Thursday, 14 November 2024

Bills

Drugs, Poisons And Controlled Substances Amendment (Paramedic Practitioners) Bill 2024

Statement of compatibility

Natalie SULEYMAN (St Albans – Minister for Veterans, Minister for Small Business, Minister for Youth) (10:17): In accordance with the Charter of Human Rights and Responsibilities Act 2006, I table a statement of compatibility in relation to the Drugs, Poisons and Controlled Substances Amendment (Paramedic Practitioners) Bill 2024:

In accordance with section 28 of the Charter of Human Rights and Responsibilities Act 2006 (the Charter), I make this statement of compatibility with respect to the Drugs, Poisons and Controlled Substances Amendment (Paramedic Practitioners) Bill 2024 (the Bill).

In my opinion, the Bill, as introduced to the Legislative Assembly, is compatible with the human rights protected by the Charter. I base my opinion on the reasons outlined in this statement.

Overview of the Bill

This Bill amends the Drugs, Poisons and Controlled Substances Act 1981 (the Act) to:

• establish paramedic practitioners as a class of registered paramedics;

• authorize paramedic practitioners to obtain, possess, use, sell and supply certain substances and for other purposes; and

• expand access to the monitored poisons database, which contains records of patients’ prescription and supply history for high-risk medicines, to paramedic practitioners.

In response to the growing high demand for urgent care in Victoria, the Bill aims to:

• increase accessibility and timeliness of healthcare, particularly in rural and regional areas;

• enable paramedic practitioners to autonomously assess, diagnose and treat patients, and make clinical decisions, in the field under an advanced scope of practice;

• reduce unnecessary patient transfers to hospital and hospital admissions;

• reduce pressure on emergency departments, public hospitals and general practitioner patient loads; and

• support the retention of experienced paramedics through greater career opportunities and job satisfaction.

Human rights issues

The Bill engages the following human rights under the Charter: the rights to life (section 9); privacy (section 13(a)); and property (section 20).

Right to life

Section 9 of the Charter provides that every person has the right not to be arbitrarily deprived of life. The right to life is one of the most fundamental of all human rights. It is concerned with both the protection and preservation of life.

The right to life has not been examined by the courts in any detail in Victoria. Under international human rights law, the right to life includes an obligation on the state to refrain from conduct that results in the arbitrary deprivation of life, as well as a positive duty to take appropriate steps to safeguard life. This includes an obligation on the State to prevent arbitrary deprivation of life, particularly towards persons in vulnerable situations where threats to life are reasonably foreseeable. An ‘arbitrary’ deprivation of life may be described as one that is unreasonable or disproportionate.

In recent years, there has been growing and increasingly complex demands on urgent care services in Victoria. This has placed increased pressure on health services, compromising the outcomes for patients including quality and quantity of life. The Bill establishes the role of the paramedic practitioner, which aims to reduce pressure on general practitioners and emergency departments, and improve the accessibility and timeliness of healthcare. In this manner, the Bill can be characterised as promoting the right to life.

On the other hand, clause 5 of the Bill authorizes paramedic practitioners to obtain, possess, use, sell and supply certain Schedule 2, 3, 4 or 8 poisons approved by the Minister under section 14A of the Act. Given the inherent dangers of Schedule 4 and 8 poisons and the risk of their misuse by persons with a drug dependence, the scheme’s implementation will be relevant to the right to life in relation to the adequacy of steps taken to safeguard against risks to life.

Accordingly, the Bill provides for strict regulatory controls that are reasonable and proportionate to the risks to human life posed by the scheme. First, the authorizations will be subject to a range of regulatory requirements and sanctions relating to the administration, prescription and supply of Schedule 4 or 8 poisons, including:

• A requirement that paramedic practitioners take all reasonable steps to check the monitored poisons database prior to prescribing or supplying any Schedule 8 or certain Schedule 4 poisons to a patient (clause 10, new section 30GA). This obligation is aimed at facilitating safer clinical decisions and preventing the misuse of high-risk medicines and drugs of dependence;

• A requirement for paramedic practitioners to apply for a Schedule 8 permit if they consider it necessary to administer, supply or prescribe a Schedule 8 poison to a drug-dependent person or for a continuous period exceeding 8 weeks in certain circumstances (clause 14, section 34);

