1. In relation to the allegations, Dr Northeast behaved in a way that constitutes professional misconduct.

1. Pursuant to s 196(2)(a) of the Health Practitioner Regulation National Law (Victoria) Act 2009 (the National Law), Dr Northeast is reprimanded.

1. Pursuant to s 196(2)(b)(iii) of the National Law, Dr Northeast's registration is subject to conditions that:
   1. he must provide a certificate in respect of appropriate professional indemnity insurance coverage to the Chiropractic Board of Australia and the Australian Health Practitioner Regulation Agency on an ongoing annual basis; and
   2. the review period for the condition is five years from the date of the Tribunal's decision.
2. Pursuant to s 196(2)(d) of the National Law, Dr Northeast's registration is suspended for a period of one month, commencing on 26 November 2019.

1. Dr Ian Northeast was first registered as a chiropractor on 19 December 2011.
2. Dr Northeast has been subject to the Health Practitioner Regulation National Law[1] (the National Law) since he was registered.
3. In 2016, Dr Northeast was selected by the Australian Health Practitioner Regulation Agency (AHPRA) for a random audit of compliance with the registration standards of the Chiropractic Board of Australia (the Board). After an exchange of correspondence between Dr Northeast and AHPRA, the Board decided to commence an investigation into Dr Northeast's conduct and, on 24 August 2018, the Board determined to refer the matter of Dr Northeast's conduct to the Tribunal under s 193(1)(a)(i) of the National Law because it reasonably believed that he had behaved in a way that constitutes professional misconduct.
4. The matter proceeded before us on 22 August 2019 by way of an Agreed Statement of Facts and Proposed Findings and Determinations.

1. We are reasonably satisfied that the following Agreed Facts encapsulate the conduct alleged against Dr Northeast:
   • 1.1 Dr Ian Northeast was first registered as a chiropractor on 19 December 2011.

2.1 On 21 November 2014 and 2 December 2015, Dr Northeast completed online applications for renewal of his registration as a chiropractor under section 107 of the National Law. The applications for renewal of registration included declarations by Dr Northeast under s 109(1)(a) of the National Law that the Board's registration standards had been met.

2.2 The declarations made by Dr Northeast were to the effect that:

• (a) in the preceding period of registration, he had practised in accordance with the requirements of the Board's professional indemnity insurance (PII) Registration Standard; and

• (b) if his registration were renewed, he would practise in accordance with the requirements of the Board's PII Registration Standard.

2.3 On 12 April 2016, Dr Northeast received an Audit Notice from AHPRA, notifying him of his selection for a random audit of compliance with the Board's registration standards for the period 1 December 2014 to 30 November 2015 (audit period). Dr Northeast was required to lodge a response to the notice by completing an audit checklist and attaching any relevant supporting documentation, which he did on 16 May 2016.

3.2 The allegations contained in the Notice of Allegations are as follows:

Allegation 1 - Failure to maintain adequate and appropriate professional indemnity insurance cover

(a) professional misconduct within the meaning of the definition of professional misconduct in paragraph (a) and/or (b) and/or (c) of s 5 of the National Law; and/or

(b) unprofessional conduct within the meaning of paragraph (a) of the definition of unprofessional conduct contained in s 5 of the National Law, meaning professional conduct that is of a lesser standard than that which might reasonably be expected of the health practitioner by the public or the practitioner's professional peers in that he contravened section 129(1) of the National Law;

in that, between on or about 22 April 2014 and on or about 26 January 2015, Dr Northeast failed to maintain adequate and appropriate PII cover in accordance with the Board's registration standards, in breach of the Board's Registration Standard and in contravention of s 129 of the National Law; and failed to give notice within 7 days that a relevant event occurred in contravention of s 130(1) of the National Law.

(i) Dr Northeast was first registered as a chiropractor on 19 December 2011.

(ii) At all material times, Dr Northeast was practising as a chiropractor (including throughout the period 22 April 2014 to 26 January 2015).

