.The Tribunal may also hearapplications for enduring guardianship.Enduring guardianship will becomeactive for decision making once a personloses capacity and the treating medicalpractitioner may be asked to report onthe ability of a patient to manage living athome independently when that occurs.Medical practitioners are not entitled towitness the signature and execution ofan enduring guardianship however theyare allowed to approach the Tribunal toseek a review if they have concerns aboutwhether their patient had capacity toconsent to the enduring guardianship.Consent to medical treatmentMedical practitioners will be awarethey have a legal duty to obtain consentto treatment before treating anypatient. It is the medical practitioner’sresponsibility to determine whethera patient is capable of understandingthe general nature and effect of thetreatment and whether they are ableto give a valid consent. If a practitionerbelieves that a patient is not capableof informed consent they must seekconsent from an appropriate substitutedecision maker including the ‘personresponsible’ or the Tribunal. TheGuardianship Act 1987 (the Act) statesthat a person responsible may be alegally appointed guardian of the person,or the spouse or de facto spouse, orrelative with a close relationship, or anunpaid carer. The Tribunal can makeorders for substituted consent, wherethere is no person responsible or wherethe person responsibly will not consentto the proposed treatment.Cont. page 18


From the CEOLooking forward – looking backFiona DaviesCEO, AMA (NSW)Elections (particularly in NSW when they onlyhappen every four years) are a good time forreflection. This election is resulting in lotsof interest in the past 16 years of the LaborGovernment and particularly why doctorsworking in the NSW public hospital system areso concerned about what has happened to theirhospitals.The issues in NSW hospitals are very similar tothe issues in other states and, in fact, hospitalsaround the world. The demand for healthcarecontinues to grow, as do the costs of providingthat care, and money to spend on hospitals isfinite. However there is a clear depth of feelingamong doctors about our hospitals. For evidenceof this you don’t have to look much further thanDr Andrew Pesce who left a quiet life as anobstetrician at Westmead Hospital two years agoto stand for the Presidency of the AMA based onthe depth of his concern.I date the difficulties in our hospitals to theevent surrounding Campbelltown and CamdenHospital in 2003-2004. I particularly recall beingat Governor Macquarie Tower in December 2003,looking over the views of the Harbour to see thenHealth Minister, Morris Iemma announce hewas going to go after the individual doctors andnurses he felt were to blame for the events atCampbelltown and Camden Hospital.As we have written over and again in The NSWDoctor, subsequent reviews cleared the doctorsand nurses of Campbelltown Hospital. Thanks tothe advocacy of the AMA and passionate doctors,Campbelltown and Camden is now “shorthand”for what happens when doctors are forced towork in a compromised, under resourced system,rather than any implications of poor medicalpractice.Despite this most doctors talk about feelinga significant loss of trust in a Government thatwas so willing to seek individuals out to makethem personally responsible for a poor system.Campbelltown and Camden was also importantbecause of the extent to which good clinicianbasedadvice was ignored for political expediency.The Greater Metropolitan Clinical Taskforce hadadvised that Camden maternity service shouldnot be opened because it was unsafe and wouldcompromise care. Despite this a political decisionwas taken to open the service and doctors had tolive with the consequences.The AMA’s advocacy in this state election hasalso been informed by the lessons learnt duringCampbelltown/Camden. We are pushing fora long-term vision for health not short-termpolitical fixes and promises. We want a planto ensure well trained doctors working wheretheir community needs them. We want generalpractice to be genuinely engaged in our hospitals,not through large bureaucracies but by beingseen as intrinsic to the care of the patients. Wewant to build on the work already achieved withhealth reform in returning doctors and nurses tofrontline decision making in our hospitals.Stop Press... AMA (NSW) Health ForumNSW HEALTH MINISTER, CARMEL TEBBUTTAND SHADOW HEALTH MINISTER, JILLIAN SKINNERWestmead Hospital Education CentreThursday, 10 March 201112.00 noon – 2.00 pmAllAMAmemberswelcomeLight refreshments available from 12.00 noon, program begins at 12.30pmRSVP to Janene Wardrop at AMA (NSW)via email at Janene@amansw.com.auor phone 02 9439 8822 www.amansw.com.au I 5


featureDeputy Premier and MinistCarmel Tebbutt MP by Narelle SchuhWell known in the political arena, ourcurrent Deputy Premier and Ministerfor Health, The Hon. Carmel Tebbuttran for Marrickville Council in 1993 andhas been involved in the left wing of theLabor Party since the mid 1980s.“What inspired me into politics wasto make a difference to the communityI lived in. I particularly wanted to havethe opportunity to make a differencefor people who struggled, experienceddisadvantage. I was very muchattracted to the social justice principlesof the Labor Party and that’s why Ijoined them in 1985. To me it offeredthe best program and philosophiesabout supporting people who aredisadvantaged, supporting workingpeople and making a difference in theirlives.”On juggling parenthood,responsibilities to her local electorateand holding the role of Health Ministerand Deputy Premier, Carmel says “Youhave to be disciplined. You have to beorganised and recognise you can’t doeverything.” Often her day starts at6.00am with the morning radio andan early walk helps “get the day offto a good start”. It’s a day that canbe completely varied. “Sometimesit can be in the office, meeting withvarious different health stakeholders.Sometimes it can be in the electorate,meeting with constituents or doingthings out and about in my electorate.I spend a lot of the time on the roadvisiting hospitals and health services soit really is mixed and I love that.”Most comfortable in the occupationof politics Carmel says it’s all about“making a difference” to local and stateresponsibilities. “It is definitely worthit. You have to work hard but so youshould because you’re representing thepeople and people expect you to put youreverything into it.”For Carmel, the essential qualitiesof a politician include liking and beinginterested in people. Representingpeople, understanding their needs andaspirations and how to help meet thoseis also crucial. An interest in issues, aninner strength to withstand pressuresand the ability to still be clear about whoyou are and what you believe in are keycriteria. “Good politicians need to becompassionate, they need to understandnot everyone has the opportunities sometake for granted.”Inner strength and a thick skin arealso essential in politics, “You can’t betoo thin skinned because people arecritical, people do criticise you and youhave to be able to withstand that and stillcontinue on doing what you believe in.”Wearing many different hats makesprioritising an essential politicalingredient for Carmel. In her electorateshe attempts to address all issues ofconcern equally, admitting some issuesare more readily resolved at a stateGovernment level. In the health portfolioCarmel relies on the clinical advice of thepeople who work in the health system.“I’m not a clinician so I can’t make thosejudgements about what is more pressingor urgent but I do try to be very receptiveto what I hear. I find the best thing isto talk to frontline doctors, nurses andother health professionals because itgives you a really good understandingof what the needs of the system are andhow best to respond.”National health reform tops Carmel’slist of achievements and she washeavily involved in the lead-up to thenegotiation of the COAG Agreementlast year which she says will continueto provide significant benefits for NSWwith the establishment of the LocalHealth Networks and Governing Councilscreating opportunities for greatercommunity and clinician involvement.Bedding-down the establishment of theLHNs to provide opportunities for greaterclinician engagement will be an ongoingchallenge. “We are the first state tomove ahead with the implementation ofthe Local Health Networks (LHNs). Weappointed the Governing Councils andthat was all ready to go on 1 January2011. There was a lot to do in the lastsix months of last year but we workedvery closely with all the key stakeholdersand while it’s going to be a challenge toactually transition to the new structure Ithink there’s a lot of positive support andoptimism about what can be achievedthrough the LHNs.”Continuing the implementation ofnational health reform is a key priority.Carmel says there is a great need tobe able to develop better incentives for6 I THE NSW DOCTOR I MARCH 2011


