Has Mr Bar-Mordecai established that he has a prima facie case?
104In Hunter v Commissioner of Police [2003] WASC 10, Pullin J had to consider applications brought under the Vexatious Proceedings Restriction Act 2002 (WA), where a similar onus is imposed by s 6(5). At [18], his Honour observed:
"18 To succeed on this application, s 6(5) of the 2002 Act requires me to dismiss the application if there are no prima facie grounds for the proposed proceedings. The ordinary meaning of the words prima facie is "at first sight; on the face of it; as appears at first sight without investigation": North Ganalanja Aboriginal Corporation v Queensland (1996) 185 CLR 595 at 615-616; Macquarie Dictionary. In the present context, the phrase "prima facie grounds" means, in my opinion, that there is a legal basis for the claim and that there is some evidence referred to in the affidavit in support of the application which, if accepted, would be capable of sustaining the proceedings: cf North Ganalanga (supra) at 639; May v O'Sullivan (1955) 92 CLR 654 at 658"
105That the duty which Dr XY owed Mr Bar-Mordecai, his patient, was a duty to take reasonable care, was not in issue, but that this duty encompassed what he seeks to pursue in these proceedings, was in issue.
106The application which the Medical Tribunal refused in 2009 depended on Mr Bar-Mordecai establishing that he was of 'good character'. Section 13 of the Medical Practice Act provided that a person could not be registered as a medical practitioner unless of good character, a term not defined in that Act. In Ex parte Tziniolis; Re Medical Practitioners Act (1966) 67 SR (NSW) 448, the meaning of the term in predecessor legislation was discussed by all members of the Court. At 451-2, it was observed by Walsh J:
"I am of opinion that, in dealing with this application, the court is required to examine for itself the evidence placed before it and to determine as a question of fact whether or not the court is satisfied that the applicant is a person of good character. If it is so satisfied, then, in a case such as this one in which no other matter relevant to the applicant's registration is suggested to be outstanding or to be in dispute, the court should make an order directing the board to register him. If not so satisfied, the court should decline to make any order. This accords with the opinion stated concerning the effect of similar legislation in In re Becker ([1934] S.A.S.R.137, at p.139).
In so far as the decision of the question of fact which the court has to determine may depend upon the onus of proof, I think it is clear that the onus is on the applicant. This does not mean that, if some particular act or conduct has been alleged as indicating that the applicant is not of good character, but no evidence at all is given in support of the allegation, the applicant has the onus of disproving that particular allegation. If an applicant produces some evidence of his good character, this would not be regarded as displaced or cut down merely because some charge had been made against him without any evidence to support it. But, if there are acknowledged writings or statements of the applicant which in their natural meaning provide evidence that he is not of good character and, if explanations are offered by the applicant designed to show that they do not really indicate that, I think the court may take such writings and statements into consideration if the explanations are unconvincing, even if the court may not be able to decide positively and confidently that the explanations are false. The question before the court is not whether it is satisfied affirmatively that the applicant is of bad character. The ultimate question for the court is whether it is satisfied that he is of good character.
Notwithstanding submissions to the contrary, I am of opinion that, in deciding this question, the court is required to consider matters affecting the moral standards, attitudes and qualities of the applicant and not merely to consider what is his general reputation.
I think, further, that we are entitled to inquire into what may be described as personal misconduct, as distinct from professional misconduct, in determining in this case whether or not the applicant is a man of good character, whilst recognizing that there may be some kinds of conduct deserving of disapproval which have little or no bearing on the question whether or not it is shown that an applicant for registration as a medical practitioner is a person of good character. In this respect, I think that some assistance can properly be obtained as to the mode of approach to be made from observations made in cases where the question was whether or not a person was a fit and proper person to be a barrister such as those made in Ziems v. The Prothonotary of the Supreme Court of N.S.W.(3) by Dixon C.J., at p. 285, by Fullagar J., at pp. 288 and 290, by Kitto J., at pp. 298 and 299 and by Taylor J., at p. 301."
107At 475-6 by Holmes JA:
"The Act provides for the circumstances in which the name of a registered medical practitioner may be removed from the register and the expression "infamous conduct in a professional respect" has been used to define such conduct. "Good character" is not a summation of acts alone, but relates rather to the quality of a person. The quality is to be judged by acts and motives, that is to say, behaviour and the mental and emotional situations accompanying that behaviour. However, character cannot always be estimated by one act or one class of act. As much about a person as is known will form the evidence from which the inference of good character or not of good character is drawn.
There is a problem of construction in the Act under consideration of which mention should be made. "Bad character" and "infamous conduct in a professional respect" are two different species. So that if a man of "good character" being registered, after registration loses that quality, it does not seem that he can be removed from the register. Does this mean that "good character" as used in the Act is a quality which if possessed is a virtue which can never be lost? If so, is the converse true? These questions would have to be answered if we thought that a man was not of good character at some point of time but when considering his application now we were at liberty to consider character as capable of change, so that he might have rid himself of that quality and acquired a better one. As will presently be seen I do not think that it is necessary to solve that problem in this case."