(iii) On or about 12 April 2016, Dr Northeast received an Audit Notice from AHPRA, notifying him of his selection for a random audit of compliance with the Board's registration standards for the audit period.

(iv) On or about 16 May 2016, Dr Northeast lodged a completed audit checklist with AHPRA.

(v) At Part 11 of the checklist, Dr Northeast indicated that he had practised in accordance with the requirements of the PII Arrangements Registration Standard during the audit period.

(vi) Attached to the checklist was a copy of a certificate of currency which indicated that Dr Northeast held PII cover from 27 January 2015 to 27 January 2017.

(vii) On or about 21 July 2016, Dr Northeast stated in an email to ... AHPRA, that he may have gone without PII cover for a period of time.

(viii) On or about 29 July 2016, Dr Northeast provided AHPRA with a certificate of currency which indicated that he held PII cover from 21 December 2011 to 21 April 2014.

(ix) On or about 9 February 2018, Dr Northeast stated in an email to ... AHPRA that he had previously attempted to obtain retrospective PII cover in respect of the period of time in which he did not hold cover, but that his application had been denied by his insurer.

(x) Principle 9.5 of the Board's Code of Conduct states:

Chiropractors have a statutory requirement to ensure that they and their practice are appropriately covered by professional indemnity insurance.

(xi) The Board's Registration Standard: Professional Indemnity Insurance Arrangements (PII Registration Standard) sets out the requirements for PII cover for chiropractors.

(xii) Section 130(3)(a)(iii) of the National Law provides that a 'relevant event' in relation to a registered health practitioner includes where appropriate PII arrangements are no longer in place in relation to the practitioner's practise of the profession.

(xiii) Dr Northeast did not notify the Board that he did not have appropriate PII arrangements in place.

(a) professional misconduct within the meaning of the definition of professional misconduct in paragraph (a) and/or (b) and/or (c) of s 5 of the National Law; and/or

(b) unprofessional conduct within the meaning of paragraph (a) of the definition of unprofessional conduct contained in s 5 of the National Law, meaning professional conduct that is of a lesser standard than that which might reasonably be expected of the health practitioner by the public or the practitioner's professional peers in that he contravened section 129(1) of the National Law;

in that, on various occasions between on or about 21 November 2014 and on or about 16 May 2016, Dr Northeast knowingly or recklessly made false declarations to AHPRA.

(i) Dr Northeast was first registered as a chiropractor on 19 December 2011.

(ii) At all material times, Dr Northeast was practising as a chiropractor (including throughout the period 22 April 2014 to 26 January 2015).

(iii) Dr Northeast completed and submitted to AHPRA online registration forms on the following dates (registration renewal forms):

• (A) 21 November 2014; and

• (B) 2 December 2015.

(iv) The registration renewal forms required that Dr Northeast declare that:

• (A) during the preceding period of registration, he practised the profession only while covered by PII that meets the Board's Registration Standards; and

• (B) if his registration were renewed, he would only practise the profession while covered by PII that meets the Board's Registration Standards.

(v) On or about 16 May 2016, Dr Northeast completed and submitted an audit checklist to AHPRA, which related to the period 1 December 2014 to 30 November 2015.

(vi) At Part 11 of the checklist, Dr Northeast declared that he had practised in accordance with the requirements of the Board's PII Registration Standard during the audit period.

(vii) Dr Northeast made false declarations on the registration renewal forms by declaring that he was covered by PII during the preceding registration period and would only practise the profession while covered by PII.

(viii) Dr Northeast made a false declaration on the audit checklist by declaring that he had practised in accordance with the Board's PII Registration Standard.

(ix) Between on or about 22 April 2014 and on or about 26 January 2015, Dr Northeast did not hold PII cover.

(x) The Board's PII Registration Standard sets out the requirements for PII cover for chiropractors.

(xi) The Board renewed Dr Northeast's registration on the basis of the information provided in the registration renewal forms, which included the false information contained therein, as particularised above.

