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5-28-00

URL:  http://caa.com.au/Features/Medical_Act


FORMAL SUBMISSION
 Chiropractorsè Association of Australia
(WA) Limited
Review of Medical Act 1894

Health Department of Western Australia March 2000

EXECUTIVE summary (May 2000)

The Chiropractorsè Association of Australia (WA) Limited (CAA 
(WA) 
Ltd) presents its response to the invitation to comment on 
the Review of the 
Medical Act 1894. 
The CAA (WA) Ltd has prepared this document in the belief 
that the views 
expressed will provide a different perspective on many health 
matters. 
Such a perspective would not normally be available because of 
the 
differences that have prevented positive communication 
between medicine 
and chiropractic in the past.
 The current state of health care in Western Australia cannot 
be divorced 
from its past history.  This submission details past events 
that have 
relevance to the situation existing today.   These events 
took place both 
nationally and internationally, as well as in Western 
Australia.
The Recommendations in ëPart Aè are considered first - from 
the point of 
view of public welfare.  Some are supported, whilst others 
are shown to be 
unsatisfactory in some respect.   Many Recommendations are 
not 
commented on because they are not directly concerned with 
public 
welfare.  Some matters are of particular concern to the CAA 
(WA) Ltd. 
1.     The CAA (WA) Ltd considers that without definition 
there are no 
boundaries to the practice of medicine.  This situation may 
have been 
justified in the past, but today there exists a number of 
health professions, 
unregistered as well as registered, who have developed well 
defined areas 
of expertise with knowledge, skill and experience well in 
excess of that 
possessed by general medical practitioners.  This situation 
requires 
recognition in the new Medical Act with a consequential 
definition of the 
boundaries of medical practice.        
2.     The present Medical Act is silent regarding the 
qualifications medical 
practitioners shall have before they are able to practise in 
areas in which 
their undergraduate medical course does not provide adequate 
training.  
Because the practice of medicine is not defined, any health 
service is 
regarded as a medical service and therefore is the province 
of registered 
medical practitioners to undertake.   Whatever justification 
there may have 
been in the past for such open-ended practice rights, the 
situation has 
changed with the advent of registration of non-medical health 
professionals. 
3.     The CAA (WA) Ltd considers private and public 
hospitals should not 
be restricted to services provided by medical practitioners.  
It is the just 
due of persons in hospitals to have access to the most 
effective and safest 
health services available.  Patterns of public patronage 
clearly demonstrate 
that services provided by general practitioners are not 
considered the safest 
and most effective health services available by a significant 
minority of the 
population in Australia.  Research evidence to be presented 
later under 
Cost Effective And Safe Chiropractic Care, partly accounts 
for this 
phenomenon.  The right of choice, particularly of people in 
hospital, is 
inalienable.  
Possibly the gravest problem facing medical care - medical 
error, is then 
considered.  The extent of the problem is revealed and the 
unfortunate 
consequences are reported.  The need for the Medical Act to 
specifically 
deal with the problem is emphasised. 
The last matter considered - under Part B - is the anti-
competitive 
arrangement that severely limits competition in the health 
sector.  Its 
history, extent and operation are detailed.  Some of the 
effects of 
registration adversely affect competition.  These instances 
are fully 
explained. 
How the health sector could be improved by the recognition of 
registered 
non-medical health services is then covered extensively.

ACKNOWLEDGEMENTS
 Authors : Douglas O Winter MA DC
and Michael R McKibbin DC
 On behalf of the Legislative Committee
Chiropractorsè Association of Australia (WA) Limited

TABLE OF CONTENTS
EXECUTIVE summary	1
1.       INTRODUCTION	3
2.       part a - CONSIDERATION OF THE RECOMMENDATIONS	3
2.1      RECOMMENDATION 1 - Objectives of the Medical Act
	3
2.2      RECOMMENDATION 2 - Defining The Practice Of Medicine
	4
2.3      RECOMMENDATION 5 - Membership of the Medical Board
	5
2.4      RECOMMENDATION 31 - Registration And Continuing 
Professional 
Development	5
2.5      RECOMMENDATION 39 - Effects Of Registration	5
2.6      RECOMMENDATION 55 - Grounds For Disciplinary Action
	5
2.7      RECOMMENDATION 75 - Restrictions In Advertising 
Medical Services
	8
3.       IATROGENESIS	9
3.1      THE EXTENT OF THE PROBLEM	9
3.2      COMMENT	11
3.3      MEDICAL ERROR IN WESTERN AUSTRALIA	12
3.4      AN ADDITIONAL OBJECTIVE	13
3.5      PROBLEMS IN THE USE OF PHARMACEUTICAL MEDICINE	14
3.5.1.      Diagnosis	14
3.5.2.      Utilisation of Medication	14
4.       PART B - NATIONAL COMPETITION POLICY	15
4.1      THE ANTI-COMPETITION EDIFICE	15
4.2      THE TRADE BARRIERS	16
4.2.1       Disinformation Barrier	16
4.2.2       The Ethics Barrier	17
4.2.3       Legislative Barrier	17
4.2.4       Access Barrier	17
4.2.5       Education Barrier	18
4.2.6       Economic Barrier	19
4.2.7       Scope of Practice Barrier	21
4.2.8       Frequency Barrier	22
4.2.9       Gate-Keeper Barrier	22
4.3      SECTION 1 - Cost Effective and Effective 
Chiropractic Care in Hospital-Related 
Settings	25
5.       conclusion	28
appendix #1	29
Medicine And Chiropractic - An Historical Perspective	29
More Recent Initiatives Regarding An Integrated Health Care 
System	30
appendix #2 -	32
Cost Effective And Safe Chiropractic Care	32
A)      Cost effectiveness	32
B)      Safety	37
references	39