108Wallace P agreed with these observations, observing that in determining character, the manner in which evidence was given, was also an important factor to consider (at 451).
109Under s 14 of the Medical Tribunal Act, a person who had been deregistered was precluded from seeking registration. The only way such a person could again be registered was on a later review of the order by which the person was deregistered. That review had to be conducted in accordance with s 94A, which provides:
"94A Inquiry into review application
(1) A review under this Division is a review to determine the appropriateness, at the time of the review, of the order concerned.
(2) The review is not to review the decision to make the order, or any findings made in connection with the making of that decision, unless significant fresh evidence is produced that was not previously available for consideration, and the appropriate review body is of the opinion that, in the circumstances of the case, the decision to make the order, or any finding on which the decision was based, should be reconsidered.
(3) In addition to any other matter that the review may take into account, the review must take into account any complaint made or notified to the Board about the person, whether the complaint was made or notified before or after the making of the order that is the subject of the review and whether or not the complaint was referred under Division 3 of Part 4 or any other action was taken on the complaint."
110In Zaidi v Health Care Complaints Commission (1998) 44 NSWLR 82, Mason P discussed the onus which falls on an applicant to displace the original decision being reviewed. The critical issue on the evidence in that case was also whether good character had been established, so that the applicant could be returned to practice. Like the circumstances in Zaidi, Mr Bar-Mordecai commenced and initially pursued his application with a continuing attack on the 2000 decision, in which various complaints against him had been found proven. He also led evidence in support of his application from Dr XY and later gave evidence himself, as to the insight he had gained. It was only after Dr XY answered questions put to him by Tribunal members, as to the nature of the insights he believed that Mr Bar-Mordecai had achieved, which he agreed were more intellectual than emotional, that Mr Bar-Mordecai recanted his attack on the 2000 decision. That attack had earlier been pursued in other litigation and in both his evidence and submissions before the Tribunal. It was this alteration which was accepted by the Tribunal to have involved an opportunistic lie.
111Mr Bar-Mordecai explained in these proceedings that it was his own study of the applicable Rules, in the course of the Tribunal proceedings, which brought about his change and that the favourable opinions which Dr XY had earlier expressed and which he had relied on in the proceedings were wrong and had no foundation. That does not appear to have been something which Mr Bar-Mordecai revealed to the Tribunal. Had it been, that development might well have confirmed the view which the Tribunal otherwise reached, that Mr Bar-Mordecai did not have the capacity to intuitively recognise doctor/patient boundaries and appreciate the reasons for those boundaries, but had rather gained an intellectual understanding of those boundaries and a desire to avoid transgression from his recent study.
112In the result, it is difficult to see that it could conceivably be concluded that Mr Bar-Mordecai could establish that he has a prima facie basis for the proposed claim, or that the evidence he relies on to support that claim would, if accepted, be capable of sustaining the proposed proceedings.
113The evidence does not provide a basis for concluding that had Dr XY provided Mr Bar-Mordecai with the treatment he claims he did not receive, that would have resulted in a change in his character; or the intuitive recognition of doctor/patient boundaries and appreciation of the reasons for those boundaries, which the Tribunal considered that he did not have, or the Tribunal's acceptance that he was a person of good character. Nor does the evidence show that had he received the treatment he claims Dr XY should have provided, it would have resulted in the Tribunal taking any different view of the other concerns which it had as to his character, which the Tribunal discussed in its decision.
114Mr Bar-Mordecai finally sought to rely on his own report and that of Dr Teoh to establish that he had a prima facie case. His own report could not be received. Mr Bar-Mordecai does not have the expertise to give the opinions expressed in that report. As he explained, while he has a medical degree, the opinions there expressed were in reality but an account of his understanding of opinions Dr Lucire had expressed in some of his numerous sessions with her, but which she herself refused to provide in her own report.
115The basis of Dr Teoh's opinions is not adequately explained in his report, as Mr Bar-Mordecai himself accepted. Also to be considered is that Dr Teoh was clearly not instructed with all the relevant material. In particular, the evidence which Dr XY and Mr Bar-Mordecai each gave before the Tribunal and what Mr Bar-Mordecai revealed in these proceedings as to what transpired during the Tribunal proceedings, does not appear to have been disclosed to Dr Teoh.
116Mr Bar-Mordecai explained in these proceedings that gaining the necessary insight into his ethical obligations was not a matter which finally required psychiatric treatment at all. He had obtained those insights by his own study of the applicable ethical rules which bound him during the course of the Tribunal proceedings. He explained that it was that study which resulted in the change in his evidence, the change which the Tribunal considered involved an opportunistic lie. That account suggests that Mr Bar-Mordecai's earlier reliance on Dr XY's reports occurred at a time when he knew that he did not in fact have the insight which both Dr XY and Dr Phillips believed he had gained. Mr Bar-Mordecai's conduct in the proceedings was plainly an important matter to be considered by the Tribunal.
