Health Care Complaints Commission v Achurch

Evidence

1. The Health Care Complaints Commission ("the Commission") provided the Tribunal with a bundle of material which included formal documents such as the Commission's complaint, initiating documents such as the mandatory notification to AHPRA, the police brief in Ms Achurch's drug supply prosecution, documentation from the District Court and AHPRA and some material provided to it by Ms Achurch.
2. Ms Achurch provided the Tribunal with documentary material including a letter commencing "To whom it may concern" which was written by Ms Achurch on 24 February 2018 and two references. We referred to and quoted from the material provided by Ms Achurch in our earlier decision: Health Care Complaints Commission v Achurch [2019] NSWCATOD 20 at [10] and [73]-[76].
3. Ms Achurch was given an opportunity to provide further material to the Tribunal after the Tribunal made its decision as to liability, but she chose not to do so.
4. Ms Achurch appeared by telephone at the second hearing. She gave sworn evidence and was cross examined.

Guiding principles

1. The Tribunal's jurisdiction is primarily protective in nature, rather than punitive (see, for example, Clyne v New South Wales Bar Association (1960) 104 CLR 186 at 201-202; Health Care Complaints Commission v Litchfield (1997) 41 NSWLR 630 at 637; Health Care Complaints Commission v Hollis [2019] NSWCATOD 6 at [13]). The purpose of the Tribunal's disciplinary powers is not to punish the practitioner concerned but rather to protect the public and maintain proper professional standards: Qasim v Health Care Complaints Commission [2015] NSWCA 282 at [73]. However, the fact that an order may have punitive effects is a reminder that a protective order should be limited to that which is reasonably necessary to provide the required level of public protection: Director-General, Dept of Ageing, Disability and Home Care v Lambert (2009) 74 NSWLR 523 at [83], citing Prakash v Health Care Complaints Commission [2006] NSWCA 153 at [101].
2. In the exercise of functions under a NSW provision, the protection of the health and safety of the public must be the paramount consideration (Health Practitioner Regulation National Law (NSW) ("the National Law"), s 3A). The provisions on which the Commission relies, and under which the Tribunal may make protective orders, are "NSW provisions."
3. In Health Care Complaints Commission v Do [2014] NSWCA 307 at [35], Meagher JA made the following comments about the National Law's objective of protecting public health and safety: "The objective of protecting the health and safety of the public is not confined to protecting the patients or potential patients of a particular practitioner from the continuing risk of his or her malpractice or incompetence. It includes protecting the public from the similar misconduct or incompetence of other practitioners and upholding public confidence in the standards of the profession. That objective is achieved by setting and maintaining those standards and, where appropriate, by cancelling the registration of practitioners who are not competent or otherwise not fit to practise, including those who have been guilty of serious misconduct. Denouncing such misconduct operates both as a deterrent to the individual concerned, as well as to the general body of practitioners. It also maintains public confidence by signalling that those whose conduct does not meet the required standards will not be permitted to practise."
4. When making orders, it is thus important to bear in mind both the protection of the public from any further misconduct or malpractice of a health practitioner, and the public interest in having a practitioner's conduct denounced as unacceptable: Health Care Complaints Commission v Do [2014] NSWCA 307 at [39].

Relevant Law

1. The Commission sought a decision under s 149C(4)(a) of the National Law that, if Ms Achurch were registered, it would have cancelled her registration. It also sought a decision under s 149C(4)(b) that Ms Achurch is disqualified from being registered as a nurse for a period of twelve months to two years.
2. Section 149C of the National Law relevantly provides: 149C Tribunal may suspend or cancel registration in certain cases [NSW] (1) The Tribunal may suspend a registered health practitioner's registration for a specified period or cancel the registered health practitioner's registration if the Tribunal is satisfied - … (c) the practitioner has been convicted of or made the subject of a criminal finding for an offence, either in or outside this jurisdiction, and the circumstances of the offence render the practitioner unfit in the public interest to practise the practitioner's profession; or … (4) If the person is no longer registered, the Tribunal may - (a) decide that if the person were still registered the Tribunal would have suspended or cancelled the person's registration; and (b) if the Tribunal would have cancelled the person's registration, decide that the person is disqualified from being registered in the health profession for a specified period or until specified conditions have been complied with; and (c) require the National Board with which the person was registered to record the fact that the Tribunal would have suspended or cancelled the person's registration in the National Register kept by the Board.
3. It may be observed that s 149C(1) provides for orders the Tribunal may make in relation to a registered health practitioner and that s 149C(4) provides for the orders the Tribunal may make in relation to a person who was formerly a registered health practitioner. The latter is relevant here.

