Health Care Complaints Commission v Cooke [2026] NSWCATOD 40;

(1) Condition 1 - that Ms Cooke practise under indirect supervision and nominate a supervisor for approval by the Council within 14 days of commencing any new employment as a nurse;

(2) Condition 3 - that within 7 days of any change in her place of practice, Ms Cooke forward evidence to the Council that she provided a copy of her full conditions to her employer; and

(3) That Ms Cooke enrol in and satisfactorily complete specified education courses in the areas of medication administration (Condition 5), reflective practice (Condition 6), professional obligations (Condition 7), and patient assessment (Condition 8) within set time frames (evidence of enrolment was required by 4 August 2022).

1. During 2023, the Council requested confirmation of compliance with Conditions 5 and 8. Ms Cooke provided self-completed Education Nomination Templates for various courses including "Safe Medicate" (for Condition 5) and "How to Assess a Deteriorating critically ill patient (ABCDE) assessment" (for Condition 8). She did not provide proof of enrolment in the courses nor did she provide documentary evidence of completion of those courses.
2. Ms Cooke left her employment at Gosford Private Hospital to move to Queensland in 2023.
3. Between 7 September 2023 and 13 November 2023, Ms Cooke commenced employment as a registered nurse at Palm Lake Care, an aged care facility, in Caloundra, Queensland.
4. On 17 October 2023, in response to email correspondence from a monitoring officer from the Council who was making enquiries about her current employment status, Ms Cooke informed the Council that she was unemployed and not residing in New South Wales. She did not disclose her employment at Palm Lake Care.
5. A member of staff from Palm Lake Care facility notified the Council that when he looked up her registration and resume, he discovered the May Conditions. Ms Cooke had applied for the role at Palm Lake using the name Melanie Cobb and while she had provided a certificate of her registration, she provided only page 1 of the Australian Health Practitioner Regulation Agency (AHPRA) materials and did not provide all 4 pages of that documentation (with pages 2 to 4 containing the May Conditions).
6. In email correspondence between the human resources department at Palm Lake Care and Ms Cooke in November 2023, she was asked a series of questions about the conditions on her registration and the documentation she had provided when she commenced employment. The following answers were given by Ms Cooke in response to certain questions

"Can you provide an explanation regarding the contents encompassed within pages 2 to 4 of your APHRA [sic] documentation?

As per my conditions and requirements I have completed my education and supervisory components and these conditions will be lifted in the very near future. I have met my requirements per my conditions outlined by APHRA and have continued to work within my guidelines and conditions which are imposed.

Do you feel you should have been more forthcoming in offering the referenced annexure during the onboarding process?

As there are no current supervisory conditions or educational requirements, a copy of my registration was provided as requested with the understanding that my care manager was completely aware of my conditions.

When you were issued with these conditions were you advised from APHRA of any potential consequences if you failed to fulfill your APHRA conditions?

Yes, I am aware of the potential consequences of completing my education and supervisory requirements. These education requirements imposed by APHRA have been completed and I have evidence to support this. I am very close to having my restrictions lifted therefore I am not inclined to jeopardise my situation any further this is why when requested document was provided to my care manager. My conditions are clearly stipulated on the APHRA website of registered practitioners for further clarification for any potential employer to access or seek clarification if required."

1. In November 2023, Palm Lake's Services Manager, Ms Jaywardhana, informed the Commission in email correspondence that Ms Cooke had only provided the first of four pages of her APRHA registration certificate, which did not include the conditions. Internal Palm Lake documents in November 2023 state that "Melanie has breached her conditions by not disclosing these conditions to us in the first instance". The Chief Operating Officer of Palm Lake noted in an email that Ms Cooke had not disclosed her conditions and that she required indirect supervision as well as education.
2. Ms Cooke's employment at Palm Lake was ultimately terminated on 1 December 2023 given the non-disclosure of the May Conditions.
3. Further proceedings under s 150 of the National Law were conducted with a hearing on 11 December 2023. The transcript of Ms Cooke's interview was before the Tribunal. During the course of that interview, Ms Cooke conceded that she had failed to nominate a supervisor for her employment at Palm Lake but explained that the care manager from Palm Lake was going to "notify the council that I was actually now employed there, and she was going to prepare to work with me while I had these conditions". When reminded that it was her responsibility to notify Council, she acknowledged that "I understand that now ... there obviously were... gaps with what was required from me and I appreciate that, and I accept that".
4. The Council suspended Ms Cooke's registration as a nurse.

