Impaired colleague: mandatory notification to Ahpra

Two duties arise at once here, and both must be met. The first is immediate patient safety: an apparently intoxicated surgeon must not operate. The registrar should escalate to the senior surgeon on call, the anaesthetist and the hospital's medical administrator or duty executive so that the fellow is stood down and the operation proceeds with a fit surgeon.

The second duty is regulatory. Under the Health Practitioner Regulation National Law, every registered health practitioner must make a mandatory notification to Ahpra if they form a reasonable belief that another practitioner has engaged in 'notifiable conduct'. The four categories are practising while intoxicated by alcohol or drugs, sexual misconduct in practice, placing the public at risk of substantial harm because of an impairment, and placing the public at risk by a significant departure from accepted standards.

This situation meets the threshold. There are direct observations of intoxication (slurred speech, ataxia, smell of alcohol), the fellow is about to practise, and there has already been a near miss. Ahpra's guidelines on mandatory notifications (2020) explain that the notification must be made as soon as practicable, that the notifier is protected from civil, criminal and administrative liability when acting in good faith, and that the employer also has a separate mandatory notification duty.

Handling it informally, or leaving it for the day team, does not satisfy the law and leaves patients exposed. Police involvement is not the regulatory pathway and is not required for practising while intoxicated, although hospital security may be needed if the fellow will not stand down.

The fellow's welfare matters too. Impairment from alcohol is a health problem, and Ahpra's health program and the doctors' health advisory services in each state exist to support practitioners into treatment.