er for Health, the Hon.more coordinated care and getting theright health professionals in the rightplaces is a challenge, especially in ruraland regional NSW. “Making sure that theAgency for Clinical Innovation can playa key role in supporting evidence-basedbest practice models of care is part ofhow we plan to manage the challengesof the future and make our healthsystem more sustainable. That has to beled by doctors, nurses and allied healthprofessionals.”Carmel is a big believer in the factGovernments have a role to play inbeing able to support people to leadhealthier lives, providing information andurban planning to increase recreationopportunities. Obesity, Type 2 diabetesand cardiovascular disease front the listof Labor’s health concerns.There is agreement with the premiseof the AMA’s Last Drinks campaign,that people have a right to have anight out without being threatened byalcohol-fuelled violence and anti-socialbehaviour. The favoured approach fromLabor however is not a “one size fits all”but one that is tailored to each particularcommunity. She says “The List” –a listing for the top 50 most violentpremises which must adhere to onerousrestrictions regarding alcohol service –and the “hassle free nights” policy havemade positive inroads into reducingalcohol-related violence across the state.On the topic of polls and focus groups,Carmel believes while they cannotreplace policy and evidence that isgrounded in good practice, “Politicsis a democratic system so you haveto be able to effectively represent thecommunity and take to the communitypolicies that are going to meet withtheir approval. So, it’s not surprisingpoliticians use focus groups and otherways to gauge community views. I don’tthink it ever replaces a commitment toyour own set of values though and todoing what is in the best interest of thepeople you are representing, guided byevidence and best practice.”Carmel is proud of their achievementplacing all medical graduates in 2011but says it’s going to take time and thereis no doubt that in future years placinggraduates will be a challenge. “It isvery good that we are seeing medicalgraduates coming through as there’sbeen a shortage of doctors and we’readdressing that now but it’s going to taketime until those doctors are trainedupin specialties and fill shortages,particularly in region and rural areas.”She cites the Clinical Education andTraining Institute (CETI) as one way ofmeeting the needs of workforce traininginto the future, together with makingbetter use of electronic resources tosupport training.“We have guaranteed we will placeall NSW domestic graduates into thefuture. Then there is the challenge thatonce they’ve done a couple of yearsand want to specialise, that we canprovide speciality training as well. Weare committed to continuing to expandspecialty training but it’s got to be in-linewith workforce needs. I think as we seemore students come through the systemthey won’t necessarily be able to chooseonly the areas that are most attractiveto them, they’ll be encouraged to go intoother areas as well.”It’s going to be a busy campaign trailfor Carmel with, at the time of goingto print, Labor set to roll-out more oftheir health policy in the lead-up to theelection. “It’s ultimately up to the peopleof Marrickville to decide whether theywant to give me another opportunityto represent them in the Parliament. Ihope they do and I’ll be working as hardas I can up until the 26th of March toconvince them they should but it’s theirdecision in the end.” www.amansw.com.au I 7


featureDeputy Leader of the OppoHealth, Jillian Skinner MPActive in politics within the Liberal Partyfor more than 20 years, Jillian SkinnerMP was elected to the NSW LegislativeAssembly in 1994, gaining re-election torepresent the people of the North Shorein 1995, 1999, 2003 and 2007.“Every day of the year, nothing issacred,” Jillian’s alarm sounds at5.59am, just in time to catch the 6.00amradio news followed by the newspaperdelivery to prepare for a day that couldinvolve commenting to the media,heading to Parliament, attendingelectorate activities or talking to peoplearound the state.A thinker and a writer, Jillian is“passionate about contributing to‘local community’ – which for me is thepeople, groups and character of theelectorate of North Shore. Everyonehas a responsibility to participate in thelocal communities they are part of andsince living in Sydney I have been activelyinvolved with community organisationsin the North Shore electorate. When thelocal Liberal Party branches wanted alocal member who was already active,passionate and not afraid to have a pointof-viewon local issues and stand-up forlocal community groups, I said ‘Yes’!”Jillian has never been afraid to standup for things she is passionate aboutincluding championing the cause ofdoctors, nurses and others working inour health system to improve patientoutcomes. “Working in health isrewarding and challenging. I have beenprivileged to be the Shadow HealthMinister for more than a decade andthere is nothing more I want in politicsthan to be the Minister for Health in anO’Farrell Government.”Over these years Jillian has met someamazing individuals and seen some ofthe best clinicians in the country performnothing short of miracles. There’s nota moment she looks back and regrets.“The long hours only serve to excite meand highlight the potential that lies atthe core of the NSW health system. Wehave the best medical workforce in thecountry. I know what our clinicians arecapable of doing and I’m eager to startworking with them to solve the problemsso they can perform to their potential.”For Jillian, the essential qualitiesof a politician include being able tolisten. She strives to ensure initiativesdeveloped truly respond to issues raisedby the community and clinicians. “For16 years I’ve been getting out there,visiting hospitals, speaking to doctors,nurses and allied health professionals.I understand their issues but moreimportantly I am committed to fixingthem, not just making announcementsthat are never delivered.”Another important quality is beingable to take on people’s concerns andtranslating that into policy and action.“Everyone can identify the problems butnot everyone can help people work-upthe solutions and I think that’s a reallyimportant skill in a politician, as isengaging others in being able to workout the solution as well.” A thick skin isalso an essential trait and somethingJillian says you have to learn on the job.Health is an area where you hear alot of tragic stories from patients andhealth professionals. The health systemisn’t perfect and can let people downand these failures also affect our healthworkforce. Most horrifying, Jilliansays, are the stories of bullying andharassment in our health system thatshe hears so often and pledges to dealwith as a top priority if elected. “I’m anempathetic person and feel for grievingfamilies and hurting employees. I wantthe health system that I lead to echo mysympathetic approach. So often whatpeople want is acknowledgement andsupport when things go wrong and aquick but fair mechanism to deal withquestions and complaints.”The ability to get a better deal forpatients and being able to fix a problemfor an individual patient or their familyJillian cites as a wonderful achievement.When I speak to her she is in theHunter Valley and has just come fromthe Wansey dialysis unit where sheannounced a small amount of extrafunding. “They’re over the moon as itwill make such a difference in the livesof people on dialysis in that community,”she says. “Meeting the requirements ofthe number of people who are going tobe on dialysis in the future is a massiveissue.”8 I THE NSW DOCTOR I MARCH 2011