1. As set out in the application, the complaints and the particulars relied upon for each complaint against Ms Cooke are as follows:

"COMPLAINT ONE

The practitioner is guilty of unsatisfactory professional conduct under section 139B(1)(c) of the National Law in that the practitioner has contravened a condition to which the practitioner's registration was subject.

PARTICULARS OF COMPLAINT ONE

1. Between 7 September 2023 and 12 November 2023, while working as a registered nurse at PLC, the practitioner contravened condition 1 of the May 2022 conditions in that she:

a. did not practise under indirect supervision as required by that condition;

b. failed to nominate a supervisor for approval by the Council within 14 days of commencing work or as specified by the Council.

2. The practitioner contravened condition 3 of the May 2022 conditions in that she:

a. on or by 14 September 2023, had not provided to the Council evidence that she had provided a full copy of the May 2022 conditions to PLC.

3. The practitioner contravened condition 5 of the May 2022 conditions in that she:

a. on or by 4 August 2022, had not provided the Council with evidence of her enrolment in an educational course that had been approved by the Council which related to medication administration;

b. did not complete an educational course that had been approved by the Council which related to medication administration.

4. The practitioner contravened condition 6 of the May 2022 conditions in that she:

a. on or by 4 August 2022, had not provided the Council with evidence of her enrolment in an educational course that had been approved by the Council which related to reflective practice;

b. did not complete an educational course that had been approved by the Council which related to reflective practice.

5. The practitioner contravened condition 7 of the May 2022 conditions in that she:

a. on or by 4 August 2022, had not provided the Council with evidence of her enrolment in an educational course that had been approved by the Council which related to professional obligations;

b. did not complete an educational course that had been approved by the Council which related to professional obligations.

6. The practitioner contravened condition 8 of the May 2022 conditions in that she:

a. on or by 4 August 2022, had not provided the Council with evidence of her enrolment in an educational course that had been approved by the Council which related to patient assessment;

b. did not complete an educational course that had been approved by the Council which related to patient assessment.

The conduct in any of Particulars 1 to 6 of Complaint One is repeated and relied upon in combination as a course of conduct amounting to unsatisfactory professional conduct.

COMPLAINT TWO

The practitioner is guilty of unsatisfactory professional conduct under section 139B(1)(l) of the National Law in that the practitioner has engaged in improper or unethical conduct relating to the practice or purported practice of nursing.

PARTICULARS OF COMPLAINT TWO

1. On 17 October 2023, the practitioner made a false and misleading representation in an email to a representative of the Council in that she stated:

in circumstances where she was at the time employed by PLC.

2. On 11 December 2023, the practitioner made false or misleading representations to the Council in that during the December 2023 section 150 hearing, she stated to representatives from the Council:

a. 'I provided her [the care manager at PLC] with my conditions';

b. 'I did disclose my conditions [to PLC] because my employer requested my - a copy of my registration, which obviously stipulates my name on my certificate of registration, and it also stipulates that this practitioner has conditions.':

in circumstances where the practitioner had not provided a full list of the May 2022 conditions to a staff member at PLC.

3. On 23 November 2023, the practitioner made false or misleading representations in an email to her employer, PLC, in that she stated:

a. 'As per my conditions and requirements I have completed my education and supervisory components and these conditions will be lifted in the very near future...',

in circumstances where the practitioner at the time had not been advised by Council that the May 2022 conditions would be removed.

COMPLAINT THREE

The practitioner is guilty of professional misconduct under section 139E of the National Law in that the practitioner has:

i. engaged in unsatisfactory professional conduct of a sufficiently serious nature to justify suspension or cancellation of the practitioner's registration, or

ii. engaged in more than one instance of unsatisfactory professional conduct that, when the instances are considered together, amount to conduct of a sufficiently serious nature to justify the suspension or cancellation of the practitioner's registration.