Do the circumstances of Ms Achurch's offence render her unfit in the public interest to practise her profession?

1. As indicated above, we have already found that Ms Achurch has been convicted of two offences. The question we have to decide, for the purposes of s 149C(1)(c) of the National Law, is whether "the circumstances of [each] offence render [Ms Achurch] unfit in the public interest to practise [her] profession."
2. In the first stage of these proceedings, we were not persuaded that Ms Achurch's conduct in supplying drugs on three occasions rendered her an unsuitable person to hold registration as a nurse, within s 144(e) of the National Law. This was because, when this conduct was considered in the context of her expression of "deep remorse" four years later, we considered that it did not demonstrate "a fundamental deficiency of character so serious as to warrant in its own right exclusion from the profession," citing Health Care Complaints Commission v Geary [2018] NSWCATOD 15 at [115] (see Health Care Complaints Commission v Achurch [2019] NSWCATOD 20 at [77]).
3. The Commission submitted that the concepts of fitness to practice (in 149C(1)(c) of the National Law) and suitability to hold registration (in s 144(e) of the National Law) are sufficiently distinguishable to permit the Tribunal to arrive at a different conclusion in relation to Ms Achurch's convictions for supply of 55g of methylamphetamine on two occasions. It relied upon Health Care Complaints Commission v Brush [2015] NSWCATOD 120 at [72]-[73] and HCCC v Schmich [2009] NSWNMT 19 at [33]-[37] and [42]-[43].
4. The concepts of fitness to practice and suitability to hold registration are very similar. The word "fitness" is a synonym for "suitability" and practising nursing and holding registration as a nurse correspond in this context, for practical purposes, in that, without registration, a person is not permitted to practise nursing. In Health Care Complaints Commission v Brush [2015] NSWCATOD 120, in a passage cited with approval by the New South Wales Court of Criminal Appeal in Jung v R [2017] NSWCCA 24 at [56], the Tribunal observed that there was "some overlap between the concepts of 'good character' and 'being a suitable person to hold registration' / 'fit and proper person''' although they were not identical. The overlap between fitness and suitability is recognised by s 55 of the National Law. One of the grounds on which a National Board may decide that an individual is not a suitable person to hold general registration in a health profession is that the individual is "not a fit and proper person for general registration in the profession" (National Law, s 55(1)(h)(i)).
5. Notwithstanding this overlap, we do not consider that our rejection of the complaint that Ms Achurch was "not a suitable person to hold registration" as a nurse under s 144(e) precludes us from reaching the conclusion that she is unfit in the public interest to practise nursing within s 149C(1)(c) of the National Law. That is for the following reasons.
6. Firstly, s 149C(1)(c) requires us to consider the circumstances of Ms Achurch's offences. This is a broader focus than that which is relevant for s 144(e). We may look at the offences themselves, the conduct the subject of Ms Achurch's admissions on the Form 1 and other surrounding circumstances. Our finding in the first stage of these proceedings was restricted to whether the conduct to which Ms Achurch admitted in the Form 1 rendered her unsuitable to hold registration as a nurse.
7. Secondly, we have now heard Ms Achurch's oral evidence and have been able to form a more nuanced view as to the circumstances of her offending and the degree of insight she has into it. Ms Achurch did not appear at the first stage hearing so the Tribunal did not have the advantage of hearing her oral evidence. The Tribunal then had before it material provided by Ms Achurch including a letter indicating that she was "deeply remorseful, and sorry for [her] actions." The Tribunal relied upon that material when rejecting the Commission's complaint that the conduct in the Form 1 made her unsuitable to hold registration.
8. Thirdly, in the second stage of the proceedings, the Commission submitted that Ms Achurch has not demonstrated the necessary degree of insight and reform which could provide the Tribunal with confidence that she appreciates why her criminal conduct was fundamentally inconsistent with the expectations placed on a nurse in serving the public interest. That was not a submission made In the first stage of the proceedings. We have now considered the Commission's submissions about Ms Achurch's state of mind in light of her written and oral evidence and submissions and the evidence as a whole.

