Regarding the role of an expert witness, which ONE of the following statements is TRUE?
Answer: B: An expert witness is someone identified by the court as having qualifications and experience relevant to the legal issue before the court. They are an independent member, engaged with the purpose of assisting the court, rather than as an advocate for a particular party. They are permitted to advance opinion in their field of expertise, which is legally admissible.
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Regarding a diagnosis of brain death for transplantation purposes, which ONE of the following statements is NOT a requirement?
Answer: B: Brain death is said to be present in a patient with irreversible cessation of function of brainstem function, and is diagnosed via repeated clinical examinations. Testing for brain death must be carried out with the patient at normal body temperature and BP, no indication of endocrine or metabolic dysfunction, and in the absence of sedatives or muscle relaxants.
Confirmation is reached via absence of reflexes including corneal, pupillary, spino-ciliary, vestibulocochlear, oculocephalic and cough. There should also be absent responses to pain, atropine injection, and absent respiratory effort at PCO2 over 60 mmHg with adequate oxygenation. In consideration for organ transplant, examinations should be carried out by at least two experienced doctors, neither of whom are on the transplant team, one of whom has not been directly involved with the patient’s current care.
Regarding coronial investigations, which ONE of the following statements is TRUE?
Answer: C: Requirements for coronial notification vary between jurisdictions; however, relevant situations usually include those in which:
A coronial inquiry may only be instituted if the death has been reported. The responsibility of the coroner is to confirm the identity of the deceased, the details and cause of a death, and any individuals contributing to the death. The coroner may comment on any matter relating to the death, in terms of public health or safety, or administration of justice. They may not include a finding that any person is guilty of an offence – such reports should be passed to the Director of Public Prosecutions for consideration of action.
An 82-year-old woman with severe Parkinson’s disease is transferred from a nursing home following an apparent benzodiazepine overdose. You are the senior doctor in the ED, and the attending paramedic informs you on arrival that an advanced healthcare directive at the nursing home states that the patient is not to be resuscitated. In this situation, which ONE of the following statements is TRUE?
Answer: A: An advance health directive allows a patient to determine medical treatments in advance. It may prevent interventions likely to have been unwanted by the patient. It should include specific elements:
Another person is usually named as guarantor of the document. Any decisions made on the ongoing care of the patient should be made following inspection of her advanced directive. This allows confirmation that it is applicable to current situation, and provides information as to what treatment is acceptable to the patient. It is therefore reasonable to continue supportive care as indicated until the document is available. An advanced health directive is legally invalidated in cases of self-harm and attempted suicide, although the patient may still be assessed as capable of consenting to or refusing treatment (see answer 22).
A junior trainee contacts the ED before the start of her morning shift, expressing concern that she is still mildly intoxicated following a departmental night out the previous night. A fellow junior notes a history of previous sick days around weekends, following social events. A senior nurse reports that the trainee has been uncharacteristically abrupt with patients over the previous weeks, particularly several with alcohol-related problems. When the nurse had raised this with her, the trainee had become defensive and dismissive.
Regarding management of an impaired health practitioner, which ONE of the following statements is TRUE?
Answer: B: AHPRA was formed by an Act of Parliament in 2009. All registered doctors in Australia must provide an annual statement, including declarations on the existence of any impairment, and whether there have been any issues in meeting the standards of the Medical Board of Australia.
An impairment includes any physical or mental impairment, disability, condition or disorder (including substance abuse or dependence) that currently affects, or is likely to detrimentally affect, a registered health practitioner’s capacity to safely practise.
Practitioners and employers are mandated by law to report certain notifiable conduct relating to registered health practitioners or students. Registered practitioners who fail to report appropriately may face disciplinary action by their national board. Notifiable conduct includes:
In the current situation, the doctor has not been intoxicated while working, and indeed, has absented herself from the workplace rather than do so. However, the reported pattern of recurrent absences and inappropriate attitude to certain patients raises concerns about the doctor’s well-being, as well as being a possible issue with discipline or unacceptable values. Chronic low-grade stress – burnout – may be difficult to recognize initially, but changes in behaviour, loss of empathy, and dependence on drugs and alcohol are features of concern. Suspension may remove the doctor from a situation of risk while further assessment is made; however, it may also be seen as ‘proof’ of wrong-doing.
When a health-related notification is received by AHPRA, the health practitioner or student may be subject to a health assessment by a relevant national board to ensure appropriate action is taken, if required, to protect the public. AHPRA is a regulatory body; assistance for the practitioner can be found via the Medical Association for each state.
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