PARTICULARS OF COMPLAINT THREE

1. The particulars in Complaints One and Two are repeated and are relied upon individually and cumulatively."

1. Particulars 4 and 5 of Complaint One were not pressed by the Commission at the hearing.

1. The principles relevant to disciplinary proceedings under the National Law are uncontroversial, with the foundational objectives and principles found in ss 3 and 3A. Section 3A of the National Law mandates that in determining proceedings the Tribunal has the protection of the health and safety of the public as its paramount consideration.
2. The Tribunal may exercise the disciplinary powers conferred by Subdiv 6 of Div 3 of Pt 8 of the National Law if it finds the subject matter of the complaint to have been proven; or if the practitioner admits to it in writing to the Tribunal: National Law, s 149. The disciplinary powers available include the power to caution, reprimand, counsel, impose conditions, suspend a practitioner's registration for a specified period, or to cancel their registration.
3. In Health Care Complaints Commission v Dr Della Bruna [2014] NSWCATOD 31 the principles underlying the purpose of orders made under these conferred powers were summarised at [88] as follows:

"(1) In the exercise of its functions under Subdivision 6 of Division 3 of Part 8 of the National Law, the protection of the health and safety of the public must be the Tribunal's paramount consideration - s 3A of the National Law.

(2) Disciplinary proceedings against members of a profession are intended to maintain proper ethical and professional standards, primarily for the protection of the public but also for the protection of the profession - Health Care Complaints Commission v Litchfield [1997] NSWSC 297; (1997) 41 NSWLR 630 at 637,

(3) The public interests served by protective orders include, indirectly, the standing of the medical profession and the maintenance of public confidence in the high standards of medical practitioners - Prakash v Health Care Complaints Commission [2006] NSWCA 153 at [91].

(4) Protective orders also involve an element of deterrence or, to put it more positively, encouragement to other practitioners to recognise the importance of complying with professional standards and the risks of failing to do so - Prakash v Health Care Complaints Commission [2006] NSWCA 153 at [91].

(5) Although the specific purpose for which the Tribunal makes orders is protective of the public interest and not punitive with respect to the practitioner, that is not to deny that such orders may be punitive in effect and that punitive effect may be relevant in formulating a protective order - Lee v Health Care Complaints Commission [2012] NSWCA 80 at [20] citing Director General, Department of Ageing, Disability and Home Care v Lambert [2009] NSWCA 102; (2009) 74 NSWLR 523 at [83]."

1. The Tribunal is not bound by the rules of evidence in these proceedings (National Law, cl 2 of Sch 5D); and the Commission bears the onus of proving the matters set out in the complaint against Ms Cooke on the balance of probabilities. In assessing whether that level of proof has been established, the Tribunal must take into consideration all the relevant evidence before it: Health Care Complaints Commission v Wilcox [2020] NSWCATOD 10 at [52].

Unsatisfactory professional conduct and professional misconduct

1. A detailed list of behaviours covered by the term "unsatisfactory professional conduct" in relation to registered health practitioners in NSW is set out in the National Law: see National Law, s 139B.
2. The relevant paragraphs regarding the complaint against Ms Cooke are ss 139B(1)(c) and 139B(1)(l), which provide as follows:

139B Meaning of "unsatisfactory professional conduct" of registered health practitioner generally [NSW]

(1) Unsatisfactory professional conduct of a registered health practitioner includes each of the following -

...

(c) Contravention of conditions of registration or undertaking

A contravention by the practitioner (whether by act or omission) of -

(i) a condition to which the practitioner's registration is subject; or

(ii) an undertaking given to a National Board.

...

(l) Other improper or unethical conduct

Any other improper or unethical conduct relating to the practice or purported practice of the practitioner's profession.

