Listening to webinar now with @ASA_Australia @snouzin and Avant lawyers. Opens with fit-testing - what is the legal obligation for employers in Australia to fit-test PPE. Australian standards say that 'Employers shall provide PPE.' Does shell = must?

Employer must take all reasonable steps to ensure health and safety of employees. Employees also have obligation to keep self safe. Inconsistency in documentation about fit-testing vs fit-check across Australia. Notes that DoH haven't enforced the standards Australia document.

If a mask has a high chance of not fitting - the employee has a responsibility to let the employer know that the mask doesn't fit. Notes that discrimination laws are at play here also -eg race / gender faces - hospital could be discriminatory if only supplying a particular mask.

Suzi explains the difference between fit-check and a fit-test.

Fit check = user seal check, done each time by the user.

Fit-test is a qualitative or a quantitative test, performed by a qualified tester. Routine in other countries, and South Australia for all who do AGP's.

One reason health services give to not fit-test is that they have insufficient masks. Ethical decision making is important here. (I note the move to resume elective surgery ... on the basis that we have enough PPE).

Who is responsible for PPE in private practice? Person controlling a business or undertaking (the principle) vs the contractor. This will depend on contract between anaesthetist and hospital (or surgeon and anaesthetist).

Most anaesthetists have no contract with private hospitals. Legal aspect is to adhere to bylaws /guidelines of individual hospital. Some have bought own PPE as dissatisfied with hospital supply. If hospital agrees - it's ok to bring. But if hospital say no, then you can't.

Concerns about consitency in PPE across staff in one hospital. Individual hospitals and anaesthetists need to come to an agreement re personal PPE. If hospital doesn't have safe PPE, and won't let you bring your own = your only recourse is to not work there.

Notes that refusing to work must be done with caution, needs to be reasonable, open, documented etc. In an emergency situation - medical board notes that not obliged to provide care if own safety cannot be guaranteed (notes this is open to interpretation).

Clash of duties: employer to provide safe workplace; employee to look after own safety; to look after patients. Need to exercise standard of care - reasonable care and skill based in negligence law. Legal answer isn't clear, ethical view needs to be considered.

Consider - this doctor, this patient, this PPE, this situation. This is all considered in negligence claims.

Employers must use available information in determining what is reasonable PPE, including documents produced by speciality colleges. They don't have to re-invent the wheel each time.

Guidelines for PPE have changed overseas in countries with many cases due to shortages of PPE. What happens if this happens here? Legal advice is that there must be regard to current guidance. Notes that guidance is changing more rapidly than every before.

Notes ethical issues of PPE are not easy, particularly when resources are tight. There are no clear answers in ethics!

Does higher level PPE incite fear in patients? Is this actually a real threat? Employers need to provide training and supervision of PPE - difficult if individuals bring from home. What if other staff become infected while assisting during more complex doffing process?

Discrimination question: if an employer prevented a woman from working with covid19 patients due to pregnancy = discrimination. Work health and safety exemption (age, pregnancy, comorbidities) will mean discrimination is not unlawful. Best to work together on this.

AHPCC have given excellent advice for vulnerable workers, as have RANZCOG. Employers and employees should ideally work together on work exclusion issues. Notes a number of discrimination issues have arisen in these 8 weeks of #covid19.

Beards and masks: it is a legitimate requirement for an employer to ask an employee to be clean shaven in order to be safe, even if the beard is there for religious reasons. Or provide an alternative mask, or alternative duties if possible.

Today the government has indicated elective surgery will start next week, at 25% usual capacity. What should anaesthetists do if lists do not fulfil policy decisions? Clinical judgement, with assistance from relevant surgical college. Does it require a mandatory report to AHPRA?

Is using excess PPE putting the public at risk, such as doing more than the advised 25% volume? Policy vs legal aspects. How would this play out with the medical board? Has not been tested.

National Cabinet considers advice of AHPCC; and then issue guidance to the public. There is no legal effect on this guidance - it is guidance. Public health direction may then issued by the state (law). Only SA made a public health direction about elective surgery (!).

Risk of adverse reputational issues for doctors who are using PPE outside of the issued guidance. (lock down discount botox doc I'm looking at you)

Anaesthetic pre-admission consults: telehealth medicare items have been quickly introduced for other doctors (video and telephone). Unfortunately didn't include anaesthetists. A number of weeks of consultation have occurred. Still unresolved. Talks ongoing.

What are the medicolegal issues of Telehealth - notes that guidelines dictate that a part of Telehealth is to determine whether a subsequent face to face is required.

Notes the Telehealth medicare items would just be for 6 months. Reluctance from MoH to introduce this for anaesthetists. Disturbing education gap re need to see patients prior to anaesthesia, particularly high risk patients having high risk surgery.

Lack of Telehealth item for anaesthesia means that patients must attend the hospital for their preanesthetic consultation. Is all this patient transport necessary in a pandemic? What is best for our patients?

Webinar now turns to @IntubateCovid registry. Is it safe medico legally to input deidentified patient information. Au legislation refers to identifiable pt and dr information. Need to identify privacy compliance of the org, and agreement that Au privacy laws are fulfilled.

Overseas transfer of patient information can be an issue. Is there a risk that the patient can be identified, even if de-identified. Can you re-identify? Take reasonable steps to ensure privacy of information you hold. The patient holds the power - consent sufficient.

How to document patient information if you are in PPE in theatre with a #covid19 patient? Anaesthetist is still responsible for documentation. Needs to be accurate. Can be done remotely.

(as an aside, @snouzin is an incredible chair here, every question is topical, pragmatic and practical)

Thank you Avant experts, @snouzin , Mark Sinclair for this excellent webinar. 200 participants. Recorded and will be available via the @ASA_Australia.