De Saxe v Medical Council of New South Wales

Dr Lee

1. In his report, Dr Lee said that Mr De Saxe had been a patient of his since 2015. He said that Mr De Saxe's principal issue since 2015 had been depressed mood and anxiety, associated with his professional misconduct and his deregistration.
2. We accept Dr Lee's evidence.

Professor Ryan and Professor Walter

1. We take into account the references provided for Mr De Saxe by Professor Ryan and Professor Walter, and the evidence given by both Professors at the hearing.
2. Both Professor Ryan and Professor Walter frankly disclosed that their knowledge of Mr De Saxe is limited, although each of them has been acquainted with him for many years. Neither of them has ever treated or examined Mr De Saxe.
3. Professor Ryan based his support for Mr De Saxe mostly on his friendship with Mr De Saxe at Medical School together with a one hour conversation with him, concerning the circumstances of his de-registration and his current thoughts about those circumstances, prior to the hearing of this matter. Apart from that conversation, Professor Ryan has had very little contact with Mr De Saxe over the last 25 years.
4. Professor Walter based his support for Mr De Saxe on his long standing acquaintance with him, which began during their training in psychiatry and continued subsequently by way of intermittent telephone calls and emails. They would have lunch or coffee together occasionally, but not in the last 10 years. They also met several times at conferences. In forming his opinion, Professor Walter also relied upon his more recent discussions with Mr De Saxe concerning the events leading to the cancellation of his registration and his present thoughts about those events.
5. Both Professor Ryan and Professor Walter expressed the view that Mr De Saxe is ready to return to practice with supervision.
6. As to the factual component of their evidence, we accept that both Professor Ryan and Professor Walter gave an accurate account of their relationship with Mr De Saxe. Whilst both Professor Ryan and Professor Walter are expert psychiatrists, neither was engaged or briefed as an expert witness. They did not examine Mr De Saxe, and nor did they obtain detailed information about the history of this matter. They were not requested to do those things. Their references do not amount to expert evidence, and they did not purport to be giving evidence as expert witnesses, notwithstanding that they both expressed an opinion. The purpose of their evidence was to serve as character references. We will accord their evidence the weight appropriate to character references.