sition and Shadow Minister forJillian is excited about the healthpolicies to be announced in the comingweeks such as their policy to reformgovernance of the health system. Thisfocuses on much greater involvement ofcommunities and clinicians in runningthe system, extended clinical referralnetworks and greater accountabilityand transparency. Passionate aboutsupporting researchers, be they inhospitals, institutes, universities orworking independently, Jillian is proudof their policy to bring medical researchback into the health portfolio, increasefunding and develop a 10-year medicalresearch strategic plan for NSW.If elected to govern Jillian says shewill work with health professionals andothers in the community to “put thepatient back at the heart of the healthsystem, firstly by improving the moraleof those working within it then movingonto priorities preventing ill-health,better managing chronic illness, keepingpeople from unnecessary hospitalisationand fixing hospitals – includingupgrading buildings and equipment.”On the AMA’s Last Drinks campaign,Jillian cites Barry O’Farrell’s electionpromise to use whatever measuresbest suited to deal with alcohol-fuelledviolence and other anti-social behaviourat licensed premises.“ I want the healthportfolio to also contribute to lesseningproblem drinking in our communitywhich is why we’ve committed to arange of preventative health measuresincluding a $10million fund to increasedrug and alcohol treatment programs.”Regarding polls and focus groupsJillian is adamant “They don’t delivergood government. A NSW Liberals &Nationals Government will deliver realchange and put the public back at thecentre of decision making, basing bigpolicy decisions on sound research andlistening to people at the coalface ratherthan the polls.”On our health workforce issues Jilliansays we need to be smarter aboutthe different places we can train ourmedical workforce and there shouldbe a “smorgasboard” of experiencesfor graduates not only in city hospitalsbut in smaller rural ones and evenpartnerships with overseas hospitals forstudent exchanges. “A student doctorI spoke to recently said a lot of hercolleagues were choosing specialtieswhere they thought they’d most likelygain employment, not the ones theyreally were passionate about. I thinkthat’s very sad. I think you are muchbetter at the things you are passionateabout doing. It might mean they all can’tbe in the city, they might need to do astint in the country and these are thekind of incentives we need to work on.”In her many discussions with the AMA,specialist doctors, colleges and otherprofessional bodies Jillian is aware ofthe critical importance of providing ahospital environment where doctors andnurses can do the right thing by patients.“These discussions have also focused onthe need to provide adequate numbersof staff and safe working hours for themedical workforce that we all need torun our health system now and into thefuture.”In the lead-up to the election Jillianwill spend time with many candidatesall over the state. As for after the 26th ofMarch… “I’ll spend some time with myfamily, friends and supporters – and ifwe win, have a glass of champagne butan early night because the next day iswhen the most important work begins.” www.amansw.com.au I 9


featureThe social glue of LMAs by Elyse CainLocal Medical Associations (LMAs)may well be the social glue stickingthe medical profession together.For decades they have providedopportunities for doctors to socialiseand discuss areas of commoninterest. This is certainly the casewith LMAs such as the Kuring-gaiDistrict Medical Association (KDMA),the Warringah District MedicalAssociation (WDMA), the Mt DruittMedical Practitioners’ Association(MDMPA) and the Nepean MedicalAssociation (NMA).Dr Robyn Napier, MedicalSecretary and Medical Directorat the AMA (NSW) stresses thatLMAs are an extremely importantpart of the medical profession.LMAs facilitate communicationbetween medical practitioners of allspecialties, something she considersabsolutely vital for the unity of theprofession. “Doctors are extremelybusy and LMAs encourage themto take a break and mix with theircolleagues. This reduces isolationand encourages the growth ofthe profession,” Dr Napier said.“Particularly with Medicare Localsreplacing many of the Divisionsof General Practice throughoutNSW, it will become increasinglyimportant for LMAs to be thelocal representative bodies for themedical profession.”It may be too early to tell whetherLMAs will experience renewedinterest from the profession in theiractivities as a direct result of thenew Division structure, leading toa heightened representative rolein local health issues that extendbeyond social and educationalevents. Dr Harry Lorang, Vice-President of the WDMA said timewill tell whether the Medicare Localswill play a role in triggering renewedinterest in LMAs as representativebodies. “I would certainly hope thatLMAs will experience an increasedrole in local health issues of theclinical or medico-legal sort but forthe moment they are predominantlythe source of most educational andsocial events for doctors,” Dr Lorangsaid.Dr Hani Bittar of the MDMPA saysthat the effects of the new Divisionstructure have not yet been noticedby general practitioners in the MtDruitt region. In spite of this DrBittar does see the potential forLMAs to become more vocal inpublic health matters at a local level.“LMAs could be major stakeholdersand team players for planning anddelivering public healthcare to localcommunity and hospital servicesdue to their connection with localcommunity, local GPs, local AHPsand, in our case, with communityhealth at the HealthOne NSW level,”Dr Bittar said.NMA President Dr MichelleCrockett hopes to see increasedinteraction between different LMAsin the future to share ideas onacquiring new membership andstrengthening the associations.“Many of our doctors do not livein the area which can sometimesbe a problem for membershipand running events,” Dr Crockettsaid. “In addition, everyone is verybusy and many already belong to anumber of different organisations,some of which are exclusively forGPs.”This is where LMAs fit into theequation; their major benefits liein the ability to bring doctors fromall specialties together, be it foreducational, social or representativepurposes.Mrs Jo Dowe of the KDMA saysit is about creating events fordoctors with busy schedules thatwould otherwise not occur, whereall practitioners can be amongstcolleagues in a relaxed atmosphere.“The KDMA is RACGP accreditedand each year hosts bi-monthlyeducational dinners, an annualinternational conference, a sociallong weekend and a golf day,” MrsDowe said. “This year we haveintroduced a social afternoon at theraces into the mix.”12 I THE NSW DOCTOR I MARCH 2011


