Care Complaints Commission v Karalasingham [2007] NSWCA 267
Health Care Complaints Commission v Kingston [2018] NSWCATOD 28
Health Care Complaints Commission v Litchfield (1997) 41 NSWLR 630
Health Care Complaints Commission v Rouen [2019] NSWCATOD 76
Health Care Complaints Commission v Russ [2021] NSWCATOD 5
Health Care Complaints Commission v Vincent [2012] NSWNMT 2
Health Care Complaints Commission v Wilcox [2020] NSWCATOD 10
King v Health Care Complaints Commission [2011] NSWCA 353
Lee v Health Care Complaints Commission [2012] NSWCA 80
Lucire v Health Care Complaints Commission [2011] NSWCA 99
NSW Bar Association v Meakes [2006] NSWCA 340
Nursing and Midwifery Board of Australia v Buckley [2010] QCAT 392
R v Qutami [2001] NSWCCA 353
Reisner v Bratt [2004] NSWCA 22
Category: Principal judgment
Parties: Health Care Complaints Commission (Applicant)
Dr Murray Govan (Respondent)
Representation: Solicitors:
Health Care Complaints Commission (Applicant)
Respondent (Self-Represented)
File Number(s): 2021/00050764
Publication restriction: Not to be published until midnight on 11 January 2022.
[2]
Introduction
On 22 February 2021 the Applicant filed an application for disciplinary findings and orders against the Respondent pursuant to s 144(a) of the Health Practitioner Regulation National Law (NSW) ("the National Law") on the grounds that, on 15 May 2020, the Respondent was convicted of criminal offences, and/or that the Respondent was guilty of unsatisfactory professional conduct by failing to notify the National Board within 7 days pursuant to s 139B(1)(b) and s 130 of the National Law that:
1. on 10 April 2019 he had been charged with offences punishable by imprisonment of 12 months or more; and
2. on 15 May 2020 he was convicted of offences punishable by imprisonment.
The Respondent, who has, at all times since the filing of the Applicant's application, been incarcerated as a result of his convictions on 15 May 2020 for offences punishable by imprisonment, has not filed any reply to the Applicant's application.
On 24 September 2021 the Applicant provided to the Tribunal, and Mr Neil, who holds an Enduring Power of Attorney for the Respondent, an amended application. It is not in doubt that, although Mr Neil received a copy of the amended application by email on 24 September 2021, the Respondent, through no fault of the Applicant or Mr Neil, first saw the Amended Complaint at the commencement of the hearing of the proceedings on 27 September 2021.
The Respondent was unrepresented at the hearing on 27 September 2021. He and Mr Neil asserted that communication between them for the purpose of preparing for the hearing had been problematic. There is no reason to reject those assertions. The Respondent does not appear to have ever had legal advice with respect to the proceedings, and certainly had no opportunity to obtain legal advice with respect to the Applicant's amended application.
The Tribunal deferred ruling on the Applicant's application for leave to rely upon its amended application until, albeit limited, the Respondent had the maximum realistic opportunity to consider it. The Tribunal facilitated the Respondent being able to discuss privately with Mr Neil his response to the amended application, and any other matters which they wished to discuss in relation to the proceedings.
The Respondent and Mr Neil ultimately expressed no objection to the Applicant being granted leave to rely upon its amended application. Although the Tribunal has taken the absence of objection into account in deciding to grant leave to amend, our decision was not dependent upon it. The Tribunal considered the circumstances of the Respondent, the terms of the proposed amendment, and the fact that the Applicant bears the onus of proof throughout these proceedings (Reisner v Bratt [2004] NSWCA 22; Ghosh v Health Care Complaints Commission [2020] NSWCA 353).
Apart from recording the details of the offences to which the Respondent pleaded guilty in the District Court on 15 May 2020, and repeating the facts of the offences, and particulars of the sentence imposed by the sentencing Judge, the amended application pleaded that:
"The conduct and accompanying circumstances to this offending were detailed in an Agreed Statement of Facts that was tendered at the sentence proceedings, which is Annexure 'A' to this Complaint, and addressed in the remarks on sentence of the court dated 15 May 2020 by reference to the evidence, including the medical reports that was before it".
The Tribunal was comfortable in ultimately allowing the amended application in circumstances where:
1. the Respondent had filed no reply to the original, and more expansive, application;
2. the amended application reduced the number of particular complaints relied upon by the Applicant, introduced no new complaints, and adduced no evidence which it had not previously served in support of it's original application;
3. as the amended application pleaded facts and circumstances which the Respondent admitted in the District Court proceedings, the Respondent could not have been prejudiced by the granting of leave to amend the Applicant's application;
4. nothing of substance changed between the original and amended applications.
Prior to Mr Neil being able to join and participate in the proceedings, which were necessarily conducted by audio visual link, the Applicant tendered (Exhibit HCCC 1) an email from Mr Neil dated 22 September 2021. Prior to doing so, and not knowing whether Mr Neil would be participating in the proceedings, and, if so, what role the Respondent would request him to assume, the Tribunal traversed with the Respondent each sentence contained in Mr Neil's email.