Dr Diamond

1. Dr Diamond has been Mr De Saxe's treating psychiatrist on a regular basis since 2015. Prior to that, Dr Diamond treated Mr De Saxe intermittently from the early 1990s.
2. Dr Diamond provided a report dated 20 October 2020. In his report, he outlines his treatment of Mr De Saxe throughout their therapeutic relationship. Dr Diamond reproduced an extract of a report he provided on 22 August 2016 in which he said, in relation to such of Mr De Saxe's offending as Mr De Saxe was acknowledging at that time: Although his conduct, as acknowledged regarding the subject matters, appears to be driven by self-gratification including exploitation of the vulnerabilities of his patients, these are not his habitual behaviours. They occur more as an aberration of his usual coping patterns when dealing with his personal psychological vulnerabilities. His need for acceptance and belonging has interfered with his ability to maintain his clinical boundaries with his patients during times of severe emotional distress in the relevant past. … the onset of his offending conduct occurred at a very specific time in his life when he was unable to meet the increasing needs of his ailing mother, stand up to [other relatives] who were not providing additional helpful care of their mother and deal with his social isolation and disturbed relationships that resulted from a very traumatic experience [for Mr De Saxe] … Finally, … [Mr] De Saxe was in transition from a more traditional psychoanalytic based psychotherapy practice to a general psychiatry practice that included treating both general psychiatric outpatients and also inpatients in the private hospital setting. The inpatient group were particularly challenging because of the range of psychiatric illnesses that were manifest. It included individuals with significant personality disorders, addictions and serious psychiatric illness including psychosis.
3. In his report of 20 October 2020, Dr Diamond recorded that, in the wake of his de-registration, Mr De Saxe had maintained his long term relationship and facilitated the endeavours of members of his partner's family to attain vocational qualifications. This included having house guests for extended periods of time. Dr Diamond said that Mr De Saxe had been successful in becoming a teacher of English to non-English speaking students at colleges until the pandemic resulted in there being fewer such students requiring lessons. Dr Diamond said: All of this was done with a degree of maturity, resignation and acceptance that his predicament was of his making and that it was his responsibility to take the necessary steps to achieve emotional stability and thereafter to assume responsibility for his personal, social and vocational life. At no stage has Mr De Saxe repeated conduct that in any way could be seen as repetitive of his previous offending conduct. During his contact with me I have probed to see whether there were any manifestations of his interactions with others, in the period subsequent to the subject matters, that were exploitative, manipulative or predatory in relation to others. I remain of the opinion that the offending sexual misconduct took place during a specific period of severe emotional distress in the life of Mr De Saxe and does not represent his innate values, personality function and habitual state. His psychological stability and emotional wellbeing, in recent times, reflects the ability to cope with the stressors of the times. He was clearly troubled by the ever deepening insights into the damage he has caused his patients, his loved ones and his friendships with his small group of friends who were shocked and distressed to find out about his professional misconduct and its details.
