Mandatory notification, professional boundaries and indemnity — structured SAQ (15 marks)

(a) Immediate professional duties (5 marks)

One mark per specific duty, with reasoning. Reasoning marks are awarded for naming the underlying principle (patient safety first; mandatory notification threshold met; loyalty to colleague is not a defence against a public-protection duty). ^[1][3]

• Patient safety first. Ensure no patient is put at risk today. The trainee should immediately raise the concern with the Director of Obstetrics / on-call consultant and ask that Dr B be removed from clinical duties pending assessment. Patient safety is the threshold consideration; rumour alone is a trigger for action, not for inaction. ^[1]
• Document contemporaneously. Make a time-stamped, factual note of the conversation with Dr A — what was said, who was present, what was not said. Stick to fact, not opinion or motive. Contemporaneous notes are the strongest evidence; later notes are contested. ^[1][3]
• Notify the Training Supervisor and the College. The trainee has a duty to discuss the concern with their supervisor and, if the threshold is met, with the RANZCOG Training Program. The supervisor is not a substitute for the regulator. Loyalty to a colleague does not override the public-protection duty; confidentiality to Dr A is overridden by the risk to patients. ^[3]
• Make a mandatory notification to AHPRA if the threshold is met. The threshold is 'reasonable belief' that the practitioner has an impairment that, when practising, may place the public at risk. Reasonable belief is an objective standard, not certainty. Failure to notify when the threshold is met is itself a breach. ^[3]
• Support the practitioner. Encourage Dr B to self-report and to engage with the practitioner health program. The duty is to patient safety, not punishment; rehabilitation is the goal where impairment is the driver. ^[1][4]

(b) The four mandatory-notification triggers (4 marks)

One mark per trigger, with the threshold test. ^[3]

• Risk to public (s 140(1)(a)) — reasonable belief that another practitioner has placed the public at risk of substantial harm because of a significant departure from accepted professional standards. Threshold: 'reasonable belief' — objective, not certainty. ^[3]
• Impairment (s 140(1)(b)) — reasonable belief that the practitioner has an impairment (physical or mental) that, when practising, may place the public at risk. Threshold: 'may place' — risk, not harm, triggers the duty. ^[3]
• Conduct — intoxicated practice, sexual misconduct, failure to comply with conditions (s 140(1)(c)) — these are named notifiable conduct categories. Threshold: specified in the section; intoxicated practice is itself enough. ^[3]
• Notifiable conduct — the conduct in (c) when it is of a serious nature, plus any other conduct the regulator considers professional misconduct. Threshold: 'serious nature' — a matter of degree. ^[3]

(c) Indemnity organisations and cover types (4 marks)

One mark per organisation, one mark for the claims-made/occurrence distinction plus run-off. ^[4][5][6][7]

• The four ANZ medical defence organisations: Avant Mutual, MDA National, MIGA, Medical Protection Society (MPS). Run from memory — examiners test this. ^[4][5][6][7]
• Claims-made cover is triggered when the claim is notified during the policy period; events before the retroactive date are not covered. Occurrence-based cover is triggered by when the event occurred, regardless of when the claim is made. Run-off (tail) cover is required on cessation of a claims-made policy unless the practitioner remains in continuous cover or the MDO provides free run-off for retirement. ^[4][5][6][7]

(d) The drug register request (2 marks)

• Refuse to sign — signing for a drug not witnessed administered is falsification of a register and is itself notifiable conduct. Documentation integrity is the duty; loyalty to a senior is not a defence. ^[1][2]
• Document the request and your refusal — contemporaneous note, raise with the Director, and notify your indemnity insurer. The insurer manages the response; do not engage with the regulator before advice. ^[1][3]