The Respondent confirmed that Mr Neil's statement that he was "aware of the complaints made against him by the Health Complaints Commission [sic] and does not intend to lodge a defence to the hearing scheduled for hearing on the 27th of September" was accurate.
The Respondent clarified that his anticipated release from custody is on or about 9 January 2022, rather than 5 January 2022 as suggested by Mr Neil in his email. The Respondent confirmed that he "understands he will be immediately deported back to New Zealand due to the length of his custodial sentence and is unlikely to return to Australia" as stated by Mr Neil in his email. During the hearing the Respondent confirmed that he does not intend to apply for registration as a medical practitioner in New Zealand, or Australia, in the future.
The Respondent confirmed that Mr Neil's statement that he "sees no advantage occurring to him in challenging or defending his ability to continue to practise medicine in Australia" was accurate.
Mr Neil's email concluded "If this circumstance were to change in the future he reserves his rights to reapply for a licence to practise". The Respondent stated during the hearing that he has no intention of reapplying for registration as a medical practitioner, either here or in New Zealand. Having regard to the circumstances in which Mr Neil apparently made that statement, and some discrepancies between statements made by Mr Neil and the Respondent during the course of the hearing, the Tribunal accepts that Mr Neil's statement may not accurately reflect the Respondent's intentions.
The Tribunal understands that, if the Applicant's complaints are made out, and the Respondent's registration as a medical practitioner is cancelled, and the orders sought by the Applicant prohibiting his provision of health services, and preventing his reapplying for a fixed period are made, those orders are likely to be recognised in New Zealand by the body governing registration of medical practitioners in that country.
The Tribunal endeavoured to explain to the Respondent the nature of the proceedings, and the potential for the proceedings to be initially confined to a hearing with respect to whether the grounds relied upon by the Applicant in its amended application were made out, in which case, there would be a further hearing to decide what protective orders should be made in accordance with the National Law.
The Respondent stated that his expectation was that "everything" would be dealt with on 27 September 2021. In view of the Respondent's inability to dispute the evidence upon which the Applicant relied, which was essentially evidence adduced on behalf of the Respondent in the criminal sentencing proceedings, and the Statement of Facts to which he agreed in those proceedings, the Tribunal was satisfied that a single hearing of all actual and potential issues would not prejudice the Respondent (King v Health Care Complaints Commission [2011] NSWCA 353, Lucire v Health Care Complaints Commission [2011] NSWCA 99). The Tribunal accordingly conducted a single hearing of the grounds of the amended application, and, if the power to make protective orders was thereby enlivened, the determination of what protective orders should be made in all the circumstances. Nothing which emerged during the hearing caused the Tribunal to reconsider the appropriateness or procedural fairness of proceeding in this manner.
The Tribunal explained to the Respondent and Mr Neil the options which were available to them in the proceedings, which were to give evidence on oath or affirmation, in which case the Applicant would be entitled to cross-examine them, or, as each of the Respondent and Mr Neil ultimately preferred, to make unverified statements to the Tribunal upon which they could not be cross-examined. It was explained to the Respondent and Mr Neil that, if they did not give verified evidence, and offer themselves for cross-examination, the Applicant would be likely to assert that the significance or "weight" which should be given to anything said by them should be reduced.
As explained later in these reasons, the potential implications of electing to make unverified statements do not ultimately assume significance in the determination of the proceedings.
On 27 September 2021, on the application of the Respondent, which the Applicant did not oppose, the Tribunal made an interim order pursuant to s 64(1) of the Civil and Administrative Tribunal Act 2013 (NSW) ("the NCAT Act") preventing publication of the Respondent's name, or any details of the proceedings. Pursuant to that order, the Respondent has been referred to as "FDE" since 27 September 2021. Pursuant to a decision made by the Tribunal prior to publication of these reasons, the identity of the Respondent, and these reasons, are not to be published, other than to the parties, the Medical Council of New South Wales and the Australian Health Practitioner Regulation Agency (AHPRA) before midnight on 11 January 2022. In those circumstances, the name of the Respondent appears in these reasons.
[3]
Evidence before the Tribunal
In addition to the documentation contained in its amended application, the Applicant tendered the Respondent's Certificate of Conviction pursuant to s 178 of the Evidence Act 1995 (NSW), the Agreed Facts tendered at the sentencing hearing, and the sentencing Judge's reasons, together with a bundle of documents tendered on behalf of the Respondent in his criminal sentencing hearing in the District Court (Exhibit HCCC 2).
The Respondent did not object to the tender of Exhibit HCCC 2, or any document contained in it. He could not have successfully done so in our view. The Tribunal is not "bound to observe the rules of law governing admission of evidence, but may inform itself of any matter in the way it thinks fit" in accordance with cl 2 of Schedule 5D to the National Law. Section 38(2) of the NCAT Act is in substantially similar terms, but "subject to the rules of natural justice". The evidence relied upon by the Applicant would be admissible in accordance with the rules of evidence in our view. As the evidence consisted of admissions made by the Respondent, whilst represented by Senior Counsel, or documents relied upon by him in the District Court proceedings, receiving it in evidence involved no breach of the rules of natural justice.