4. Dr Diamond noted that Mr De Saxe suffers from an adjustment disorder with mixed features of depression and anxiety. The symptoms of depression and anxiety appear at times of hardship and distress. Dr Diamond said: He had problems at a time in the past when he was severely distressed through life's circumstances at the time and self-treated with antidepressants and minor tranquillisers. These have not been at the core of his treatment with me. His treatment remains psychotherapy aimed at assisting him to recognise, communicate and better express his emotional needs and distress utilising the cumulative deepening insight that continues as a longterm endeavour as he faces the full consequences of his conduct and its repercussions. The nature of the treatment has, of course, focussed intensely on the full extent of his professional misconduct both in terms of its emergence, its underpinnings and its consequences for his patients, for himself and for his professional colleagues as the misconduct was revealed. His prognosis, on balance, has improved as he has more fully and more deeply processed the underpinnings and consequences of his misconduct and its implications. Whilst he has shown impressive stability overall, he also has demonstrated appropriate emotional reactivity to life events that have occurred over the ensuing months since the Tribunal decision.
5. Dr Diamond said that Mr De Saxe clearly had not been fit to practice in the period which includes the time of the offending conduct. However, Dr Diamond said that, following treatment: He is not the same man that he was at the time of committing the offences that characterised professional misconduct. He has been through a significant and substantial therapeutic process that has assisted maturation, stabilisation of his underlying psychological vulnerabilities and has allowed him to fulfil his emotional needs in a safe and appropriate way within a settled secure relationship with his partner. The substantial changes all contribute to assist in minimising the chance of the same, or similar, conduct from reoccurring if Mr De Saxe is permitted to return to the practice of medicine.
6. Dr Diamond said that there is no aspect of Mr De Saxe's personality that prevents him from safely practising medicine. Dr Diamond is in support of Mr De Saxe's return to practice, subject to conditions. Dr Diamond's views on the appropriate conditions are as follows: Conditions on his registration could include oversight of the location and nature of his practice. He is not suited, at this point of pending re-engagement as a practising psychiatrist, to work alone and to conduct individual therapy away from a peer group. His return to practice should be under supervision. The supervision should include review of individual cases with his supervisor, regular review of his record keeping and correspondence and review of the nature and content of referrals so that he conducts practice within an established area of expertise.
7. In evidence, Dr Diamond said that Category C supervision would be the most appropriate form of supervision for Dr De Saxe.
8. Dr Diamond did not consider that it would be necessary to restrict Dr De Saxe's ability to prescribe Schedule 4D drugs, but he thought a restriction on Schedule 8 drugs would be appropriate.
9. Dr Diamond considers that a practice which includes a clinical component, but is principally a medicolegal practice would be suitable to Mr De Saxe initially. He suggested the re-imposition of the conditions which were in place before Mr De Saxe was suspended. He further suggested that Mr De Saxe continue with psychiatric treatment.
10. In cross-examination, Dr Diamond said that Mr De Saxe does not presently meet the criteria under the National Law to be assessed as an impaired practitioner. Dr Diamond said that Mr De Saxe remains vulnerable to possible future impairment, however (transcript p 114 line 41): … the nature of his impairment is a reactive psychiatric condition. It's not a lifelong biochemical or intrinsic psychiatric disorder that is inevitably going to relapse. It's a reactive condition which is a different order of psychiatric vulnerability. It's different say from bipolar disorder or recurrent unipolar, depression or schizophrenia or serious mental illness.
11. Dr Diamond made it clear, under cross-examination, that it was his opinion that Mr De Saxe would be able to apply the insights he had acquired subsequent to the conduct the subject of the disciplinary proceedings, in the event that he were subject, in the future, to a very high level or external stress or threat, making a relapse unlikely. Dr Diamond indicated that Mr De Saxe is now much better able to avoid a relapse than he was prior to his offending conduct.

