Case study
Managing clinician’s conflicts of interest in the public health system: the ICAC experience

Speaker:
Vicki Klum
Senior Corruption Prevention Officer, Corruption Prevention, Education and Research, Independent Commission Against Corruption

Abstract:
Public sector organisations that deliver health services face a range of corruption risks in both their clinical and corporate functions. In 2006, the ICAC published a report based on an extensive consultation with area health services and other organisations within the health sector to obtain their views about key corruption risks that they face, and how these corruption risks could be addressed. The report synthesised current knowledge of corruption risks in the health sector and the corruption risks identified from the experience of the ICAC and public health organisations and other stakeholders. Two of the four main corruption risks identified in the project concerned the potential for conflicts of interest.

In the health sector, it is common for clinicians to have private interests outside their work for the public health system. Conflicts of interest are not restricted to clinical staff; they are also a risk for non-clinical staff. The ICAC project focused on clinical staff because this seemed to be an area that was particularly hard for public health organisations to deal with. Consultation with the sector confirmed this view and comments tended to focus specifically on the activities of specialist doctors: staff specialists and VMOs.

Having private interests is not in itself a problem; however, problems can occur when these interests are not managed effectively, or improperly influence decision making. Potential conflicts of interests commonly occur in relation to:

• the provision of clinical services in the private sector, such as having a private practice or having a second job working in a private hospital
• the provision of private health care services in the public sector, including when private patients are seen in public facilities
• private business interests, such as owning or having a financial interest in a business that makes products that are used in clinical work
• research work and private interests, including a chief investigator of a research study having a financial interest in a product or therapy being trialled
• administrative work and private interests, such as where the person responsible for coordinating the purchase of specialist medical equipment has a relationship with one of the suppliers of the equipment.

Clinician’s relationships with suppliers may involve the provision of, for example, gifts, corporate hospitality and overseas travel. A common example is the relationships that exist between medical professionals and pharmaceutical companies. These issues have received some attention within the medical profession and were explored in the project in terms of possible corruption risks.

This presentation is based on the findings of the ICAC’s project and ongoing liaison work with the public health sector in NSW.