1. Professional misconduct is defined in the National Law, s 139E:

139E Meaning of "professional misconduct" [NSW]

For the purposes of this Law, professional misconduct of a registered health practitioner means -

(a) unsatisfactory professional conduct of a sufficiently serious nature to justify suspension or cancellation of the practitioner's registration; or

(b) more than one instance of unsatisfactory professional conduct that, when the instances are considered together, amount to conduct of a sufficiently serious nature to justify suspension or cancellation of the practitioner's registration.

1. The National Law provides that the appropriate standards, codes or professional guidelines may be considered by the Tribunal when assessing a health practitioner's conduct. This is found in s 41, which states as follows:

41 Use of registration standards, codes or guidelines in disciplinary proceedings

An approved registration standard for a health profession, or a code or guideline approved by a National Board, is admissible in proceedings under this Law or a law of a co-regulatory jurisdiction against a health practitioner registered in a health profession for which the Board is established as evidence of what constitutes appropriate professional conduct or practice for the health profession.

1. In this matter, the appropriate professional codes are the Nursing and Midwifery Board of Australia's Code of Conduct for Nurses (2018) and the Code of Ethics for Nurses (2021). The Code of Conduct specifies that nurses must "practise honestly and ethically and should not engage in unlawful behaviour", while the Code of Ethics provides that "nurses have an ethical duty to be truthful and to uphold the trust placed in them by the public".
2. The Commission relies on both limbs of s 139E of the National Law; that is, that individual acts of Ms Cooke, particularly her "pattern of dishonesty" should be considered by the Tribunal to be of sufficient seriousness to warrant cancellation under the National Law, s 139E(a). Further, that the numerous instances of unsatisfactory conduct set out in Complaints One and Two, when considered together, meet the threshold for professional misconduct as per the National Law, s 139E(b).
3. The Commission submits that Ms Cooke's breaches of her conditions and supplying misleading information to her employers and the Council are in violation of both Codes.

1. The Commission provided evidence which included contemporaneous records, various correspondence and statements that had been made by Ms Cooke.
2. Ms Cooke relied on her oral submissions at the hearing, a report of Dr Peter Clark of 27 August 2025 that attached documents including some that were provided to him by Ms Cooke. The attachments included an independent medical examination report by Dr Ranjan, psychiatrist, dated 9 June 2025; a performance and development appraisal dated 25 February 2022; an independent assessment report dated 20 March 2022; and a bundle of certificates of completion of various courses by Ms Cooke in 2021 (prior to the imposition of the May Conditions).

1. On 28 August 2025, Ms Cooke corresponded with the Commission to seek consent to an adjournment of the hearing date on the basis that she had a family commitment in Queensland that she could not reschedule. The Commission requested evidence about the family commitment to which Ms Cooke responded that "my family have booked a surprise event for my son for his birthday which is a milestone and one of my relatives is unwell, we are hoping that he will hold on until after the family reunion. I am available to attend after the 17/11/25."
2. Ms Cooke then sent a receipt for a ticket to "SF IV Circus Circus Circus" as evidence in support of the adjournment.
3. The Commission researched the event and found that it was the "2025 Sexytime Swingers SexFest" which was to take place between 11 and 17 November 2025.
4. Ms Cooke later asserted she had sent the wrong supporting documentation and said her and her family were on the Gold Coast and getting together for her son's birthday.
5. At the hearing of the adjournment application, Ms Cooke appeared to abandon the alleged family event as the basis for the adjournment and instead said she could not travel because she had damaged her knee in a work accident and was awaiting surgery. She had no medical evidence to support her application.
6. The Tribunal asked the Commission whether it would consent to Ms Cooke appearing the hearing remotely so as to avoid an adjournment. Ms Cooke said she was content to appear remotely and the AVL at the directions hearing appeared to work quite well - a matter neither party disputed. However, the Commission would not consent in the absence of evidence of her condition - nor would it agree to pay Ms Cooke's travel expenses to appear in person.
7. The Tribunal ultimately refused Ms Cooke's application for an adjournment.
8. In refusing the adjournment the Tribunal had regard to the guideline to the Administrative and Equal Opportunity and Occupational Divisions of the Tribunal concerning adjournments (at [3] and [4]), and the objects of the Civil and Administrative Tribunal Act 2013 (NSW) in s 3 (NCAT Act).
9. The Tribunal considered that an adjournment of the hearing would not facilitate the overriding objectives of the NCAT Act and that there was an absence of evidence to satisfy the Tribunal that it should exercise its discretion to adjourn the hearing. Instead, in circumstances where there was a panel of four members who had set aside other work commitments to make themselves available for the hearing; the evidence had been filed and the matter prepared for hearing; and there was an ability to have the matter heard on the scheduled date by allowing Ms Cooke to appear via AVL, the overriding objectives of the NCAT Act could be better facilitated by maintaining the hearing date and directing Ms Cooke appear at the hearing via AVL.
10. Ms Cooke subsequently provided a worker's compensation certificate dated 8 October 2025 in respect of her right knee and the need for arthroscopic surgery.