Dr Sullivan

1. In his report, Dr Sullivan set out a comprehensive summary of the factual background to Mr De Saxe's application for the reinstatement of his registration. Dr Sullivan also related the content of his two lengthy teleconference interviews with Mr De Saxe.
2. In Dr Sullivan's opinion, Mr De Saxe's history is consistent with recurrent depressive disorder of mild to moderate severity. Dr Sullivan said, at paragraphs 118 to 127 of his report: [118] He exhibits clear interpersonal difficulties manifest in difficulties forming and sustaining relationships. There is evidence of sensitivity to rejection and of a desire for approval, admiration and affection. These were factors integral to the misconduct which led to his suspension. [119] Mr De Saxe's personality vulnerabilities overlap with issues associated with his psychosexual development, and create a particular issue in which erotic attraction to patients has been sufficient for Mr De Saxe to act on his desires and engage in sexual activity with patients during consultations. [120] It appears on the evidence that this has occurred when he has been under stress associated with his relationship, his family, his personal life and his health. At times when under significant stress, Mr De Saxe may deteriorate in mood, with consequent impairment of judgment and impairment in functioning. [121] I consider that evidence of poor record-keeping, documentation, communication with others and of aberrant prescribing practices are clearly made out but of less concern than the sexual boundary violations. All of those issues are more straightforwardly remediable. [122] There is no indication that Mr De Saxe was unaware of the wrongfulness of his actions at the time of his misconduct. The question is to what extent these episodes of sexual exploitation related to mental illness which has been effectively treated; to the influence of stressors on his capacity to manage himself; and to the influence of personality vulnerabilities which are more longstanding and - given the occurrence of these events in his early fifties after many years of psychoanalysis - might not respond so easily to psychotherapeutic and insight-oriented interventions. [123] Mr De Saxe has engaged in effective treatment for mood disorder and currently presents no indication of clinically significant mood disorder. I agree with Dr Diamond that the predominant effective interventions are likely psychological rather than pharmacological. [124] There is evidence from Mr De Saxe and supported by Dr Diamond and Associate Professor Ryan that Mr De Saxe has reflected on the nature of his misconduct and expresses improved insight into the factors underlying his misconduct. He has also clearly engaged in a concerted, directed pattern of learning though reading, discourse and didactic interventions. [125] The accumulation of stressors affecting Mr De Saxe at the time of the misconduct has dissipated. [126] It is possible that he will suffer further mood disorder and may be subject to stresses which result in a relapse of mood disorder or detrimentally impinge upon his insight or coping. At such times, Mr De Saxe will be at increased risk of exhibiting poor judgment and - if practicing - of exploiting patients. [127] Mechanisms of ongoing general practitioner and specialist treatment, and of using effectively supervision, mentoring, peer review and support, are potentially in place. It is noted that in the past Mr De Saxe progressively stepped away from these supports, and did not use them to discuss or admit to boundary violations. This is perhaps understandable given the likely impact of such disclosures. However it also may pose obstacles to Mr De Saxe's return to practice if he is unable to use these external supports effectively to address situations in which there is increased risk of sexual boundary violations. In particular, were a sexual boundary violation to occur this would require his immediate disclosure and the inevitable consequences to his registration.
3. We accept that evidence.
4. At paragraph 131 of his statement, in response to a question posed by the Council, Dr Sullivan said: As depression may be prone to recurrence, I consider he would meet the definition of impairment as set out in the Health Practitioner Regulation National Law (NSW).
5. At paragraph 134 of his statement, again in response to a question posed by the Council, Dr Sullivan said: I do not consider him currently suffering from depressive symptoms, but note the potential for relapse of depressive illness. This has not prevented him from reflecting on his misconduct. However at times when his mood disorder is actively symptomatic, it is likely that his insight into his conduct is reduced.
6. Consistently with his statement, Dr Sullivan confirmed, in evidence, that he does not consider Mr De Saxe to be presently suffering from a mood disorder, however, he believes Mr De Saxe to be 'impaired' on account of his past episodes of depression.
7. Dr Sullivan's evidence was that, should Mr De Saxe return to practice, Category C supervision would be appropriate. Dr Sullivan did not consider that it would be necessary for a supervisor to be present at the site at which Mr De Saxe would be consulting at all times.
8. Dr Sullivan also said that, if Mr De Saxe were to return to practice, he should not be permitted to prescribe Schedule 8 drugs, but ought to be able to prescribe Schedule 4D drugs.
9. In his statement, in response to a question he was asked by the Council in relation to the appropriate conditions should Mr De Saxe be reinstated, Dr Sullivan said the following: 143 If reinstated, Mr De Saxe should not have a practice which includes young males, or people with primary presenting problems of substance use disorder or psychosexual disorders. 144 His practice should not include psychoanalytic or psychotherapeutically focussed treatment. 145 He should practice with the support of supervisors and staff aware of his history of misconduct. He should not be in solo practice. 146 He would need to maintain engagement with a treating psychiatrist and general practitioner. 147 Practice should be limited to reduce time pressure and stressors. 148 His record-keeping and prescribing should be audited regularly by his supervisor. 149 Mr De Saxe would need to be proactively involved in raising and addressing concerns rather than concealing these as he did in the past.