• Offence provisions in relation to the administration, supply and prescription of Schedule 8 poisons (clauses 16 and 187, sections 34B and 34C), a failure to comply with Schedule 8 permit requirements concerning quantity and duration (clause 21, section 35), and the obligation to check the monitored poisons database (clause 10, new section 30GA);

• Record-keeping obligations, specifically the duty to record prescribed information in the monitored poisons database, in accordance with the requirements set out in Part 13 of the Drugs, Poisons and Controlled Substances Regulations 2017 (the Regulations) (clause 12, section 31(1) and (2)); and

• A mandatory notification provision, specifically the requirement to notify the Secretary of reportable drug events in relation to the administration, supply and prescription of Schedule 4 and 8 poisons (clause 13, section 32A(1)).

These safeguarding provisions are directed at reducing the incidence of harm, including death, from the administration, supply and prescription of high-risk substances. To further minimise risks to life, the Bill introduces stringent eligibility criteria in relation to the authorization of registered paramedics as paramedic practitioners, specifically:

• Paramedic practitioners will be required to have prescribed postgraduate qualifications and experience (clause 4, new section 4(1)). These mandatory minimum requirements are aimed at facilitating high professional standards and ensuring that paramedic practitioners have the knowledge and skills required to safely provide treatment for their patients; and

• Practice limits apply in relation to registered paramedics who are subject to a condition, limitation or restriction prohibiting the obtaining, possession, use, sale or supply of a Schedule 2, 3, 4 or 8 poison, where they will not to be authorized under the Act to obtain, possess, use, sell or supply the relevant poison (clause 6, new subsection 14(3A)). These restrictions, which are consistent with those currently imposed on other practitioners (eg, registered nurses), protect against any risk of harm associated with practice of a practitioner who has been sanctioned by the Paramedicine Board of Australia.

Accordingly, I conclude the Bill is compatible with the right to life.

Right to privacy

Section 13(a) of the Charter provides that a person has the right not to have their privacy unlawfully or arbitrarily interfered with. An interference will be lawful if it is permitted by a law which is precise and appropriately circumscribed, and will be arbitrary only if it is capricious, unpredictable, unjust or unreasonable, in the sense of being disproportionate to the legitimate aim sought.

Clause 9 of the Bill amends section 30C(2) to expand the access to, and use and disclosure of, information on the monitored poisons database, to paramedic practitioners for certain specified purposes. The database relevantly contains confidential information of persons who are being supplied with monitored poisons, including their personal and health information. Additionally, clause 13 of the Bill amends section 32A(1) to extend the mandatory notification of reportable drug events to paramedic practitioners.

Accordingly, these provisions engage the privacy rights of patients whose health records are used, accessed or disclosed, or about whom reportable drug events are notified to the Secretary. However, any access, use and disclosure of information on the database and any notifications to the Secretary will be authorised by the Act, in circumstances that are consistent with the health privacy principles in the Health Records Act 2001. Therefore, any interference with privacy will be permitted by laws that are precise and appropriately circumscribed.

Further, paramedic practitioners will be authorised to access the monitored poisons database in the same way and for the same specified purposes as other prescribers (eg, registered medical practitioners, nurse practitioners). Such access is necessary to ensure that the database operates effectively to prevent misuse of high-risk medications. Moreover, the use, access and disclosure of health information is only authorised for confined purposes such as the medical treatment or care of a person, and it is an offence for anyone to access, use or disclose information if they are not authorised to do so by the Act. Similarly, the mandatory notifications to the Secretary are part of a suite of measures aimed at protecting against the misuse of Schedule 4 and 8 poisons. Given the above, I consider that any interferences with privacy will not be arbitrary because the new authorisations are appropriate, circumscribed and proportionate to the legitimate aims sought.

Finally, as the purpose of both provisions is to promote safe supply, prescription and dispensing practices and reduce harm from high risk medication and drugs of dependence, they serve important public policy objectives. As such, any limitation on privacy rights is thus proportionate to the objective of protecting individuals and the community at large from harm.

Thus, whilst the right to privacy may be engaged, it is not limited by the Bill because the new provisions are neither unlawful nor arbitrary. Accordingly, I consider that the provisions are compatible with the right to privacy in section 13(a) of the Charter.