Circumstances of Ms Achurch's offences

1. When considering whether "the circumstances of the offence render the practitioner unfit in the public interest to practise the practitioner's profession" (within s 149C(1)(c)) we have taken a broad approach to a consideration of what constitutes such circumstances. One of the Macquarie Dictionary definitions of the word "circumstance" is "(usually plural) the existing condition or state of affairs surrounding and affecting an agent." In our view, the words "circumstances of the offence" in s 149C(1)(c) permit us to take into account the broad state of affairs surrounding and affecting each offence.
2. The relevant circumstances of Ms Achurch's offences are as follows.
3. Ms Achurch's offences of supplying 53.2 grams and 55.7 grams of methylamphetamine in September and November 2014 respectively were not isolated offences. She also admitted on her "Form 1" to knowingly taking part in the supply of 27.7 grams and 28 grams of methylamphetamine in September and November 2014 respectively, and supplying 55.2 grams of that drug in October 2014. She and a co-offender were paid for each transaction. The offences formed part of a pattern of offending in which Ms Achurch supplied drugs in return for cash.
4. An important part of the circumstances of Ms Achurch's offending is that she was employed as a nurse at the time. As the Commission submitted, the offending conduct was antithetical to the conduct of nursing. Ms Achurch acknowledged, under cross-examination, that before the offences she had seen people suffering from drug addiction as a nurse and knew that it could produce psychosis and that it had long term health effects. Her role as a nurse was to promote her patients' health and to administer drugs responsibly and lawfully, and yet in her non-working life she was supplying and consuming illegal drugs which could seriously damage a consumer's health. She had no control over the composition of the drugs or the identity of the end consumer.
5. Another relevant circumstance is that Ms Achurch was regularly consuming illicit drugs at this time. The sentencing judge remarked that Ms Achurch smoked ice about twice a week from September 2014 until her arrest on 27 February 2015. In oral evidence before the Tribunal, Ms Achurch said that one of the reasons for supplying drugs was so she could obtain drugs for personal use. We find that her reasons for offending were the desire for money and to obtain unlawful drugs. The supply of illicit drugs to obtain money and more drugs is indicative of an unfitness to practise nursing. This is particularly so, given Ms Achurch's evidence that she was not heavily addicted to drugs at the time and so, we infer, was not supplying drugs to support a habit which she could not control.
6. It is also relevant that, at the time of offending, Ms Achurch was a single mother of two children under four. Her children were vulnerable people for whom she had responsibilities in her personal life, just as her patients were vulnerable people to whom she owed obligations in her professional life. Her supply and consumption of drugs displayed a disregard of her responsibilities towards her children, because she risked becoming addicted to drugs and going to gaol where she would not be in a position to look after them. Her evidence that she was never affected by drugs in front of the children does not negate this consideration. Her conduct demonstrates that she was prepared to put her own interests above those of vulnerable people who were close to her, and might suggest that she would also do so in certain circumstances where patients were concerned.
7. The relevant circumstances also include that she had, at the time of her first offence, recently been prosecuted for an unrelated offence.
8. Early in 2014, Ms Achurch had been charged with the offences of assault of police officer in execution of duty and resist or hinder police officer in the execution of duty. On 15 September 2014, just nine days before she committed her first supply offence, the assault charge was dismissed and she was found guilty of the resist or hinder police charge, but it was discharged under a conditional release order pursuant to s 10(1)(b) of the Crimes (Sentencing Procedure) Act 1999. She did not report either the charges or the finding of guilt to AHRPA within seven days as she was required to do under s 130(1) of the National Law. The potential consequences of flouting the criminal law should have been fresh in her mind. Further, both the failure to report a finding of criminal guilt and the decision to supply illicit drugs (occurring within days of each other) indicate a lack of appreciation of her responsibilities as a nurse.
9. Ms Achurch's evidence before the Tribunal was that she stopped offending shortly after her last offence. She said that this was for the sake of her children and because she came to a realization about the detrimental nature of her conduct. In cross-examination, Mr Aitken put to Ms Achurch that the agreed facts and the sentencing judge's remarks indicated that she had stopped supplying drugs following a dispute with a co-offender about the settling of a debt. Ms Achurch accepted that this was the case but said that she chose to walk away instead of resolving the dispute with her co-offender. Ms Achurch also explained that the reason why she had only then come to a realization about her conduct was that she had been under stress as a single mother, two family members had passed away in a short space of time and she was not thinking of anyone else at the time.
10. We are not persuaded that we should give significant weight to Ms Achurch's decision to stop supplying drugs as a factor indicative of her fitness to practise. Ms Achurch was less than candid in her evidence about her reasons for making this decision, only conceding that a dispute about money contributed to this decision after this was put to her in cross examination. She also said that she stopped supplying drugs on the advice of her parents who said to her, "Do you see what's happening to you?" Ms Achurch said she followed her mother's advice to "take stock." There was some tension between her mother giving her this advice and her mother being a co-offender in one of Ms Achurch's offences (a fact Ms Achurch did not volunteer when giving evidence-in-chief). Ms Achurch's explanation that her mother was only charged because she was in Ms Achurch's company when the transaction occurred downplays her mother's role. The agreed facts in Ms Achurch's prosecution indicate that Ms Achurch's mother was the person who received the money for the drugs on one occasion.
11. The deaths in Ms Achurch's family and her responsibilities as a single mother may have caused her a lot of stress at the time of her offending, but they do not justify her offences nor her lack of appreciation of the significance of her offending at the time. It should have been apparent to Ms Achurch from the outset that supplying illegal drugs in return for cash or more drugs was reckless, imprudent and inconsistent with her training and responsibilities as a nurse. We acknowledge the candour of Ms Achurch's admission that she was only thinking of herself.
12. Having regard to the circumstances of Ms Achurch's offences, which we have described above, we are satisfied that those circumstances render Ms Achurch unfit in the public interest to practise nursing. The public interest extends to denouncing her conduct as unacceptable, even if there is minimal risk of her reoffending.
13. Section 149C(1)(c) focuses on whether the circumstances of an offence render a practitioner unfit to practise his or her profession, rather than the practitioner's current fitness. We have therefore considered Ms Achurch's present attitude towards and insight into her offending as part of our consideration of the appropriate orders to make.