Consideration of the evidence of Dr Diamond and Dr Sullivan

1. Dr Diamond and Dr Sullivan are largely in agreement on the issues relevant to the application.
2. A critical difference between their opinions was that Dr Diamond does not consider that Mr De Saxe is presently impaired within the meaning of the National Law, and Dr Sullivan believes that he is.
3. The National Law defines 'impairment' in s 5 as follows: impairment, in relation to a person, means the person has a physical or mental impairment, disability, condition or disorder (including substance abuse or dependence) that detrimentally affects or is likely to detrimentally affect - (a) for a registered health practitioner or an applicant for registration in a health profession, the person's capacity to practise the profession; or (b) for a student, the student's capacity to undertake clinical training - (i) as part of the approved program of study in which the student is enrolled; or (ii) arranged by an education provider.
4. The definition of 'impairment' is expressed in the present tense. For a health practitioner to have an impairment under the National Law, it is necessary for that health practitioner to be suffering from the impairment at the time that the assessment as to whether an impairment is present is made. A past impairment, or a vulnerability to a possible future impairment, do not fall within the definition, although a present impairment which does not yet affect the health practitioner's capacity to practise the relevant profession, but which is likely to do so in the future, does fall within the definition.
5. In the opinion of both Dr Diamond and Dr Sullivan, Mr De Saxe suffered from a depressive disorder in the past and is vulnerable to suffering from a depressive disorder in the future, but does not presently suffer from a depressive disorder. On the basis of the evidence before us, therefore, Mr De Saxe would not be assessed as presently suffering from an impairment under the National Law.
6. We note that the definition of 'impairment' requires both the diagnosis of a physical or mental impairment, disability, condition or disorder and the assessment that the condition diagnosed detrimentally affects or is likely to detrimentally affect the practitioner's capacity to practice. The severity of the condition will, in many circumstances, be a contributing factor in relation to the assessment of whether the practitioner's capacity to practice is detrimentally affected or is likely to be detrimentally affected. It will not always be possible to anticipate the severity of a future occurrence of a condition to which a practitioner is vulnerable, and consequently it will not always be possible to assess whether, even if there is a recurrence of the condition, a detrimental effect on the practitioner's capacity to practice will thereby be occasioned. This fortifies our conclusion that it was not intended that a vulnerability to a physical or mental disability, condition or disorder arising in the future was not intended to be included in the definition of 'impairment'.
7. We find that Mr De Saxe is not presently impaired.
8. Regardless of whether Mr De Saxe presently has an impairment under the National Law, we understand Dr Sullivan to have reservations about whether he ought to return to the practice of psychiatry on the basis that, should a significant 'life stressor' such as loneliness or isolation, physical health problems or anxiety related to any of those circumstances, arise for Mr De Saxe, a recurrence of the depressive disorder may occur and may be of sufficient severity as to impair his judgment and to lead him to act upon any sexual attraction to a male patient which may exist at the time (see transcript p 70 at 45 and Exhibit R1 Tab 16 (Dr Sullivan's statement) at paragraphs 119 and 120).