1. The Tribunal is satisfied on the evidence that Ms Cooke breached each of conditions 1, 3, 5 and 8 of the May Conditions.
2. On the evidence it is clear that from 7 September 2023, when Ms Cooke practised at Palm Lake Care, she did not have indirect supervision, nor did she nominate a supervisor for approval by the Council within the 14 days of commencement of that employment. She also failed to notify the Council that she was employed or that she had provided her conditions to Palm Lake Care.
3. We do not accept Ms Cooke's excuses to the effect that she thought the manager would arrange supervision and notify the Council. It is clear on the documentary evidence before us, that Ms Cooke did not provide a copy of the May Conditions to Palm Lake Care such that they were not informed that there were any conditions on her registration. Consequently, they were not aware that they needed to provide indirect supervision.
4. Ms Cooke continued to work in that employment without the indirect supervision that she knew was required, in blatant disregard for the conditions on her registration.
5. Ms Cooke admitted in cross-examination that she did not disclose the May Conditions to her new employer at Palm Lake Care at the time of her employment. However, Ms Cooke sought to minimise that admission by saying that employers usually check for themselves.
6. Further, Ms Cooke failed to notify Council of her employment at Palm Lake Care. She ultimately admitted in cross-examination that when she informed Council in October 2023 that she was not "currently working and do[es] not reside in NSW", that she had lied to Council about her employment. She knew she was in breach of the conditions and tried to conceal it from the Council.
7. We find that Ms Cooke breached conditions 1 and 3 of the May Conditions on her registration.
8. In respect of conditions 5 and 8, Ms Cooke had consistently maintained until the hearing that she had completed the education that she was required to complete. She pointed to the various nomination forms as evidence of completion of the courses and also said that she had completed the mandatory education but had just not yet uploaded the evidence. We do not accept Ms Cooke's evidence in this respect.
9. The only documentary evidence Ms Cooke provided (other than the forms nominating the courses she would complete) was various transcripts and certificates she had provided to Dr Clarke (who had attached them to his report). The training transcript and certificates of completion were for courses completed by Ms Cooke in 2021 (before the May Conditions). The transcript shows that of those 15 courses, Ms Cooke did refreshers in respect of 13 of those courses in 2023. As for the two courses that Ms Cooke nominated as meeting conditions 5 and 8 (being education related to medication administration and patient assessment), there was no evidence that she had completed those courses.
10. Ultimately, during the course of cross-examination Ms Cooke admitted that she had completed at least 80% of the mandatory education and was still in the process of completing the courses. She said she had been unable to complete the courses because her life was in complete and utter chaos. When she had said to Palm Lake Care in email correspondence in 2023 that the conditions would be lifted, she was hoping for that because she had almost completed her study. Ms Cooke ultimately conceded in cross-examination that the representation she made to Palm Lake Care that the conditions would be lifted was incorrect and that she had lied.
11. On the evidence before us, we find that Ms Cooke breached conditions 5 and 8 when she failed to complete the courses and consequently failed to provide evidence of completion of the courses of education as required under those conditions.

Does this conduct constitute unsatisfactory professional conduct?