Remorse, insight and reform

1. The degree of insight Ms Achurch has into her offending, her degree of remorse, and any steps she has taken to reform herself, are relevant to the appropriate orders to be made.
2. We accept Ms Achurch's evidence that she had stopped the offending behaviour (that is, the supply of drugs) before her arrest. She also said (and we accept) that she went "cold turkey" in relation to her consumption of drugs of her own accord. She said that, whilst she was in custody, she was classified as "low risk." Ms Achurch also reported that, after her release from custody in April 2018, the Parole Authority assessed her and placed her on an unsupervised parole condition. This meant, in Ms Achurch's submission, that she was not a risk to the community.
3. Ms Achurch did not provide any documentary evidence of her parole conditions or her classification whilst in custody. We have given this evidence little weight as a result. However, we are satisfied from other evidence given by Ms Achurch that she is unlikely to offend again. For example, Ms Achurch described her room in custody where women sat on the floor mixing drugs, about to inject, and said she had no desire to be like that. She also said that she was traumatised by confronting situations she had experienced in custody and recognised the impact her absence had had on her own children whilst she was in gaol. We are satisfied that Ms Achurch perceives that it is not in her own interests, or those of her children, to offend, and that she also feels remorse for what she did.
4. Ms Achurch told the Tribunal that she had learnt from an "Equips course" she completed whilst in custody that she needed to change the way she thought, and that it was important to consider the impact her choices had on the community. She said she had found it confronting to consider the impact of crime on people affected, such as the victim and the victim's family. Ms Achurch gave evidence that she considered that her crime had a massive impact on other people and made their lives "really negative," because when they were addicted to drugs, they committed other crimes and this set up a vicious cycle of crime. Ms Achurch also considered that her crime had caused trauma to her own children as they had been separated from her for eighteen months whilst she was in custody.
5. Ms Achurch described herself as "very remorseful" and said she had done everything she possibly could to reform. She also said she "owned" her mistakes and would like to help others with rehabilitation. Ms Achurch told the Tribunal that she had been a mentor to younger girls in custody who had a drug problem. She said she now had a passion for helping people to rehabilitate themselves.
6. We accept that Ms Achurch now has a different attitude to consuming and supplying drugs from the attitude she had at the time of her offending. We also accept that she is generally sorry for her conduct, and ashamed of it. To a certain extent, she has learnt from the experience and has some insight into the effect her conduct has had on others. However, we consider that her level of insight is more limited than she wished to portray.
7. Ms Achurch's evidence that her drug consumption only had effect on her for a few hours, and that she was never affected in front of her children or at work, sought to minimise the effects of her drug-taking. When giving evidence that she would "sleep over" at a friend's house when she took drugs, she made no mention of the effect that her regular absences might have had on her children (albeit that she and her children were living with her mother). The suggestion that she could effectively separate her personal and work lives by not being affected by drugs at work did not come to terms with the derogation from her responsibilities as a nurse to administer drugs responsibly and lawfully. Ms Achurch was not aware of the purity or otherwise of the drugs she supplied illegally and should have known of the risks involved for others consuming them. Further, she did not mention in her evidence that she met her co-offender at her workplace, Liverpool Hospital, to discuss the settling of his debt to her (as stated in the agreed facts), thus further blurring the line between her unlawful behaviour in her personal life and her conduct in her professional life.
8. Whilst Ms Achurch expressed remorse in her oral evidence and the materials she provided to the Tribunal, she also focused upon herself to a significant degree. In oral evidence, Ms Achurch recognised that her crime had a "massive impact on other people" but also said it had not been easy on her, that she had endured a lot and been confronted by a lot. Her written submissions in support of being allowed to practise as a nurse also sought to minimise her crimes and to focus on the hardship caused to herself. On 2 March 2017, she wrote to the Commission as follows: "I am asking the board to consider me keeping my registration. Yes I am currently serving a goal [sic] sentence for Drug offenses, but these were never committed at work, nor did they ever include a patient I had ever treated. I made an error in my judgement and for that I am paying the price. I have lost my job and am away from my family. …"