featureHealth needs and outcomes for children in out-ofbyMelinda Clarke and Kylie Gwynne | Life Without BarriersMost Australian children have thechance to grow up safe and well infamilies where they are cared for,supported and enabled to growinto contributing members of thecommunity. Some children, however,grow up in out-of-home care. For thesechildren growing up safe and well is afar less certain outcome.Out-of-home care is provided acrossAustralia for children and youngpeople who are unable to live withtheir families. Out-of-home care cantake the form of foster care (living witha family), residential care (living in astaffed house with other children), orkinship care (living with a relative).Children enter out-of-home carefollowing an assessment by the statebasedcommunity services governmentdepartment, usually because achild abuse or neglect matter issubstantiated, or their family is unableto care for them. In NSW this is theresponsibility of Community Services,part of the Department of HumanServices. Children may be placed intemporary or short term out-of-homecare by the Department and then theChildren’s Court can determine if achild will be placed in the care of theMinister and in out-of-home care in thelonger term.Health is one of the most basicindicators of wellbeing in children andyoung people, including social andemotional wellbeing, which in turnis related to quality of life. Childrenand young people in out-of-homecare are a particularly vulnerablepopulation and are more likely to havephysical and mental health problemscompared to the general population ofchildren. There is a myriad of researchdemonstrating that children in out-ofhomecare have higher rates of health,dental, developmental, behavioural andemotional problems and a significantnumber also have a physical and/orintellectual disability. For example,Nathanson and Tzioumi 1 (2007)found that, compared to the generalpopulation, children seen at the SydneyChildren’s Hospital out-of-home clinicwere:n Four times more likely to haveproblems with vision;n Eight times more likely to haveproblems with hearing;n Two to three times more likelyto have speech and languagedifficulties; andn Much less likely to be fullyimmunised.There are a range of risk factors inthe early life of children and youngpeople who enter care that increasetheir risk for developing healthproblems including:n Poor diet;n Inadequate healthcare;n Increased risk of accidental injuryassociated with poor parentalsupervision;n Physical and emotional traumaassociated with various forms ofmaltreatment;n Exposure to parental drug abuse(pre- and post-birth);n Exposure to high levels of conflictand family violence; andn Attachment disruption.Some children and young peopleare further disadvantaged by multipleplacement changes, leading to pooremotional and social adjustment.Placement changes can sometimestranslate into poor communicationabout health history leading to delaysin accessing the right healthcare andsupport services. Although there isa large body of research evidencepointing to the poor state of healthof children in out-of-home care, andthis evidence has been accepted bygovernments across Australia, furtherwork is required in order to alter thecourse of the trend.The National Standards for Outof-HomeCare 2 will be implementedthis year and were developed viaan extensive national consultation.The KPMG Final Report – NationalStandards for Out-of-Home Care 3 –identifies physical and mental health asone of the six key areas of overall childwellbeing. Standard 5 requires thatchildren and young people have theirphysical, developmental, psychosocialand mental health needs assessed andattended to in a timely way.The standard goes on to state that:Children and young people enteringcare are to have their health needsassessed and receive specialisedservices to respond to their healthchallenges so that their chances foroptimum health are maximised. The16 I THE NSW DOCTOR I march 2011