1. The parties have agreed that the Tribunal ought to find that Dr Northeast has engaged in professional misconduct under paragraph (a) of the National Law definition in respect of each of the two allegations. We agree that Dr Northeast's conduct in practising without holding professional indemnity insurance (PII) for a period of nine months, failing to notify the Board of this before May 2016, and falsely completing two registration renewal applications and the audit checklist amounts to professional misconduct.
2. In light of our findings set out below about the importance of health practitioners having current PII and dealing accurately and honestly with the Board, we are reasonably satisfied that the conduct set out in each allegation amounts to conduct that is substantially below the standard reasonably expected of a registered health practitioner of Dr Northeast's level of training and experience.

1. The parties have agreed it is appropriate for Dr Northeast to be reprimanded and for a condition to be imposed for three years on Dr Northeast's registration to the effect that he must provide a certificate in respect of appropriate PII coverage to the Board and AHPRA on an ongoing annual basis.
2. The Board submits that Dr Northeast's registration as a chiropractor ought to be suspended for one month. Dr Northeast does not agree this is necessary or appropriate.
3. The objective of sanctions in this jurisdiction is primarily the protection of the public, providing both specific and general deterrence and the maintenance of professional standards in the eyes of the public. It is not to punish the health practitioner. However, matters personal to the health practitioner, such as financial difficulties, are of little relevance save in so far as they contribute to the specific deterrence of the health practitioner. Further, the degree to which the practitioner has acquired insight into the conduct is relevant.[2]

1. The Board submits that a period of suspension is warranted for the following reasons:

1. the purpose of holding PII is to protect both the patient and the public from the expense of any loss or damage that may be occasioned by the health practitioner's conduct, and a failure to hold PII is inherently serious; 2. it is a matter of public confidence in the profession that health practitioners are adequately insured;

1. the ability of the Board to oversee the suitability of those in the profession and ensure ongoing compliance with professional standards is fundamental to the maintenance of the good reputation of the profession;

1. the failure to provide correct information in registration renewal forms and an audit checklist, and the failure to notify the Board of a lack of PII, frustrates the Board's oversight role and prevents the Board from fulfilling its functions, in particular its role in protecting the public; 2. the period during which Dr Northeast did not hold PII was not insignificant in duration; 3. Dr Northeast's conduct in providing false information to the Board on three separate occasions over approximately two and a half years could be characterised as frequent and was certainly more than an isolated incident; and 4. Dr Northeast has displayed a limited level of insight into the seriousness of his conduct.
2. In his Outline of Argument provided to the Tribunal on 19 February 2019, Dr Northeast submitted that any suspension of his registration is not required when taking into account the following:

1. Dr Northeast's circumstances at the time of the conduct and now; 2. Dr Northeast's remorse and insight given his active participation in the investigation and finalisation of this matter; and

1. the delay between the conduct and the finalisation of these proceedings.
2. While we did not hear from Dr Northeast himself at the hearing, counsel for Dr Northeast expanded on those submissions at the hearing as follows:

1. Dr Northeast was suffering significant personal and financial difficulties during the period in question, accruing significant debts that he is still paying off. He stopped checking his mail because of the correspondence he was receiving about his financial difficulties, which he wanted to ignore at the time. He acknowledges that the PII payments were made by direct debit from his bank account, that because of the debts he accrued those debits would have been declined, and that he then ignored notification of this at the time for the same reason he was ignoring other correspondence about his financial circumstances. 2. When Dr Northeast submitted his registration renewal form in early December 2015, he had stated that he held appropriate PII for that year because he had renewed his PII in January of that year.

1. When told the period of the audit was from December 2014 to the end of November 2015, he again stated he held PII during the audit because he recalled he had renewed it in January 2015.