9. The tenor of that letter is that, because the offences did not directly impact on her work and she was sentenced to imprisonment and suffered as a result of them, she should be allowed to practise nursing. The description of her offending as "an error in my judgement" minimises the significance of the error. The idea that she can "pay the price" for her crime and be absolved approaches the question of whether she is fit to practise nursing without an understanding of the protective nature of the jurisdiction.
10. On 26 February 2018, Ms Achurch wrote a letter addressed "to whom it may concern." In the letter, she states that she is writing the letter from the consideration of the NSW Nursing and Midwives Board and this Tribunal. Relevant parts of the letter include the following: "I am currently serving an 18-month prison sentence for my crime in taking part in the supply of a prohibited drug. I am fully aware of my responsibility in participating in such crime, I am eternally sorry and I am deeply ashamed of my actions. Throughout my incarceration I have continually processed the enormity of the consequences brought about [sic] my actions. I have come to the conclusion that no amount of apologising or dwelling on the past will change what I have done. The only power I have in this situation lies in the choices I make moving forward. I have accepted what I have done and while I am not proud of myself it does not serve anyone for me to go on feeling undeserving of a positive future. If anything it would be selfish and an insult to society if I do nothing with what I have learnt during my incarceration. I still have time to give back to the world, I want my mistake to be the catalyst for a new direction in my life focusing on positivity and healing. … … Please consider my case with diligence, I have suffered endlessly throughout my incarceration and have paid back my debts to society having served an 18-month long custodial sentence in a correctives service facility. I do not believe it would be just that I be dismissed, as I believe it would be a major loss to the nursing profession as well as double jeopardy to me. I hope you can acknowledge I am deeply remorseful, and sorry for my actions. …"
11. The letter alternates, on the one hand, between expressing remorse for her actions and acknowledging her responsibility for her crime and, on the other, expressing a sense of having suffered, paid her debt and almost of having an entitlement to continue nursing. When asked in cross-examination about her failure to reflect, in any detail, on the impact her behaviour had on others in the written material she provided to the Tribunal, she responded that she had reflected, even if this was not on paper, and that it was not easy to express remorse on paper.
12. Ms Achurch chose to put a lot of sentiments on paper, including those concerning her love of nursing. We agree with Mr Aitken that her failure to address in her written material in any detail the impact her conduct has had or could have had on others, including the end users of the drugs she supplied, is indicative of a lack of focus on this.
13. We also have some concerns in relation to Ms Achurch's lack of insight into her conduct of making misleading statements on her renewal forms. When asked about these misleading statements, Ms Achurch's evidence was that, the way she read it, she was not convicted until her sentence. Ms Achurch informed the Tribunal that her intentions were "to notify" when she had been convicted.
14. Ms Achurch did not appear, at the hearing, to understand the seriousness of her failure to notify AHPRA of her charges and convictions, nor of the seriousness of incorrectly answering the questions on her renewal forms about her criminal history. On two occasions, she answered questions on her registration renewal forms asking her whether there had been any change to her criminal history in the negative. On the first occasion, it had been a month since she had been charged with assault and resist police officer and on the second it had been a month since she had been charged with the supply of drugs and six months since the resist police officer charge was discharged under a conditional release order. Despite what Ms Achurch said at the hearing about her intentions, she did not notify AHRPA or any other authority after she had been convicted for drug supply.
15. As we observed in our decision in the first stage of these proceedings, the statements on Ms Achurch's renewal forms were deliberately false (Health Care Complaints Commission v Achurch [2019] NSWCATOD 20 at [42]). A failure to appreciate the seriousness of this conduct in the hearing supports the conclusion which we have drawn from her criminal conduct that she is currently unfit to practise nursing.