1. We find that the breaches of conditions 1,3, 5 and 8 of the May Conditions constitute unsatisfactory professional conduct.
2. Ms Cooke was aware of the importance of compliance with the May Conditions and yet she took steps to deliberately conceal those conditions from her new employer at Palm Lake Care. She also lied to Council to conceal from them the existence of her new employment.
3. Conditions 1 and 3 were designed to ensure that any new employer was aware of the restrictions on Ms Cooke's practice. This is to ensure maximum safety of patients by having the appropriate workplace supervisions in place. By concealing these restrictions from Palm Lake Care, Ms Cooke disregarded the framework for the protection of the public from harm. Palm Lake Care unknowingly employed Ms Cooke as an unrestricted registered nurse and assigned her duties (including night shifts as the sole nurse on duty) that she was unauthorised to perform. This exposed vulnerable aged residents to risk and exposed Palm Lake Care to liability.
4. Conditions 5 and 8 were designed to remediate deficiencies in Ms Cooke's practice which had been identified following the initial s 150 proceeding. Those deficiencies included issues with medication administration and patient assessment. It was imperative that the further education be completed to protect patients. Ms Cooke's failure to complete those courses shows a disregard for the importance of the education and reflects the underlying belief she held as expressed in cross-examination, that "I'm not the only one that made a mistake" and that she had been unfairly blamed originally for the conduct that had occurred at Gosford Hospital, which then led to disciplinary action and the imposition of the May Conditions. We note while Ms Cooke made many admissions during the course of her cross-examination, she never once demonstrated insight that her behaviour put vulnerable patients at risk.
5. Ms Cooke accepted in cross-examination that she understood the restrictions that had been placed on her registration and knew it was important to comply with them but that she also said she had been mentally unstable for several years and did not think through her actions clearly. It was from that state of mind that she asked the Tribunal to view her conduct. She relied on the evidence of Dr Clarke, her psychiatrist, in support of the mental instability she had suffered.
6. Dr Clarke was cross-examined at the hearing. He noted that Ms Cooke (whom he referred to throughout by her name Ms Cobb) had been consulting with him since March 2025. She had been on WorkCover following a serious assault in the workplace at Queensland Child Protective Services in 2024 and that she had suffered from anxiety, depression and post-traumatic stress disorder.
7. Dr Clark said that Ms Cooke was very ill in March 2025: she was clinically depressed, self-medicating with alcohol and substances; she was a risk to herself and had a mood disorder. He said that she did not recognise that she was experiencing a psychiatric condition and was reluctant to take medication. He said that it had only been recently that she has presented to consultations as a "cognitively intact normal person". Dr Clark expressed the opinion that Ms Cooke's judgment had been askew and that she had not been able to understand that she needed help.
8. Dr Clarke also explained the treatment plan for Ms Cooke which included taking medication for the next 1-2 years and that for occupational rehabilitation to occur, there must be a three month period of wellness. He said the only caveat being whether there was a relapse. He expressed the opinion that she was some months away from being able to return to work but that she was fit to engage in the process and that a graduated return to work in an environment free of violence would benefit her.
9. He explained that Ms Cooke was affected by complex emotional cognitive issues which had dictated her behaviour. When she was supervised by other nurses, she performed well. He also indicated that Ms Cooke now realises that while her frame of thinking at the time of her conduct was that she was being truthful, it was not so. Dr Clark considers that Ms Cooke was naïve rather than malfeasant; put herself at the lower end of priority from a very young age; and that her personal life, which was extremely difficult following separation from her partner, impaired her on numerous fronts. He opined that Ms Cooke is now learning from her mistakes and "her heart is in the right place".
10. While this evidence speaks to the mental instability of Ms Cooke in 2025, it does not opine on her mental condition in 2023 when the conduct occurred and prior to her workplace injury. Rather, his evidence relied on Ms Cooke's self-reporting about her mental state in 2023. While we accept Ms Cooke may have suffered extreme personal difficulties in 2023 when she moved to Queensland following the separation from her partner, this does not excuse her impugned conduct, nor do we accept that this prevented her from being honest with Palm Lake Care or the Council.
11. We find that Complaint One is established and Ms Cooke is guilty of unsatisfactory professional conduct.