1. At the time he did not hold PII he did not understand the importance of reporting relevant events as required by s 130 of the National Law. 2. Dr Northeast has never had any claims made against him that would require recourse to his PII and, to date, no claims have been made against him for the period during which he did not hold PII. 3. Dr Northeast has shown genuine remorse and contrition for his past conduct and cooperated with AHPRA's investigation. 4. Dr Northeast currently works at a chiropractic services office with two other practitioners and has started his own mobile practice for horses and horse riders, which is covered by his current PII. His wife works part-time and they have a five-month-old child. 5. The need for specific or general deterrence should be given little weight in this matter as Dr Northeast is highly unlikely to ever be without PII again.
2. Counsel for the Board referred us to several decisions of the Tribunal and similar decisions in other jurisdictions in support of their submissions. In particular, they noted that:
   1. in Psychology Board of Australia v Rigley (Review and Regulation) [2018] VCAT 1400 (Rigley), the registration of a psychologist was suspended for three months after being found to having not held PII for four years, having made six false declarations that PII was held and falsifying documentation about PII;
   2. in Medical Board of Australia v Stewart [2018] VR 6 (Stewart), a medical practitioner did not hold PII for twelve months and was suspended for two months.
3. Counsel for Dr Northeast submitted that in both of those cases the period without PII was significantly longer than the time Dr Northeast did not hold PII, and that Rigley could be distinguished because of the potentially criminal conduct by the practitioner in falsifying documents she gave to the relevant Board. He noted that in Chiropractic Board of Australia v Carbery [2018] VCAT 147 (Carbery), the chiropractor the subject of the decision was without PII for a longer period than Dr Northeast - 16 months - but his registration was not suspended at all.
4. In making our assessment of the appropriate determination in this matter, we have been concerned about whether Dr Northeast's conduct was reckless or deliberate. We are satisfied that it was, at the very least, at the high end of reckless. In particular, we are concerned by Dr Northeast's admissions that he ignored correspondence and other notifications that his payment of his PII fees were not being processed during 2014.
5. On balance, however, we are satisfied that the declarations he made to the Board in late 2014 and late 2015 were not deliberately meant to mislead the Board but rather were significantly reckless as to whether he actually held PII during the relevant periods for his registration at that time. We are also satisfied that he did not deliberately intend to mislead the Board when responding to the audit request given that he did, in fact, hold PII between January and December 2015.
6. We find that it is more likely than not that Dr Northeast was aware by January 2015, at the latest, that he had not held PII since April 2014. There is no other explanation for why he renewed his PII in January 2015 other than that he was aware it had lapsed. The relevant section of the National Law required that Dr Northeast report not holding PII as a relevant event to the Board within seven days. Accordingly, we find that the seven-day period of the reporting of a relevant event began at the latest, on 26 January 2015, when Dr Northeast renewed his PII. He did not report that he did not hold PII to the Board until after he was questioned in relation to the audit in, at the earliest, May 2016.
7. We accept that Dr Northeast did not understand the importance of complying with the reporting requirements as set out in the Chiropractic Board of Australia Code of Conduct and Professional Indemnity Insurance Arrangements Registration Standard. However, we again assess this as evidence of his recklessness as to the importance of holding current PII and reporting honestly and accurately to the Board.

1. We agree that it is appropriate that we reprimand Dr Northeast. A reprimand is a serious form of censure and condemnation. It "does not trivialise a serious lapse of professional standards and has the potential for serious adverse implications for the ... practitioner".[3] A reprimand clearly sends the message to the public and profession that Dr Northeast's conduct was unacceptable.

1. In considering whether the proposed conditions should be placed on Dr Northeast's registration, we note that Dr Northeast had stated he was "severely embarrassed" by his conduct[4] and that at the hearing it was stated on Dr Northeast's behalf that he has no intention to ever again practise without holding PII.
2. While we give some weight to Dr Northeast's stated intentions, we also agree with the proposal that conditions be placed on Dr Northeast's registration to ensure that he has as full insight as possible into the way in which his conduct the subject of this application has been inconsistent with good practice, and why it amounts to professional misconduct under the National Law.
3. In particular, although we accept that the risk of Dr Northeast not holding PII in the future is low, we consider it appropriate to require that the review period be after five years rather than three years, to ensure that he holds the necessary PII for the next five years.