Appropriate orders

1. We consider that, given the gravamen of the criminal conduct proven in Complaint One, Ms Achurch's limited insight into her offending, the need to protect the public through general deterrence and by denouncing transgressions, and the importance of maintaining public confidence in the profession, disqualification of Ms Achurch's registration for a period of two years is warranted.

Costs

1. The Tribunal's power to award costs in these proceedings is contained in clause 13(1) of Schedule 5D to the National Law.
2. The Commission sought its costs. Ms Achurch did not put forward any basis on which the Tribunal should not award costs and said she would leave the question of costs "up to the Tribunal."
3. Ordinarily costs should follow the event unless there are reasons to conclude otherwise: Qasim v Health Care Complaints Commission [2015] NSWCA 282 at [85]; Health Care Complaints Commission v Philipiah [2013] NSWCA 342 at [42]. Impecuniosity is not a justifiable reason for departing from that rule: Health Care Complaints Commission v Philipiah [2013] NSWCA 342 at [42].
4. In this case, our preliminary view is that Ms Achurch should be responsible for half the Commission's costs.
5. The Tribunal upheld three of the Commission's four complaints. Considerable time was spent on the fourth (unsuccessful) complaint, on which the Tribunal invited additional submissions from the parties.
6. The Commission ultimately did not seek any orders in relation to the third complaint. The third complaint was, broadly, that Ms Achurch is guilty of unsatisfactory professional conduct because she made false and misleading statements on her renewal applications with respect to her criminal history. The Tribunal found, in the first stage of the proceedings, that this complaint was established: Health Care Complaints Commission v Achurch [2019] NSWCATOD 20 at [27]. In the second stage, Mr Aitken, for the Commission, explained that, because Ms Achurch was no longer registered as a nurse, and the Commission would not have sought conditions if she were, there were no suitable orders available under s 149A of the National Law.
7. The Tribunal has no power to make declaratory orders in respect of a complaint being established. Rather, it has the power to make the orders set out in Subdivision 6 of Division 3 of Part 8 of the National Law. It appears to us, although we have not heard submissions on this point, that it is not appropriate for the Commission to make a complaint before the Tribunal if an order is not sought in respect of that complaint. We are also of the preliminary view that the respondent should not be liable for the Commission's costs of making the third complaint.
8. We propose to order that Ms Achurch pay 50% of the Commission's costs, on the basis that it succeeded on two complaints in relation to which it sought orders, was unsuccessful on another and made a complaint in relation to which it did not seek orders. However, given that the Commission has not had an opportunity to respond to our proposed basis from departing from the usual order as to costs, we will invite the Commission to make submissions about it. If it chooses to make submissions, Ms Achurch will be given an opportunity to respond.
9. The Tribunal considers, subject to hearing the parties' submissions, that the costs issue is suitable for determination on the papers: Civil and Administrative Tribunal Act 2013, s 50(2).

Orders

1. We make the following orders: 1. The Tribunal decides pursuant to s 149C(4)(a) of the Health Practitioner Regulation National Law (NSW) that, if the respondent were still registered, the Tribunal would have cancelled her registration. 2. The Tribunal decides pursuant to s 149C(4)(b) of the Health Practitioner Regulation National Law (NSW) that the respondent is disqualified from being registered as a nurse for a period of two years. 3. The Registrar is requested to notify the Nursing and Midwifery Council of NSW and the Australian Health Practitioner Regulation Agency of Orders 1 and 2 above as soon as practicable. 4. Unless the applicant files and serves submissions as contemplated by order 5, the respondent is to pay 50% of the applicant's costs, as agreed or assessed. 5. The applicant may file and serve written submissions in support of a different costs order, within 21 days of the date of these orders. The submissions should address the question of whether the costs issue may be determined on the papers. 6. If the applicant files and serve submissions in accordance with order 5, the respondent may respond within 42 days of the date of these reasons. Her submissions should address the question of whether the costs issue may be determined on the papers.

I hereby certify that this is a true and accurate record of the reasons for decision of the New South Wales Civil and Administrative Tribunal. Registrar 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: 15 July 2019