Scott Lynda: Health Practitioners Competence Assurance Bill — In Committee 
Scott Lynda: Health Practitioners Competence Assurance Bill — In Committee 
[Volume:611;Page:8140] 
Dr LYNDA SCOTT (NZ National—Kaikoura) 
: 
 Part 5 deals with appeals to the District Court and the High Court and I think that we will see the concept of scopes of practice really being tested out in courts of law. A person has the right of appeal against a decision made by an authority to decline or suspend that person’s practising certificate or include conditions in that person’s scope or proposed scope of practice. It may be that foreign doctors in this country may appeal and challenge a judgment over scopes of practice and a person’s right to practice within a particular scope. It will come down to the definition of what an individual can do. We heard about Dr Monty Hornbeck. If one were to say that he could practise in a limited scope or try to deny him practice if he appealed that then he could look at grounds for denying him a limited scope or not denying him that scope but allowing a broader scope. This is where we will find that people will test the concepts. It will probably take some years before there is case law that will really define and differentiate where the grounds of that new term lie. 
The terms we heard used about scopes of practice were “leading” “cutting edge” and one that was used under the Resource Management Act: “permissive”.There was a similar sort of permissiveness there about scopes of practice in that we will find how it works when we look at people challenging a decision through the District Court. I bring up the situation in Opotiki at the moment where nurses who are running the local health centre hospital have become quite concerned that they do not have medical cover. That happened on the West Coast as well. Because they had a real lack of locum relief practice nurses were doing first-line call in the weekends. If we are to look at people practising within their scopes of practice—and they can be taken to the disciplinary tribunal if they practise outside their scope—what will happen to the nurses on the West Coast and in Opotiki who feel that basically they are being made to practise outside what would be a safe scope of practice because there are no doctors there? There are 10000 people in Opotiki with no after-hours doctor service. Nurses are on the front line and some of them are expressing concern—just as the nurses down on the West Coast did—that they are being asked to practise outside of what would be their normal scope of practice. They are having to develop diagnostic skills that they feel very concerned about because they do not have the back-up. Nurses on the West Coast pulled out of doing the after-hours roster. They did not feel that they wished to be placed in that sort of position. 
We have heard a lot from the Minister in recent times about the development of nurse practitioners. There is no problem with developing a nurse-practitioner concept so long as they can still practise within the bounds of their training. With scopes of practice we do not want to see our medical and nursing systems being downgraded so that there is a lower level of ability especially in rural areas to develop and provide services. 
Under the bill people who do practise outside their scope are really putting themselves on the line. However People practise outside their scopes every day in this country. It will be interesting to see how that works under the appeal situation. If the system is such that people are pushed to work in that way who will get the blame? It is always the nurse and doctor on the front line who end up before the disciplinary tribunal and who have to take the rap. Eventually they are the ones who will appeal and use Part 5 through the appeals process.