1. While we have accepted that Dr Northeast's conduct was at the high end of reckless rather than deliberate, we consider that it is of significant importance for the general deterrence of conduct of this sort that Dr Northeast's registration be suspended for a period of time. In particular, we are concerned about the length of time between when Dr Northeast became aware that he had not held PII and when he first advised the Board of this.
2. As found in Rigley:[5]

The honesty and reliability of health practitioners is essential to ensuring that clients receive proper care and that patients and other practitioners may place trust in the expertise of those providing health care. It also impacts on ... the willingness of persons to seek out appropriate and necessary treatments, or to recommend them to others in need. It is also essential when practitioners are dealing with the Board and other regulatory agencies - those bodies rely on practitioners honestly providing information which is important to decisions regarding registration and other matters. ... the public should be confident that practitioners have the appropriate PII and they will be able to have recourse to that PII if something goes amiss.

1. We have considered the cases referred to by Counsel in this matter, noting that in the medical regulation context, comparison with previous outcomes should be engaged in with "extreme care".[6] In this case, we accept that Dr Northeast has not engaged in the deliberate falsification of any documents as was the case in Rigley. Similarly, in HCCC v Peng Seng Chan (4003 of 2011) a doctor's registration was suspended for three months where he had provided false PII documents to cover his lack of cover. However, in Stewart, the practitioner's registration was suspended for two months without there having been any conduct of that sort in that case. In Lee, a doctor who did not hold PII for just over five years had their registration suspended for ten weeks. In Carbery the chiropractor's registration was not suspended, but in that case any failure to report a relevant event was not raised by the Board.
2. We give some weight to the remorse shown by Dr Northeast but remain concerned that he has not shown a clear level of insight into how serious his failure to honestly and accurately report to the Board, and how serious the risk was to his patients of him practising without PII during 2014, have been.
3. In the circumstances, even taking into account the context of the conduct (including the personal and financial stress we accept Dr Northeast was facing at the time) and the length of time since the investigation of the conduct began (being approximately three years), we find that the serious degree to which Dr Northeast was reckless as to the importance of holding PII, not providing false declarations to the Board and abiding by the relevant reporting requirements, it is appropriate to suspend his license for one month, reprimand him, and place the condition that he provide a professional indemnity insurance certificate with his registration application, to be reviewed after five years. We are also satisfied that the period of suspension and subsequent conditions will assist to maintain proper ethical and professional standards to protect the public and the stature and integrity of the profession.

The Tribunal finds that, in relation to the allegations, Dr Northeast behaved in a way that constitutes professional misconduct.

1. We will make the following orders:
   1. Pursuant to s 196(2)(a) of the Health Practitioner Regulation National Law (Victoria) Act 2009 (the National Law), Dr Northeast is reprimanded.
   2. Pursuant to s 196(2)(b)(iii) of the National Law, Dr Northeast's registration is subject to conditions that:
      1. he must provide a certificate in respect of appropriate professional indemnity insurance coverage to the Chiropractic Board of Australia and the Australian Health Practitioner Regulation Agency on an ongoing annual basis; and
      2. the review period for the condition is five years from the date of the Tribunal's decision.
   3. Pursuant to s 196(2)(d) of the National Law, Dr Northeast's registration is suspended for a period of one month, commencing on 26 November 2019.

[1] As applicable in Victoria, set out as a schedule to the Health Practitioner Regulation National Law (Victoria) Act 2009.

[2] See for example Ha v Pharmacy Board of Victoria [2002] VSC 322; Medical Board of Australia v Jansz (Occupational and Business Regulation) [2011] VCAT 1026; Psychology Board of Australia v Mair [2010] VSC 628; Pharmacy Board of Australia v Foo (Review and Regulation) (Corrected) [2019] VCAT 203.

[3] Medical Practitioners Board of Victoria v Swieca (Occupational and Business Regulation) [2009] VCAT 419 (16 March 2009) at [52].

[6] Lee v Health Care Complaints Commission [2012] NSWCA 80 (Lee) at [24] and [25] - [34] more generally.