Decision making - healthcare decisions

In effect from: 1 July 2025

The Right to Information Act 2009 (Qld) (RTI Act) gives people the right to apply to an agency or Minister for access to documents. This right is subject to limitations set out in section 47(3).

Sections 47(3)(a)-(f) set out when an agency can refuse access to information. This page explains how to apply section 47(3)(d):

• access can be refused to the extent the document comprises an applicant’s relevant healthcare information the disclosure of which might be prejudicial to the physical or mental health or wellbeing of the applicant under section 51.

Note: references to an agency on this page include a Minister.

Healthcare decisions

A healthcare decision is a decision to refuse access to the applicant's own relevant healthcare information because releasing it might be prejudicial to the applicant's physical or mental health or wellbeing.

The power to make healthcare decisions can only be exercised by the principal officer of the agency or Minister, or given to an appointed, appropriately qualified healthcare professional.

If a healthcare decision maker refuses access under a healthcare decision, they can direct that access be given to an appropriately nominated and approved healthcare professional. It will then be up to the nominated healthcare professional to decide whether to give the applicant access to all or part of the healthcare information.

Healthcare decisions can only be externally reviewed by the Information Commissioner.

Primary decisions

The phrase 'primary decision' refers to an access decision which is not a healthcare decision, for example a decision to refuse access to exempt information.

The primary decision maker must decide whether access should be refused to information other than under a healthcare decision. This includes deciding whether relevant healthcare information is exempt or contrary to the public interest to release.

The healthcare decision maker should only be asked to consider making a healthcare decision on relevant healthcare information the primary decision maker considers can otherwise be released, ie unless a healthcare decision is made.

What is relevant healthcare information?

Relevant healthcare information is healthcare information given by a healthcare professional. It is not limited to medical information prepared by a registered medical practitioner. It extends to information prepared by a psychologist, social worker, registered nurse or other healthcare professional.

Because of the broad range of information that is considered to be relevant healthcare information, many agencies hold this type of information, although on most occasions it will be held by a Hospital and Health Service.

Who can be an appropriately qualified healthcare professional?

A healthcare professional means:

…a person who carries on, and is entitled to carry on, an occupation involving the provision of care for a person’s physical or mental health or wellbeing, including, for example—

(a)          a doctor, including a psychiatrist; or

(b)          a psychologist; or

(c)          a social worker; or

(d)          a registered nurse.

Appropriately qualified means having the qualifications and experience appropriate to assess relevant healthcare information.

This is a non-exhaustive list.

Deciding to refuse access to relevant healthcare information

The healthcare decision maker should consider:

• if the information is relevant healthcare information of the applicant; and
• if giving the relevant healthcare information to the applicant might prejudice their physical or mental health or wellbeing.

Before providing relevant healthcare information to the healthcare decision maker to make these determinations, the primary decision maker should determine whether other grounds of refusal apply, eg whether it is exempt or contrary to the public interest to release. If so, access cannot also be refused under a healthcare decision.

Might disclosing the relevant healthcare information to the applicant be prejudicial to their physical or mental health or wellbeing?

For access to be refused under a healthcare decision there must be a real and tangible possibility of prejudice to the applicant's health or wellbeing if they receive the information. The anticipated prejudice must not be fanciful, remote or far-fetched (S and Medical Board of Queensland (Unreported, Queensland Information Commissioner, 12 October 1994)).

Healthcare decisions must be made on a case-by-case basis, taking into account all of the relevant factors relating to the specific content of the information and the individual considerations relating to the applicant. It is not appropriate, for example, to make a broad policy decision that a document which contains information about an applicant’s psychiatric diagnosis will, in every case, cause prejudice to the applicant’s physical or mental health or wellbeing.

On external review, the Office of the Information Commissioner (OIC) will expect the healthcare professional to explain how the disclosure of the healthcare information might have a detrimental impact on the applicant. The reasons for making the healthcare decision should be documented.

Reasons for a healthcare decision

It is important to document why the health care decision was made at the time it was made. If an applicant applies for external review of a healthcare decision, the OIC will request the reasons for the healthcare decision. This will be much simpler to provide if they were recorded when the decision was made.

Th reasons do not need to be a formal statement—bullet points in an email, for example, could be sufficient—but there should be a record of why giving the applicant their relevant healthcare information would have a detrimental effect on the applicant's health or wellbeing.

Documenting these reasons is an important part of decision-making accountability and can assist in quickly and efficiently resolving an external review.

Primary decision makers could consider developing a brief form the healthcare decision maker could complete to indicate their reasons. The healthcare decision maker's reasons could also be provided verbally to the decision maker, who could record them in a file note.

Making a healthcare and a primary decision

The power to make primary decisions and the power to make healthcare decisions are differently delegated powers with different review rights.  Accordingly, it is possible to make two decisions on a single application when it involves relevant healthcare information.

An agency will need to make two decisions, ie a primary decision and a healthcare decision, if:

• the application is solely for relevant healthcare information and:
  • only some of it might be prejudicial to the applicant's wellbeing; or
  • some it is exempt or otherwise contrary to the public interest to release and some of it might be prejudicial to the applicant's wellbeing; or
• the application is for relevant healthcare information which might be prejudicial to the applicant's wellbeing and other, non-healthcare information.

An agency will only need to make one decision (ie a healthcare decision) if the application is solely for relevant healthcare information that might be prejudicial to the applicant's wellbeing and none of it is exempt or otherwise contrary to the public interest to release.

Unless the entire application is personally decided by the principal officer, the healthcare decision maker must make the healthcare decision and the primary decision maker must make a decision on the information not covered by the healthcare decision.

It is important that each decision maker only makes the decision they have the authority to make. The division of decision making must be appropriately managed and communicated to the applicant, along with the correct review rights for each decision.

Ideally, the decisions should be communicated simultaneously to the applicant (eg, included in the same envelope or attached to the same email). An explanation should be included as to why the applicant is receiving two decisions.

Access through a nominated healthcare professional

If the principal officer, Minister or appointed healthcare professional decides to refuse access to a document containing the applicant’s relevant healthcare information, they may instead direct that access is given to the applicant through an appropriately qualified healthcare professional, identified by the applicant.

The applicant can nominate the healthcare professional through which they wish to access the documents. However, the principal officer, Minister or appointed healthcare professional has the discretion to not approve the applicant’s nominee. There is no criteria in the RTI Act on which to base this approval.  It is anticipated that wherever possible, the applicant’s nominated healthcare professional will be approved, taking into account their qualifications and relationship to the applicant.

If the applicant fails to nominate an appropriate healthcare professional it may not be possible for them to access the documents. It is therefore important to assist the applicant with the process of nominating a healthcare professional.

It is also good practice to check with the nominated healthcare professional that they understand and accept responsibility for determining disclosure of the relevant healthcare information to the applicant. The nominated healthcare professional can then decide:

• whether or not to disclose all or part of the relevant healthcare information; and
• the way in which the information is disclosed to the applicant.

To ensure the nominated healthcare professional is still practicing and has no limitations placed on their right to practice, you can research the practitioner on the Australian Health Practitioner Regulation Agency's Register of Practitioners.

Review rights

As noted above, the decision to refuse access to relevant healthcare information because it might be prejudicial to an applicant's physical or mental health or wellbeing cannot be internally reviewed. Only external review to the Office of the Information Commissioner can be sought.

Some decisions relating to healthcare information are not reviewable at all. These non-reviewable decisions are:

• whether or not to approve a nominated healthcare professional
• directing that access be given to a nominated health care professional under section 77 of the RTI Act
• the nature of the access the nominated healthcare professional decides to give the applicant.

Sample decision notices