home care in Australiachild or young person’s physical,developmental and psychosocialand mental health needs are to beidentified in a preliminary healthcheck. This will provide advice on thespecialist services required and thetiming of a comprehensive health anddevelopmental assessment. Childrenand young people are to have their ownwritten health record which moves withthem if they change placements.Effective implementation of thisnew National Standard will go someconsiderable way to ensuring that thehealth needs of children in out-of-homecare are met in a more consistent way,leading to more positive outcomes.This will require substantial effortand commitment on the part of stategovernments – both communityservices and health portfolios and themany non-government organisationsthat provide out-of-home care services.Children in out-of-home care are partof our community and experience pooroutcomes through no fault of their own.It is incumbent on all of us to work toensure that they have a better chanceto grow up safe and well.Life Without Barriers is the largest nongovernmentprovider of out-of-home careacross Australia1 Nathanson, D., & Tzioumi, D. (2007). Health needs ofAustralian children living in out-of-home care. Journal ofPaediatrics and Child Health, 43, 695-699.2 http://www.fahcsia.gov.au/sa/families/pubs/nat_std_4_outofhomecare/Pages/default.aspx3 http://www.fahcsia.gov.au/sa/families/pubs/kpmg_final_report_nsfohc/Pages/default.aspx4 Report on Government Services 2010 http://www.pc.gov.au/__data/assets/pdf_file/0006/93966/61-chapter15.pdfp 15.125 Report on Government Services 2010 http://www.pc.gov.au/__data/assets/pdf_file/0006/93966/61-chapter15.pdfTable 15A.166 http://www.community.nsw.gov.au/docswr/_assets/main/documents/bcg_report.pdf p A. 60.7 Harden, B. (2004) Safety and Stability for Foster Children:A Developmental Perspective in Children, Families andFoster Care Vol.14, No.1, p 39.8 Northern California Training Academy (2008) PlacementStability in Child Welfare Services: Issues, Concerns,Outcomes and Future Directions Literature Review. p 4.9 http://www.lboro.ac.uk/research/ccfr/Publications/placementstabilitylitreview.pdf p.2.10 Report on Government Services 2010 http://www.pc.gov.au/__data/assets/pdf_file/0006/93966/61-chapter15.pdfTable 15A.2411 Life Without Barriers 2008/09 data for NSW OOHCservices12 http://www.create.org.au/news-and-events/kids-in-carewithout-a-road-mapOut-of-home in AustraliaThere are about 34 000 children in out-of-home care in Australia, including15,211 in NSW 4 . The rate of children in out-of-home care Australia-wide is6.7 per 1,000 children. This rate is 44.8 per 1,000 for indigenous children, and4.9 per 1,000 for non-indigenous children.The rate for children in out-of-home care in NSW is 9.4 per 1,000 children(71.3 indigenous; 6.6 non-indigenous). Victoria is 4.3 per 1,000 children (48.7indigenous; 3.8 non-indigenous), Queensland 6.7 per 1,000 children (36.0indigenous; 4.6 non-indigenous) and Western Australia 5.1 per 1,000 children(38.8 indigenous; 3 non-indigenous). 5In NSW, Community Services directly provides out-of-home care forapproximately 85 per cent of children in out-of-home care with the remaindercared for by non-government agencies. Non-government agencies haveresponsibility for 84 per cent of high needs children. 6Placement stability for children in out-of-home care is often used as aproxy indicator of quality. 7,8,9 In NSW, 43.5 per cent of children in out-of-homecare have moved three or more times per year. 10 Australia-wide this statisticis 50.3 per cent. For non-government agency Life Without Barriers in NSW,the proportion of children moved three or more times per year is 2.3 percent 11 ). The higher the number of moves the greater the impact on schooling,healthcare and social networks.Outcomes for children in out-of-home care are very poor. A survey by theCREATE Foundation found that:“They are at higher risk of developing recognised characteristics ofyouth who have left care such as being more likely to be undereducated,unemployed, to earn less, become a parent at a younger age, be involvedin the juvenile justice system, become homeless, be dependent on socialassistance, have mental health issues, attempt suicide and be at a higher riskof substance abuse”.The CREATE report noted that:n 64 per cent of young people do not have a leaving care plan (a strategy forlife after being in the care system).n 35 per cent of young people in out-of-home care are homeless in the firstyear after leaving care.n 46 per cent of boys in out-of-home care are involved in the juvenile justicesystem.n 35 per cent of young people in out-of-home care completed Year 12.n 29 per cent are unemployed (compared to the national average of9.7 per cent).n 28 per cent were already parents themselves. 12 www.amansw.com.au I 17


medico-legalGuardianship Tribunal proceedings –the role of the medical practitioner Cont. from page 4Defined in the GuardianshipRegulation 2010 (the Regulations)are four types of medical treatment –special, major, minor and urgent.A medical practitioner must approachthe Tribunal for consent if:n the proposed treatment is special;n the person responsible is not availableand the proposed treatment is major;n the patient is objecting to theproposed treatment (major or minor)and there is no appointed guardian tooverride objections.An application for consent to medicalor dental treatment is available on theTribunal’s website.Only the Tribunal can consent tospecial medical treatment (whichincludes a pregnancy termination,vasectomy or tubular occlusion).The 2010 Regulation removed theprescription of drugs of addictionfrom the special medical treatmentcategory and it is now consideredmajor medical treatment for which theTribunal or a person responsible canconsent. Major medical treatment alsoincludes procedures for which a generalanaesthetic is required.For minor medical treatments (asdefined in the Regulation), where theperson responsible is not available,medical practitioners may chose to treatthe patient, without consent, providedthat the doctor notes in the patient’sfile that the patient is not objectingto the treatment, that the treatmentis necessary and that the treatmentwill promote the patient’s health andwellbeing.In any of the categories of treatment, ifthe practitioner considers the treatmentis urgent and necessary they may treatwithout consent.All consents and requests for consentmust generally be provided in writingexcept where this is not practicable.The Regulations require that the medicalpractitioner keep a record of the name18 I THE NSW DOCTOR I MARCH 2011and address of the person providingconsent as well as any conditionsattached to the consent and the nature ofthe treatment for which consentwas given.It is important that practitioners areaware of the safeguards containedwithin the Act and the Regulations whichensure that treatment is only given topeople who lack the capacity to consentto medical treatment where it is clearly inthe best interest of the patient.Concerns about a patientIf a doctor has concerns about a patient’sdecision making ability in respect of thepatient’s lifestyle, financial management,or their ability to consent to medical ordental treatment, the practitioner shouldspeak to the patient and the family(being conscious of confidentiality) aboutwhether there is an enduring guardianor power of attorney already in place forthe patient. If not, provide details of theGuardianship Tribunal for the family toapproach and discuss their options.In respect of medical treatment ifthere is a ‘person responsible’ to makedecisions about consent, the proposedmedical treatment can be discussedwith them in order to obtain substitutedconsent. If possible a request forconsent should be made in writingwith information about the particularcondition that requires treatment, thenature of the proposed treatment andits effects, the risks associated and anyalternative treatments.If you treat a patient with anintellectual or physical disability or familymembers of such a person and you haveconcerns about the family coping withcaring for that person, the Departmentof Aging, Disability and Homecare shouldbe contacted to arrange respite care.For moreinformationThe Medico-Legal and IndustrialDivision at the AMA (NSW) are happyto answer any questions you haveabout the Guardianship Tribunal,phone 02 9439 8822.Alternatively the Tribunal has avery helpful website at http://www.gt.nsw.gov.au/


