The Student Who Witnessed an Impaired Colleague
Mr Tan is a third-year student paramedic on a 6-week clinical placement with a metropolitan ambulance service. During a night shift he observes a registered paramedic, Ms Reid, prepare and administer what Ms Reid says is morphine to a patient with suspected fractured femur. Mr Tan notices that Ms Reid draws up 10 mg when the protocol and the patient's weight indicate 5 mg. He raises it quietly; Ms Reid says 'I know what I'm doing' and administers the full dose. The patient later becomes drowsy and requires naloxone. Mr Tan also notices Ms Reid's speech is slightly slurred and she smells of alcohol. He is supervised by Ms Reid for the rest of the shift. He is worried about his placement assessment, which Ms Reid will contribute to. He tells no one that night. Two days later he mentions it to a university clinical coordinator, who asks whether he wants to 'make it formal'.
1. Analyse Mr Tan's obligations under the code of conduct and the notifications framework. Is he a mandatory notifier?
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Mr Tan is a student, not a registered health practitioner. Mandatory notification obligations in the National Law attach to registered health practitioners (and to employers and education providers in specified circumstances). A student is not a registered practitioner for this purpose, so Mr Tan is not personally a mandatory notifier in the strict statutory sense.
However, that does not mean he has no obligations. The student code of conduct and his university's placement requirements impose expectations of professional behaviour, including protecting patients from harm and reporting concerns through appropriate channels. The code's core principles - patient safety first, acting within scope, honesty, and raising concerns about unsafe practice - all point to reporting.
Even for registered practitioners, the mandatory notification threshold is a reasonable belief that a practitioner has practised while intoxicated or has placed the public at risk because of impairment. Here there is a specific clinical event (10 mg instead of 5 mg), a patient harm outcome (respiratory depression requiring naloxone), and observed signs consistent with intoxication. That would comfortably meet the threshold if Mr Tan were registered.
So the answer is: not a mandatory notifier, but professionally obliged to escalate, and the escalation should be to the placement supervisor or clinical educator and the university, not left to a corridor conversation.
2. What are the barriers Mr Tan faces, and how should he manage the conflict between patient safety and his assessment?
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The barriers are real and the Board-style exam expects them to be named:
- Power imbalance - Ms Reid supervises him and contributes to his assessment; a poor report could affect his degree.
- Hierarchy and loyalty - 'dobbing in' a colleague feels disloyal, especially in a small team.
- Uncertainty - he is a student; he may doubt his own reading of the drug chart.
- Fear of being wrong - if Ms Reid was not impaired, he fears looking foolish.
Managing the conflict. Patient safety is not negotiable and is not balanced against his grade. The correct reasoning is that a patient has already been harmed and the risk is ongoing (Ms Reid may be on shift again). His duty is to report promptly, and the system is designed so that the report is about the event and observed facts, not a character judgement.
Practical steps: document contemporaneously what he saw (dose, time, patient response, Ms Reid's speech and smell of alcohol) while it is fresh; report to the most senior appropriate person outside the immediate line - the shift supervisor, clinical educator, or the service's clinical governance unit - and also notify the university; ask for a written record of the report; and ask to be supervised by someone else for the remainder of the placement. He should not confront Ms Reid alone or investigate the drug chart himself.
3. Suppose the matter is notified to the Board. Outline how the Board would assess it and what immediate action might follow.
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The Board would first triage the notification: is there a serious risk to the public that requires action before the investigation is complete? The alleged facts - practising while apparently affected by alcohol, a dosing error, patient harm - are high-risk indicators.
Assessment. The Board would consider the source and credibility of the information, the seriousness of the alleged conduct, whether the conduct is repeated or isolated, and whether the practitioner has been notified and given an opportunity to respond. It may ask the notifier for a statement and the employer for the incident report and drug charts.
Immediate action. Under the National Law the Board can take immediate action if it reasonably believes the practitioner poses a serious risk to persons and that action is necessary to protect public health or safety. Options include suspending registration, imposing conditions (for example, no night shifts, no access to schedule 8 medicines, supervised practice), or accepting an undertaking. Immediate action is protective, not punitive, and can be taken before the investigation concludes, but the practitioner must be given a chance to respond unless the delay would itself create a risk.
Investigation. The Board may appoint an investigator, refer for a health assessment if impairment is suspected, or refer directly to a panel or tribunal if the conduct is serious. A health assessment pathway is common where impairment by alcohol or drugs is alleged; a performance pathway is more apt for competence issues. The outcome might be conditions, a caution, suspension, or referral to the tribunal for more serious disciplinary findings.