Is it now appropriate to order the reinstatement of Mr De Saxe's registration as a medical practitioner?

1. The onus is on Mr De Saxe to demonstrate that he can now be trusted to practice psychiatry in a way that conforms to the expected professional standards and poses no risk to the safety of the public and the confidence of the public in the medical profession (see Qasim quoted above at [23]).
2. The conduct which led to Mr De Saxe's registration being cancelled occurred in circumstances which were causing him a great deal of stress, which led to an episode of reactive adjustment disorder with mixed features of anxiety and depression (see Dr Diamond's report in Exhibit A1 at p 8). The relevant circumstances included a very high work load, distress occasioned by his mother's deteriorating health on account of Alzheimers disease, and his obligation to care for her throughout most of the weekends, social isolation, isolation in his work by reason of being in a solo practice and having withdrawn from peer support, and his own serious medical condition. None of those circumstances remain. In particular, Mr De Saxe has, for some years now, been in a stable and happy relationship with a partner and has an active social life. There is no evidence that there are presently any extraordinary stressors in Mr De Saxe's life at present, with the exception of these proceedings.
3. We accept Mr De Saxe's evidence that he has undertaken numerous courses, including courses with respect to many aspects of psychiatry, medical ethics, doctor/patient boundaries and medical records and documentation. Evidence of the courses completed has been provided with Mr De Saxe's statement (see Exhibit A1 Tab 4). In his evidence, Mr De Saxe explained the deficiencies in his patient notes and demonstrated his understanding of what is required.
4. We accept the evidence of Mr De Saxe and Dr Diamond that, in his treatment by Dr Diamond, Mr De Saxe has developed insight into how he came to be socially and professionally isolated and why his judgment became impaired so that he was able to seek to satisfy his need for sexual connection in the setting of his practice, despite knowing that his conduct was unethical. We accept that Mr De Saxe has been deeply embarrassed by his conduct becoming public and is deeply remorseful.
5. Mr De Saxe has undertaken his own study into issues of consent and the capacity to consent. He has come to an understanding of how misguided his remarks to Patient C were and he has clearly stated that he no longer holds the views that he expressed.
6. We are persuaded that Mr De Saxe now understands that he must make genuine use of the support system which is available to him within his profession.
7. In our assessment, were Mr De Saxe practising as a psychiatrist, he would not presently pose a risk to the health and safety of the public. He has worked steadily, over many years, to address the deficiencies in his character which led to his offending. We are confident that, in the event that a significant life stressor were to arise for him, he would have the necessary insight to deal with the situation without compromising professional boundaries and ethics.
8. We have considered the likely impact upon the confidence of the public in the medical profession in the event that Mr De Saxe is registered as a medical practitioner again. In the light of the treatment and education he has undergone in the years since his offending, together with his changed life circumstances, we do not consider that the public's confidence in the medical profession is likely to be compromised by Mr De Saxe's re-registration.
9. We are satisfied that Mr De Saxe is now a fit and proper person to be registered as a medical practitioner.
10. Mr De Saxe's registration should be subject to conditions to assist him to make full use of professional support.
11. Both parties provided us with a draft set of suggested conditions. Most of the conditions are common to both drafts.
12. The Council sought the imposition of a condition to the effect that Mr De Saxe will not consult, examine, treat or perform any procedure on any male, except in an emergency. Dr Sullivan gave evidence that he thought that such a condition may have a role in the event that Mr De Saxe experienced a relapse of his depressive illness to the extent that his judgment were impaired. It was Dr Diamond's evidence that such a condition would not be necessary or appropriate. In our view, the safety of the public, and, in particular, the male section of the public who may seek psychiatric treatment, does not require that this restriction be placed upon Mr De Saxe's registration. We are confident that, in the circumstances which presently exist, the conditions which we will impose with a view to providing for support to be readily available to Mr De Saxe, will be amply sufficient to maintain the public's safety. We are further confident that Mr De Saxe has developed sufficient insight to act in accordance with the applicable ethical principles and to observe the appropriate professional boundaries in the event that his life circumstances change adversely.
13. The Council sought the imposition of a condition which would prevent Mr De Saxe from prescribing Schedule 4D drugs. Dr Diamond did not consider that such a condition would be a necessary limitation upon Mr De Saxe's ability to prescribe in an appropriate manner. Dr Sullivan's evidence was that he did not believe that Mr De Saxe's ability to prescribe Schedule 4D drugs would pose any danger.
14. The Council sought a condition that Mr De Saxe be subject to Category B supervision. Mr De Saxe sought to be subject to Category C supervision. The difference between the two levels of supervision is that in Category B supervision, the supervisor must practise at the same location as the practitioner being supervised and must meet fortnightly with the practitioner and report to the Council every 3 months, whereas in Category C supervision, the supervisor may work at a different location but must be contactable by telephone and should attend at the practitioner's practice periodically to review records and files, must meet with the practitioner monthly and report to the Council every 6 months. Given that Mr De Saxe is to be required to continue under the care of a psychiatrist, we are satisfied that Category C supervision is the appropriate level of supervision.