1. This complaint concerns the misrepresentations made by Ms Cooke:

(1) To the Council in October 2023 that she was not currently working;

(2) To Council in the s 150 hearing in December 2023 that she provided the care manager at Palm Lake Care with her May Conditions; and

(3) To Palm Lake Care in November 2023 that she had completed her education and supervisory components and that the conditions would be lifted shortly.

1. We find on the documentary evidence before the Tribunal that each of those representations was false. Ms Cooke ultimately admitted during the course of her cross-examination that each of these representations were lies.
2. We are satisfied that these lies constitute improper or unethical conduct under s 139B(1)(1) of the National Law and Ms Cooke is guilty of unsatisfactory professional conduct in this regard.

1. Complaint Three alleges that Ms Cooke is guilty of professional misconduct under s 139E of the National Law by reason of the conduct alleged in Complaints One and Two considered individually or together.
2. When considering whether the conduct amounts to professional misconduct, it may be relevant to consider the circumstances in which the conduct occurred, including the practitioner's motivation and the state of mind, as well as the risk of harm that the conduct was apt to create: Health Care Complaints Commission v Robinson [2022] NSWCA 164 at [30]- [37] (Kirk JA).
3. On the evidence before us, we consider that Complaint Two of itself and Complaints One and Two cumulatively are sufficiently serious to constitute professional misconduct as:

(1) Ms Cooke's breaches of conditions 1, 3, 5 and 8 of the May Conditions were serious breaches;

(2) In failing to undertake the necessary courses of education that were there for the protection of the public and to disclose to her employer that there were conditions on her registration, she put vulnerable patients in her care at risk and also exposed her employer to liability for her actions;

(3) Ms Cooke was deliberately dishonest with Council about being employed by Palm Lake Care and deliberately dishonest with Palm Lake Care in failing to disclose the May Conditions and then in stating that the conditions were soon to be lifted. Ms Cooke's continued dishonesty is the most serious of the conduct and as noted above constitutes unethical and improper conduct; and

(4) Ms Cooke's behaviour shows a blatant disregard for the importance of these conditions and the authority of the regulator.

1. For the same reasons we expressed above, we do not consider that the personal circumstances of Ms Cooke at the time of the conduct, albeit that these were difficult circumstances, excuse or minimise the gravity of her conduct. The evidence of Dr Clark does not establish that Ms Cooke was suffering from any particular mental illness in 2023 at the time of Ms Cooke's conduct as opposed to 2025 when he was treating her.
2. Consequently, Complaint 4 is established.

What if any disciplinary orders should be made?

1. As each of the complaints are made out, we are required to consider what if any protective orders should be made.
2. Part 8, Div 3, Subdiv 6 of the National Law which is headed "Disciplinary Powers of Tribunals" sets out the disciplinary powers available to the Tribunal where a complaint is found proven: see ss 149A, 149B and 149C of the National Law. They include the power to caution, reprimand and counsel a practitioner, and impose conditions on the practitioner's registration. Where, as in this case, the Tribunal is satisfied the practitioner is guilty of professional misconduct, the Tribunal may suspend the practitioner's registration for a specified period or cancel their registration: National Law, s 149C(1).
3. In determining the appropriate orders, the paramount consideration is the protection of the health and safety of the public: see s 3A of the National Law. As the Tribunal's paramount consideration is the protection of the health and safety of the public, imposition of restrictions on the practice of a health professional is only to be made in pursuit of according with this higher objective. Such restrictions are only to be imposed where necessary to ensure health services are provided safely, at an appropriate quality: see National Law, s 3A(2)(c).
4. This determination may only be made by reference to the facts of the particular case before the Tribunal and by considering what measures are needed to ensure future behaviour of the practitioner is shaped in such a way that is consistent with these protective goals: Lee v Health Care Complaints Commission [2012] NSWCA 80 at [34].
5. In addition to the protection of the public being the paramount consideration, it has also been held that other relevant purposes of such proceedings include the need to maintain the standards of the relevant profession, and to deter others from engaging in like conduct: see for example, Health Care Complaints Commission v Litchfield [1997] NSWSC 297; (1997) 41 NSWLR 630 at 637.
6. As such, the purpose of the disciplinary powers of the Tribunal is not to punish a practitioner but rather to protect the public and maintain proper professional standards.