Australian Medical Association (NSW) LimitedELECTION NOTICE2011 ELECTION OF COUNCILRichard Kidd, Principal of Australian Election Company will be the Returning Officer for the 2011 election of theCouncil of the Australian Medical Association (NSW) Limited pursuant to the Industrial Relations Act, 1996 andthe Regulations thereunder.NOMINATIONSN.B. No member or Nominated Representative shallnominate for more than one class (position) on Council.Nominations in writing are hereby invited for thefollowing positions on Council:SPECIAL INTEREST GROUPONE (1) to be elected from each of the followingclasses:Physician ClassSurgeon ClassOphthalmologist ClassPsychiatrist ClassPathologist ClassGeneral Practitioner ClassRadiologist ClassAnaesthetist ClassObstetrician/Gynaecologist ClassSalaried Doctor ClassRural Doctor ClassDoctor in Training ClassStudent Member ClassZONESONE (1) to be elected from each of the followingclasses:Northern Metropolitan Zone ClassSouthern Metropolitan Zone ClassCentral Metropolitan Zone ClassWestern Metropolitan Zone ClassNorth Western Metropolitan Zone ClassSouth Western Metropolitan Zone ClassNew England and North Coast Zone ClassIllawarra and South Coast Zone ClassNorth West Zone ClassSouth Zone ClassHunter and Central Coast Zone ClassUNRESTRICTED GENERAL MEMBERCATEGORYIn the “Unrestricted General Member Class”, afurther SIX (6) to be elected from any of the aboveclasses (with the exception of the Student MemberClass) provided that at least three (3) of those six (6)shall be general practitioners.With the exception of the Student Member Class, candidates and theirnominators must be Ordinary Members, or in the case of a company,the Nominated Representative of an Ordinary Member. Candidatesmust be members of the relevant class of the Association and must befinancial members of the Association as at the date of the closing ofnominations, i.e. 5:00pm, Wednesday, 6 April 2011. Candidates mustbe nominated by not less than two (2) other members of the relevantclass who must be financial members of the Association. No personmay nominate more candidates than the number to be elected in eachclass.In respect of the Student Member Class, candidates must be StudentMembers of the Association and must be nominated by not lessthan two (2) other Student Members of the Association. No StudentMember may nominate more than one (1) candidate.A candidate may complete a Statutory Declaration in Support ofCandidature, the contents of which will be included in a CandidateInformation Sheet which will accompany voting material when it isposted. A Nomination Form and Statutory Declaration in Support ofCandidature are included in this issue of The NSW Doctor. Additionalcopies are available from Australian Election Company, telephone1800 224 420.CLOSE OF NOMINATIONSNOMINATION FORMS AND STATUTORY DECLARATIONS IN SUPPORTOF CANDIDATURE MUST BE RECEIVED BY THE RETURNINGOFFICER, AUSTRALIAN ELECTION COMPANY, NOT LATER THAN5:00PM, WEDNESDAY, 6 APRIL 2011. THEY MAY BE POSTED TOTHE RETURNING OFFICER, PO BOX 3016, CABOOLTURE BC QLD4510 OR PREFERABLY FAXED TO (07) 3408 8722, (07) 3289 1096,(07) 3351 2537 OR HAND DELIVERED TO AUSTRALIAN ELECTIONCOMPANY, 43 MARINA BLVD, BANKSIA BEACH QLD 4507.Any defect in a Nomination or Statutory Declaration in Support ofCandidature must be rectified by the candidate prior to the close ofnominations. A candidate may only withdraw his/her nomination inwriting prior to the close of nominations.Should more than the required number of nominations be received, adraw will be conducted to determine the order of candidates’ nameson the ballot paper at the Australian Election Company office at11:00am, Thursday, 7 April 2011. Candidates or their representativesare invited to witness the draw.VOTINGIf the election is contested, a postal ballot will be conducted and closingat 12 Noon, Tuesday, 10 May 2011. Members of the Australian MedicalAssociation (NSW) Limited, financial as at 5:00pm, Wednesday, 6 April2011 (and Student Members of the Association) entitled to vote inthat class or classes that are contested will be sent a ballot paper onWednesday, 20 April 2011.The method of voting to be observed for this election will be “First Pastthe Post”. Any enquiries concerning this election should be directed toAustralian Election Company, telephone 1800 224 420.Richard Kidd, Returning Officerfor the 2011 Australian Medical Association (NSW) Limited Election.


COUNTRY ZONES7. One (1) member of Council shall bea member who carries on his or herprofession in the Hunter and CentralCoast Zone (Hunter and Central CoastZone Class), which comprises the localGovernment areas of:Muswellbrook WyongGosford NewcastleLake Macquarie CessnockPort Stephens GloucesterMaitland Great LakesDungog Upper HunterSingletonBroken Hill8. One (1) member of Council shall bea member who carries on his or herprofession in the Illawarra and SouthCoast Zone (Illawarra and South CoastZone Class), which comprises the LocalGovernment areas of:Bega Valley Wollongong EurobodallaShellharbour Wollondilly ShoalhavenWingecarribee Kiama9. One (1) member of Council shall be a member whocarries on his or her profession in the New England andNorth Coast Zone (New England and North Coast ZoneClass),which comprises the Local Government areas of:Moree Plains Tamworth Port Macquarie –Armidale – Coffs Harbour HastingsDumaresq Narrabri Richmond ValleyBellingen Lismore BallinaKempsey Inverell KyogleTenterfield Gunnedah Liverpool PlainsNambucca Guyra GwydirByron Greater Taree UrallaGlen Innes Walcha Clarence ValleyTweed10. One (1) member of Council shall be a memberwho carries on his or her profession in the SouthZone (South Zone Class), which comprises the LocalGovernment areas of:Wentworth Leeton NarranderaBombala Berrigan AlburyCarrathool Wagga Wagga Goulburn-Coolamon Greater Hume MulwareeNORTH WESTSOUTHMoreeNEW ENGLAND &NORTH COASTArmidaleHUNTER &CENTRAL COASTDubboMudgeeNewcastleOrangeBathurstCowra(Metropolitan)AlburyGoulburnWagga WaggaILLAWARRA &SOUTH COASTBatemans BayEdenWollongongCoffsHarbourPortMacquarieGundagai Urana TumbarumbaSnowy River Murray JuneeQueanbeyan Tumut YassDeniliquin Boorowa PalerangYoung Harden ConargoJerilderie Upper Lachlan BalranaldWakool Lockhart CootamundraHay Griffith MurrumbidgeeTemora Cooma-Monaro Corowa11. One (1) member of Council shall be a member whocarries on his or her profession in the North West Zone(North West Zone Class), which comprises the LocalGovernment areas of:Broken Hill Mid-Western BourkeParkes Regional CabonneOberon Bland ForbesWellington Lithgow City LachlanCoonamble Weddin DubboBathurst Bogan WalgettCowra Gilgandra WarrumbungleBrewarrina Warren Central DarlingBlayney Cobar NarromineOrangeINTERPRETATIONd) “Doctor in Training” means an employed member who is undertaking a course of post graduate training and who does not otherwise fall within any ofthe classes referred to in paragraphs (a) to (i) of Rule 36.1.e) “Rural Doctor” means a member or Nominated Representative who is engaged in a private medical practice in one of the Zones referred to inparagraphs (l) to (p) inclusive of Rule 35.2 where the practice at which that member or Nominated Representative is primarily engaged in carrying onhis or her profession is not in a Town or City which has a Base Hospital.f) “Student Member” must be an undergraduate of the faculty of medicine from a university in New South Wales & Student Member. All ipso factocases to be a Student Member of the Association and when he/she is qualified to be an Ordinary Member of the Association of if he/she ceases tobe a medical student.