Orders

1. We make the following orders: 1. Pursuant to s 163(1)(c) of the Health Practitioner Regulation National Law (NSW), should Mr De Saxe apply for registration to the Medical Board of Australia then Mr De Saxe may be registered in accordance with Part 7 of the Health Practitioner Regulation National Law (NSW), and such registration shall be subject to the following conditions: PRACTICE CONDITIONS 1. To obtain Medical Council of NSW approval prior to commencing practice or changing the nature or place of his practice. 2. To practise only in a group practice or a public hospital approved by the Medical Council of NSW where there is at least one other registered medical practitioner with at least one other registered health practitioner always on site. The practitioner must only practise on site at a Council approved group practice unless prohibited by circumstances beyond the practitioner's control (such as a COVID-19 stay at home order). 3. Not to practice in a manner that is comprised solely or predominantly of psychoanalysis or psychotherapy focussed treatments. 4. To consult or treat no more than 10 patients per day. 5. To practise no more than 30 hours per week not exceeding 5 days per week or 12 hours per day. 6. To obtain Medical Council of NSW approval prior to commencing practice or changing the nature or place of his practice. 7. Not to possess, supply, administer or prescribe any "drug of addiction" (Schedule 8 drug) as defined by Poisons and Therapeutic Goods Act 1966 (NSW). 8. To practise under category C supervision in accordance with the Medical Council of NSW's Compliance Policy - Supervision (as varied from time to time) and as subsequently determined by the appropriate review body. (a) At each supervision meeting the practitioner is to: (i) Review and discuss his practice with his approved supervisor with particular focus on: (A) professionalism and professional ethics including maintaining appropriate professional boundaries with patients; (B) good medical record keeping including complying with treatment plans and therapeutic guidelines; (C) appropriate prescribing practices; (D) management of stressors related to practice, including workload; and (E) Recent developments in practice. (ii) Authorise the approved supervisor to randomly select and review a minimum of 3 patient records from the practitioner's patient list for the preceding fortnight. When reviewing these records the approved supervisor is to consider such matters as professionalism and professional ethics including the maintaining of appropriate professional boundaries with patients; recent developments in practice, appropriate prescribing practises including treatment plans and therapeutic guidelines, workload management, compliance with conditions and good medical record keeping standards and legislative requirements. (b) To authorise the Medical Council of NSW to provide proposed and approved supervisors with a copy of the public and private conditions on the practitioner's registration and the decision which imposed these conditions. (c) Not to practise until a supervisor has been approved by the Medical Council of NSW. 9. To submit to an audit of his medical practice, by a random selection of his medical records by a person or persons nominated by the Medical Council of NSW and: (a) The audit is to be held within 12 months from the date of reregistration and subsequently as required by the Council. (b) The auditor(s) is to assess his compliance with good medical record keeping standards and legislative requirements and compliance with conditions. The auditor(s) should pay particular attention to appropriate prescribing practices. (c) To authorise the auditor(s) to provide the Council with a report on their findings. 10. To authorise and consent to any exchange of information between the Medical Council of NSW and Medicare Australia and Pharmaceutical Services for the purpose of monitoring compliance with these conditions. HEALTH CONDITIONS 1. Not to prescribe for self-medication. 2. To attend for treatment by a general practitioner of his choice, at a frequency to be determined by the practitioner and the treating practitioner. (a) To authorise the treating practitioner to inform the Medical Council of NSW of failure to attend for treatment, termination of treatment or if there is a significant change in health status (including a significant temporary change). (b) The practitioner must provide the Council with the professional details of the treating practitioner. 3. To attend for treatment by a psychiatrist of his choice, at a frequency to be determined by the treating psychiatrist. (a) To authorise the treating psychiatrist to inform the Medical Council of NSW of failure to attend for treatment, termination of treatment or if there is a significant change in health status (including a significant temporary change). (b) The practitioner must provide the Council with the professional details of the treating practitioner. 4. To adhere to treatment recommendations from his treating practitioners, including taking any medication as prescribed. 5. To attend for review by the Council Directed Health Assessor on a three monthly basis or as otherwise directed by the Medical Council of NSW. 6. To attend for a Review Interview at the Medical Council of NSW on a three monthly basis, or as otherwise directed by the Council. 7. That the extent of his professional medical duties is to be guided by his health status and the advice of his treating practitioner/s and Council-appointed practitioners. 8. To authorise the Medical Council of NSW to forward copies of the decision which imposed these conditions and any subsequent Council Review Interview or other reports and any other information relevant to his health and treatment to the Council Directed Health Assessors and to his treating practitioners. 1. The Medical Council is the appropriate review body for the purposes of Part 8, Division 8 of the Health Practitioner Regulation National Law (NSW). 2. Sections 125 to 127 of the Health Practitioner Regulation National Law (NSW) are to apply at any time at which Mr De Saxe's principal place of residence shall be anywhere in Australia other than in New South Wales, so that a review of these conditions can be conducted by the Medical Board of Australia.

I hereby certify that this is a true and accurate record of the reasons for decision of the Civil and Administrative Tribunal of New South Wales. Registrar DISCLAIMER - Every effort has been made to comply with suppression orders or statutory provisions prohibiting publication that may apply to this judgment or decision. The onus remains on any person using material in the judgment or decision to ensure that the intended use of that material does not breach any such order or provision. Further enquiries may be directed to the Registry of the Court or Tribunal in which it was generated. Decision last updated: 02 February 2022