1. The Commission sought an order that Ms Cooke's registration be cancelled with a non-review period of 2 years.
2. We do not agree that cancellation of Ms Cooke's registration, with a non-review period of two years, is required to protect the public or to reflect the seriousness of her conduct. We consider that a further suspension of 6 months from the date of this decision is sufficient ad proportionate protective response.
3. We consider this is an appropriate period for the protection of the community.
4. We have taken into account the fact that Ms Cooke has been suspended since December 2023.
5. We also note that Ms Cooke has engaged in the Tribunal process and demonstrated some insight into the consequences of her behaviour which fell well short of what is expected of a registered nurse. She ultimately admitted during the course of the hearing that she had been dishonest, was deeply sorry, and that she would never engage in this kind of conduct again.
6. We also acknowledge that her inability to practise as a nurse since December 2023 has caused her financial stress and mental health issues. However, she has also sought to minimise her dishonesty and continues to blame others including Gosford Hospital for insufficient resources and support. This demonstrates some lack of insight into her conduct.
7. Consequently, we are unable to be satisfied that Ms Cooke has demonstrated sufficient genuine insight into her conduct to enable her to practise as a registered nurse at this time. This was apparent when she initially sought to blame or minimise her conduct and by not accepting that she had been dishonest - saying instead that she had given all the information to Palm Lake Care. She also maintained that she had completed the courses that would have satisfied Conditions 5 and 8, despite the fact that there was no documentary third-party evidence of completion of those courses (such as the type of certification she had previously obtained in 2021 and provided to her psychiatrist which was before the Tribunal).
8. In light of her late admission of dishonesty and her reflection on the impact her suspension and these proceedings has had on her life, we find that Ms Cooke is very unlikely to engage in behaviour in disregard of critical safety measures or deceive those monitoring her or employing her. In this regard we note the evidence of Dr Clark that Ms Cooke has acknowledged that she made serious errors of judgment and that she should have sought psychological assistance earlier in time. Dr Clark's unchallenged evidence was that a supervised and graduated return to her previous nursing role will assist in her rehabilitation but that she was still some months off that return to work. We note that Ms Cooke intends to continue to obtain support from Dr Clark.
9. However, we consider that a period of suspension for an additional six months from the date of this decision, will give Ms Cooke the opportunity to reflect and gain further insight into the gravity of her conduct and in particular her dishonesty, but also enable her to obtain the necessary certification that she agreed to in the May Conditions. It will also enable her to gain insight into the impact of her actions, by potentially placing at risk vulnerable patients, and gain respect for the regulatory system which is designed to protect the community and patients in the care of registered nurses.

1. The Commission seeks an order for costs as agreed or assessed and submits that substantial costs have been incurred in their investigation, particularly in respect of having to gather evidence due to Ms Cooke's lack of candour.
2. The power to award costs is conferred by cl 13 of Sch 5D to the National Law. In exercising that power, the general rule is that costs follow the event unless there has been disentitling conduct on the part of the successful party: Health Care Complaints Commission v Philipiah [2013] NSWCA 342 at [42]; Qasim v Health Care Complaints Commission [2015] NSWCA 282 at [85] and Health Care Complaints Commission v Do [2014] NSWCA 307 at [51].
3. There is no suggestion that the Commission is disentitled, nor has Ms Cooke made any submissions regarding costs to the contrary. We have decided to exercise the power to order Ms Cooke to pay the Commission's costs, as agreed or assessed.

(1) The respondent's registration is suspended under the Health Practitioner Regulation National Law (NSW), s 149C(1)(b).

(2) The respondent cannot seek a review of Order 1 before 6 months from the date of these orders.

(3) The respondent is to pay the applicant's costs as agreed or assessed under the Health Practitioner Regulation National Law (NSW), cl 13 of Sch 5D.

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.