117When all of this is considered with the evidence that other psychiatrists' opinions do not support the claim which Mr Bar-Mordecai seeks to advance against Dr XY, it cannot be concluded that the evidence establishes that he has a prima facie case. Amongst many other things, for example, Dr Lucire observed in her report:
"It was his expectation that a period of treatment with Dr. XY might rehabilitate him, although it is hard to understand this kind of reasoning, based, as it is on a legal fiction that if a doctor commits transgressions it is because there is something wrong with him that is accessible to a medical specialty, psychiatry. This legal fiction spawns more legal fictions such as this contrived differentiation between "intellectual" and "emotional" "insight." This is a concept beyond my understanding, and one that appears in the Tribunal Judgment.
...
The NSW Medical Tribunal seems to have considered something that is 'not advisable in policy documents to be "a strike off' or "keep off the register" offence, and subject to something called "emotional insight" a concept in this context with which with which I am not familiar for which further "contemplation" is required.
With due respect, Dr XY's evidence with regard to his opinion at the hearing of
"at an intellectual level he accepts that what he has done is wrong but on an emotional level he doesn't want to"
with reference to Mr Bar-Mordecai's eleven year treatment of his former de facto wife makes not sense to me.
...
The damage alleged to flows from the right of the tribunal to choose what option it accepted from Dr. XY, between
"... it is not against the law, is it"
and
"... what most peers would think"
So what influenced the Tribunal (and it was influenced, as it accepted the second answer not the first) was what Dr. XY believed most peers would think. As Dr. XY had correctly stated, namely that treating a relative was not against the law or ethics but that "most peers would" think it was."
118It also has to be considered that the claim which Mr Bar-Mordecai seeks to pursue would be governed by the provisions of the Civil Liability Act, which include:
"5B General principles
(1) A person is not negligent in failing to take precautions against a risk of harm unless:
(a) the risk was foreseeable (that is, it is a risk of which the person knew or ought to have known), and
(b) the risk was not insignificant, and
(c) in the circumstances, a reasonable person in the person's position would have taken those precautions.
(2) In determining whether a reasonable person would have taken precautions against a risk of harm, the court is to consider the following (amongst other relevant things):
(a) the probability that the harm would occur if care were not taken,
(b) the likely seriousness of the harm,
(c) the burden of taking precautions to avoid the risk of harm,
(d) the social utility of the activity that creates the risk of harm."
5C Other principles
In proceedings relating to liability for negligence:
(a) the burden of taking precautions to avoid a risk of harm includes the burden of taking precautions to avoid similar risks of harm for which the person may be responsible, and
(b) the fact that a risk of harm could have been avoided by doing something in a different way does not of itself give rise to or affect liability for the way in which the thing was done, and
(c) the subsequent taking of action that would (had the action been taken earlier) have avoided a risk of harm does not of itself give rise to or affect liability in respect of the risk and does not of itself constitute an admission of liability in connection with the risk.
5D General principles
(1) A determination that negligence caused particular harm comprises the following elements:
(a) that the negligence was a necessary condition of the occurrence of the harm (factual causation), and
(b) that it is appropriate for the scope of the negligent person's liability to extend to the harm so caused (scope of liability).
(2) In determining in an exceptional case, in accordance with established principles, whether negligence that cannot be established as a necessary condition of the occurrence of harm should be accepted as establishing factual causation, the court is to consider (amongst other relevant things) whether or not and why responsibility for the harm should be imposed on the negligent party.
(3) If it is relevant to the determination of factual causation to determine what the person who suffered harm would have done if the negligent person had not been negligent:
(a) the matter is to be determined subjectively in the light of all relevant circumstances, subject to paragraph (b), and
(b) any statement made by the person after suffering the harm about what he or she would have done is inadmissible except to the extent (if any) that the statement is against his or her interest.
(4) For the purpose of determining the scope of liability, the court is to consider (amongst other relevant things) whether or not and why responsibility for the harm should be imposed on the negligent party."
119These provisions raise a number of considerable difficulties for the case which Mr Bar-Mordecai seeks to pursue, all of which it is unnecessary to discuss. It is sufficient to observe that apart from the problems flowing from its admissibility, which I have already discussed, Dr Teoh's report could not establish the necessary requirements which flow from this statutory scheme as to causation. That is, that it was the alleged negligence in Dr XY's treatment of Mr Bar-Mordecai and the other alleged failures which he seeks to rely on, which caused the Tribunal to reach the conclusion that he was not a person of good character.
120The but for test discussed in Adeels Palace Pty Ltd v Moubarak [2009] HCA 48; 239 CLR 420 at [43] - [44] could not be satisfied on this evidence. It could not establish that the alleged negligent acts, Dr XY's treatment and failures, were a necessary condition of the occurrence of the harm relied on, which resulted from the Tribunal's decision. Mr Bar-Mordecai could not thereby prove on the balance of probabilities that without the alleged negligence the Tribunal would not have made the decision it did.