The AMA (NSW) Clinical ConferenceNEWYORK8-14 May 2011ENQUIRIES – MEDICAL TOURS AUSTRALIA PTY LTDEmail: info@medicaltoursaustralia.com.au • Web: www.medicaltoursaustralia.com.auPO Box 4109, Winmalee NSW 2777 • Ph: 02 4754 5000 • Fax: 02 4754 47398948 4000


AMA (NSW) / NSW HEALTHMEDICAL CAREERSEXHIBITIONIf you’re a medical student, intern or registrar who hasn’t yet picked a training programor are looking to change specialties, this is an event that you cannot miss. Have yourquestions answered by expert exhibitors. Pre-registration is highly recommended.DATE AND TIME Saturday 19 March 201110:00am – 4:00pmREGISTRATION FROMVENUEADMISSION9:30amAJC Convention CentreRandwick RacecourseFREELASTCHANCETOREGISTER!Proudly sponsored byNSW HealthCare FlightQualityOccupationalHealthRANZCPLast MinuteLocumsAustralasian College of Sport PhysiciansFaculty of Medicine Sydney UniversityMDA NationalMedic OnCallNSW GP training providersThe Royal Australian and New Zealand College of RadiologistsAvantRoyal Australasian College of PhysiciansRoyal Australian and New Zealand College of OphthalmologistsRoyal Australian and New Zealand College ofObstetricians and GynaecologistsThe Royal College of Pathologists of AustralasiaMedical Indemnity Protection Society LtdAustralian and New Zealand College of AnaesthetistsREGISTER ONLINE AT: events@amansw.com.au www.amansw.com.au I 21


AMA (NSW), together withpartners Investec Experien,Cutcher & Neale andThe Prosper Groupinvite you to a:TAX, PROPERTY ANDFINANCE STRUCTURINGMASTERCLASSKey steps to wealthgeneration and preservationDate & LocationWednesday, 30 March 2011, 6.00-8.00pmAMA (NSW) Conference CentreGrd Flr, 69 Christie StreetSt Leonards NSWEvent details6.00pm Drinks and Canapes6.30pm Welcome6.40pm PresentationsCostAMA (NSW) Members – $45Non Members – $75AMA (NSW) Member bring a non member friend -$20 discount for member ($25 for member, $75for non member)Attendees will receive $100 towards their 2012AMA (NSW) membershipThis unique, interactive workshop takes the formof a panel discussion with AMA (NSW) PreferredPartner experts. Using a number of scenariosunique to medical practitioners our panel will showyou how to make the most of your earning power.The panel consists of:Stafford HamiltonInvestec ExperienJarrod BrambleCutcher & Neale Accounting and Taxation ServicesChris WhiteThe Prosper GroupRSVPFor more information and bookings emailAMA (NSW) at events@amansw.com.auAMA (NSW) GOLF SOCIETYCALENDAR OF EVENTS 2011Interstate Weekend - Coolum | Friday, 4 - Monday, 7 MarchAMA Charity Golf Classic(PRO-AM) - Terrey Hills Golf Club, Thursday, 17 MarchThis is an AMA (NSW) Charitable Foundation EventThe President’s CupMonash Country Club, 2 MayCountry Weekend & Spring Cup Bonville Golf ResortAccommodation: Bonville Golf ResortThursday, 8 - Sunday, 11 SeptemberThe AMA International ShieldMauna Lani, Big Island, Hawaii | Sunday, 9 - Tuesday, 18 OctoberBMA CupElanora Country Club, 15 DecemberCHARITY CLASSIC, TERREY HILLS GOLF CLUBPRO/AM | 17 MARCH 2011RSVP to Kathy Thornton by 7 March 2011 on 02 9902 8144 oremail amagolf@amansw.com.auAs a key component of the AMA (NSW) Charitable Foundation’sfundraising efforts the 2011 Charity Classic golf tournament willbe held at the prestigious Terrey Hills Golf Club. More than100 amateur and senior Pros will test their skill on thischallenging course.A senior PGA professional will join each team of three andprovide personalised attention and expert instruction throughoutthe day. Free coaching clinics will also be conducted by seniorPGA professionals prior to the event which will be a stablefordcompetition (individual and team) over 18 holes, with nearest thepin and longest drive.Schedulen 11.30am – registration, lunch and free golf clinicn 1.00pm sharp – hit-off with shotgun start (players ready to moveout at 12.40pm)n 6.30pm – tournament dinner and presentation of trophiesand prizesTHE PRESIDENT’S CUP, MONASHCOUNTRY CLUB | 2 MAY 2011Monash is situated in a unique and naturalbushland setting offering a magnificent golfcourse and ocean views. Situated high in thehills above Narrabeen on Sydney’s beautiful northern beaches,Monash has an acclaimed par 72 par layout with superb,challenging greens. Registration from 10.00am. Golf Societymembers will receive registration forms in March.The President’s Cup is a stableford event and all golfers arewelcome. For more information contact Kathy Thornton on02 9902 8144 or email amagolf@amansw.com.au www.amansw.com.au I 25