Right to property (s 20)

Clause 11 of the Bill amends section 30J(1) of the Act, which provides immunity from liability to paramedic practitioners for anything done in good faith in carrying out any duty or function in relation to the monitored poisons database in accordance with the Act or the Regulations.

Insofar as a cause of action may be considered ‘property’ within the meaning of section 20 of the Charter, this provision may engage the right. However, even if this immunity provision could be considered to deprive a person of property, any such deprivation will be ‘in accordance with law’ and will therefore not limit the Charter right to property. This provision is drafted in clear and precise terms. In addition, any deprivation of a cause of action is reasonably necessary to achieve the important objective of ensuring that the paramedic practitioners can effectively perform their functions without the threat of significant personal repercussions. The scope of the immunity is also limited to good faith actions such that it is proportionate to the legitimate aim sought. As such, there are no less restrictive means of achieving the Bill’s objectives. Accordingly, the relevant immunity is, in my view, appropriately granted.

For these reasons, I consider that amended section 30J does not engage the right in s 20.

The Hon. Mary-Anne Thomas

Minister for Ambulance Services

Second reading

Natalie SULEYMAN (St Albans – Minister for Veterans, Minister for Small Business, Minister for Youth) (10:18): I move:

That this bill be now read a second time.

I ask that my second-reading speech be incorporated into Hansard.

Incorporated speech as follows:

Introduction

Victoria will be the first state to introduce the advanced practice role of paramedic practitioner in Australia. This innovative role will increase access to timely and appropriate healthcare with the first 25 paramedic practitioner graduates trained and on the road in regional Victoria by the end of 2026.

The paramedicine workforce plays a critical role in our healthcare system providing pre-hospital care, medical transport and emergency medical response to over 6.7 million Victorians.

Paramedics regularly transfer patients with serious, but not life-threatening, conditions to hospitals. With advanced clinical training, the new paramedic practitioners will be able to assess, diagnose and treat patients in the field, make clinical decisions and take pressure off our busy emergency departments. They will operate with more capabilities to make clinical decisions, and assess, diagnose, and treat many conditions locally, without the need to transfer patients to hospital.

They will add to other initiatives like our Victorian Virtual Emergency Department, which has seen over 400,000 patients, increasing healthcare timeliness and accessibility and reducing pressure on our busy emergency departments.

This delivers on the Allan Labor Government’s commitment to increase recognition of this important workforce whilst also addressing the national failings in our primary care system. This will be implemented through changes to the Drugs, Poisons and Controlled Substances Act 1981.

The proposed amendments will:

• establish and implement a new paramedic practitioner role in Victoria;

• expand the scope of practice not recognised in the existing legislation by authorising paramedic practitioners (that is, registered paramedics who have completed a prescribed postgraduate qualification and satisfied the prescribed experience requirements to autonomously obtain, possess, use, supply, administer and prescribe scheduled medicines under instruction;

• allow paramedic practitioners to access, use and disclose information on the monitored poisons database (SafeScript), and to require that paramedic practitioners check SafeScript before supplying or prescribing a monitored poison, similar to a registered medical practitioner or a nurse practitioner; and

• ensure that legislative amendments are in effect to provide authorisation in time for the first deployment of paramedic practitioner graduates in regional and rural Victoria in 2026.

The 2023–24 Victorian State Budget invested $20 million in this initiative, which is providing scholarships over four years to enable experienced paramedics to pursue a master’s-level clinical qualification in paramedicine.

The Master of Paramedic Practitioner program is being delivered by Monash University with the first intake of 30 students having commenced their studies in February 2024. The second cohort will commence their studies in February 2025.

These amendments provide the legal basis for Victoria to lead the way in advocating for the new role within the national workforce framework alongside other Australian jurisdictions.

This innovative Australian-first model of care will complement other health workforce models, including nurse practitioners and general practitioners.

Paramedic practitioners will support the delivery of integrated, cross-disciplinary and contemporary healthcare that meets the needs of our community.

I commend the Bill to the house.

David SOUTHWICK (Caulfield) (10:18): I move:

That the debate be adjourned.

Motion agreed to and debate adjourned.

Ordered that debate be adjourned for two weeks. Debate adjourned until Thursday 28 November.