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Vortex 95Call AMA (NSW) member 813 services super Metropolitan fund for doctors,423 (outside onareas)and practice Metropolitan 4www.nswama.com.auMEDPRACneeds of members. Finance areas) 4www.nswama.com.auand Diesel and 1.5cpl American Special off Vortex reduced Express 98. rates on standard gym02 9439 SUPERANNUATION 8822 or emailA with property no services@amansw.com.auentry advisory fees. 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Business AMA (NSW) WineGow-Gates GroupA property advisory (buyer’s agent)Society Free standard installation of our business valueDislclaimer: AMA (NSW) may financially benefit fromCompleteits relationshipinsurancewithandPreferredfinancialPartnersservices Qantas ClubOther benefits: who can source, perform due diligenceBoutique package, wines plus at specially two months negotiated free on a 12-month25with special packages for AMA members.prices contract. for members every month.Receive automatic subscriptions and negotiate to the your following home,Servicespublications: investmentinclude: Wealth Creation, Risk % Discounted REBATErates for AMA members.Save up to $365 on membership.properties or commercial premises,Fees as follows: Joiningn n AMA List of Medical Services and Fees Book Management, Doctors’ Practice InsuranceCaltex $200; StarCard www.amansw.com.au I 27saving you time and money.One year $265; Twoand Superannuation.Consolidate years $465. your vehicle fuel expensesn n The NSW DoctorIntroduce a new member to AMA (NSW) onto one and easy-to-read receive monthly statementn Other n The Medical benefits: Journal of Australiawith access to the following fuelOther benefits:Membership has its rewardsAMA (NSW) has the most comprehensive Medico-Legal and Employment Relations advice in Australia.Just some of the services that are available include awards advice and updates, court representation,mediation and human resource consulting. A comprehensive range of legal packages and draft contractsare available for members for a nominal fee. In addition, below are a list of our member service partnersto assist you whatever the need.MEDPRACSUPERANNUATIONAMA Auto Buying ServiceA free service specialising in theacquisition, funding and disposal of allmakes and models of motor vehicles.Assign MedicalAssists members to source competent,friendly and committed staff for yourbusiness or practice.Commonwealth BankOffering a special merchant facility at alow fee of 0.68% for most credit cards.Investec ExperienSpecialist finance to meet the personaland practice needs of members. Financesolutions for practice requirements, motorvehicles, commercial/residential propertyand overdraft facilities.Gow-Gates GroupComplete insurance and financial serviceswith special packages for AMA members.Services include: Wealth Creation, RiskManagement, Doctors’ Practice Insuranceand Superannuation.Medprac Super FundThe perfect super fund for doctors,with no entry fees. Have the option ofmanaging your fund using a range ofinvestment managers.Prosper GroupA property advisory (buyer’s agent)who can source, perform due diligenceand negotiate your home, investmentproperties or commercial premises,saving you time and money.Receive automatic subscriptions to the following publications:n n AMA List of Medical Services and Fees Bookn n The NSW Doctorn n The Medical Journal of Australian n Australian Medicinen n AMA Action (e-newsletter)AMA (NSW) Member Service PartnersTressCox LawyersExpert legal advice for the medicalprofession. Members are entitled to aunique duty solicitor scheme offeringone free consultation (referral required).Accountants/Tax Advisers PanelExperienced accounting firms whocan assist you with your personal andprofessional accounting and taxationneeds. Select the firm most suitable foryour requirements.AMA (NSW) Member Reward CardSignificant savings every year withparticipating restaurants, hotels andtourist attractions.American ExpressOffering corporate affinity programs andspecial discounts to members for creditcards and merchant facilities.Auscellardoor AMA (NSW) WineSocietyBoutique wines at specially negotiatedprices for members every month.Caltex StarCardConsolidate your vehicle fuel expensesonto one easy-to-read monthly statementwith access to the following fueldiscounts: 2.5cpl off unleaded, Vortex 95and Diesel and 1.5cpl off Vortex 98.HertzAs the official car rental partner for AMA,Hertz offers discounted rates and a rangeof member benefits all year round.Qantas ClubDiscounted rates for AMA members.Save up to $365 on membership.Fees as follows: Joining $200;One year $265; Two years $465.25 % REBATEIntroduce a new member to AMA (NSW) and receivea cheque equal to 25% of the new member’ssubscription via our Member Get Memberprogram. There are no limits.To take advantage of your benefits call AMA (NSW) Member Services on (02) 9439 8822or 1800 813 423 (outside Metropolitan areas) 4www.nswama.com.au


membershipThe AMA is leading the discussion in the proposed healthsystem reform. You can help support your professionalorganisation by encouraging your colleagues to join.There has never been a better time to refer a colleague.2011 Subscription RatesFrom 1 MarchCATEGORY Total (incl GST) Monthly amount25%rebatemember-getmemberprogramIntroduce a new member toAMA (NSW) and receive a chequeequal to 25 per cent of the newmember’s subscription.No limits apply!Refer today!Specialist Member 1099.17 109.92General Practice Member 978.33 97.83Members first year after graduation (Intern) 161.66 16.17Members second year after graduation 283.33 28.33Members third year after graduation 283.33 28.33Members fourth year after graduation 522.50 52.25Members fifth year after graduationand subsequent years as RMO/Registrar 640.17 60.42Non-Specialist salaried Medical Officer 894.16 89.42Joint subscription member & spouse or partner ** **Members in academic position not in active practice 769.17 76.92Members in part time positions engaged 11-25 hours pwk 580.84 58.08Members in part time positions engaged up to 10 hours pwk 247.17 27.42Members in full-time post graduate study 428.33 42.83Members over 70 still in active practice 446.66 44.67Members absent from Australia for full calender year 449.17 44.92Members permanently retired 218.33 21.83Fifty year members and Gold Medal Recipients NIL NILMaternity Leave* NIL NILStudent Members NIL NIL* 1 year maximum. Please contact AMA (NSW) to arrange.** 30% discount applies to each individual subscription.Yes join me up!I wish to become a member of the Australian Medical Association and the Australian Medical Association (NSW).I agree to observe the principles stated in the Declaration of Geneva and the Rules of the AMA.NAME AND TITLEgender MALE FEMALE DOBADDRESSPOSTCODE business homeTelephoneMOBILEemailCategory/DisciplineAMOUNT $I was referred by my colleague (optional)AMEX MASTERCARD VISA CHEQUECARD NOEXPIRY DATE ____ /____NAME ON CARDCARDHOLDER’S SIGNATUREmail to AMA (NSW), PO Box 121, St Leonards NSW 1590, or fax 02 9438 3760enquiries@amansw.com.auwww.amansw.com.au


While you builda career, we’ll helpbuild your wealth.You don’t need us to tell you how much dedication and commitment is requiredto build a successful career in medicine.But we can tell you how to build your fi nancial success and security.As specialists in accounting services for medical practitioners, we understandboth your unique circumstances and the opportunities available to you. By puttingthe right structure in place now, you can be confi dent of reaping the appropriaterewards in the future.And if you’re already well into a career, we can review your current structureto ensure you’re maximising the available opportunities.To start the conversation, simply contact Jarrod Bramble on freecall 1800 988 522.There’s no obligation and no charge for the initial discussion for AMA members.■ Freecall 1800 988 522cnmail@cutcher.com.au

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