The Respondent and Mr Neil each made statements and submissions to the Tribunal. Although not verified on oath or affirmation, we have considered them as if they were evidence.
[4]
Background
The background to the proceedings is not controversial, and is conveniently set out in the Applicant's submissions filed on 24 September 2021. As those submissions record, the complaints against the Respondent "fundamentally arise from the Respondent's arrest, charge and subsequent conviction" in relation to three criminal offences:
1. use of carriage service on 9 April 2019 to transmit child pornography contrary to s 474.19(1) of the Criminal Code (Cth) ("the Code"), an offence which carries a maximum penalty of 15 years imprisonment;
2. possession of child abuse material between 9 and 11 April 2019 contrary to s 91H(2) of the Crimes Act 1900 (NSW) ("the Act"), an offence carrying a maximum 10 years imprisonment; and
3. attempt to procure a child, being a fictitious child aged 11 years, between 18 March and 10 April 2019, for unlawful sexual activity contrary to s 66EB(2) of the Act, an offence which carries a maximum penalty of 15 years imprisonment.
On 15 May 2020, after entering a plea of guilty to each of the three charges identified above in the District Court of New South Wales, the Respondent was sentenced to a total term of 4 years and 6 months imprisonment, commencing on 10 April 2019 and expiring on 9 October 2024, with a non-parole period of 2 years and 9 months, dating from 10 April 2019, the Respondent thus being eligible for parole on or about 9 January 2022.
The Respondent was aged 49 at the time of his offending conduct. The Respondent obtained a Degree in Medicine in 1993 from the University of Otago, New Zealand. Thereafter, the Respondent held positions as a Surgical Registrar and House Surgeon at Dunedin and Invercargill Hospitals, before migrating to Australia in December 2001.
After arriving in Australia, the Respondent worked at a skin cancer clinic in Coffs Harbour, and obtained a position as a Senior Career Medical Officer at the Coffs Harbour Base Hospital. In 2007 the Respondent obtained a Master's Degree in Medicine from the University of Queensland, and in 2008 established his own skin cancer clinic in Coffs Harbour, which he owned and ran until 2018.
The skin cancer clinic treated thousands of patients, and the Respondent was responsible for 10 staff, and provided training for local general practitioners. In 2016 the Respondent became a Fellow of the Skin Cancer College of Australasia, and lectured on behalf of the College in Australia and New Zealand. In 2018 the Respondent became a Board Member and Treasurer of the College. At the time of his offending conduct, the Respondent was also employed as a Medical Practitioner and Director with a skin cancer clinic in Coffs Harbour, in which role he managed numerous clinics in Queensland, New South Wales and Victoria, and supervised more than 100 other practitioners. The Respondent was still working as a Career Medical Officer with the Intensive Care Unit, Coffs Harbour Health Campus at this time. Testimonials tendered on his behalf in the criminal sentencing proceedings attest to the Respondent's reputation for clinical ability and dedication to his profession.
During the course of the hearing before the Tribunal, the Respondent confirmed that the Skin Cancer College of Australasia is not accredited by the Australian Medical Council, or AHPRA, that the Respondent did not have Specialist Registration, and that his qualifications in skin cancer treatment were not recognised by AHPRA. The Respondent clarified that he was not a dermatologist, and that the description "non-specialist practitioner working in the area of skin cancer" more accurately described his pre-incarceration professional activities. Similarly, with respect to the expression "Career Medical Officer", the Respondent confirmed that the expression "non-specialist doctor in a public hospital, not on a training course" was an apt description of the Respondent's professional classification at the time when he was working in an ICU unit. The Applicant did not seek to take these matters further, and, in those circumstances, the Tribunal does not propose doing so.
The Respondent has been incarcerated since his arrest on 10 April 2019.
[5]
The facts which the Respondent admitted in the criminal proceedings
The agreed facts upon which the Respondent was sentenced in the District Court were contained in the Applicant's original Complaint (together with the Certificate of Conviction) (Exhibit HCCC 2, tab 10).
Rather than paraphrase them, it is appropriate to set out in full the 29 paragraphs of agreed facts which were before the District Court:
"MOTHERLESS CHATS
1. On 18 March 2019 the Offender accessed a pornographic website "Motherless", which features pornography videos, community groups and a private messaging feature where users can directly message other users on their listed email addresses.
2. The Offender, registered with the username "mikeoz" sent a message to the inbox of an assumed online identity (AOI) of a 32 year old female operated by NSW Police with the codename CEIU22. The message read:
"nice to see an aussie female who luvs incest port! I luv all types incest - esp daddy-daughter stuff, but always so hot to see a mum playing with lil girls and boys too. Nothing is off limits for me. What r u looking for here. Cheers, Mike."
3. The AOI send a reply message that read:
"It seems we have the same interests… I'm here to find someone who's on the same page as me with this type of thing. Im not into time wasters. RL not only fantasy."
4. On 25 March 2019 the Offender sent a message from "mikeoz"to "CEIU22":
"hey do you play for real with lil girls or boys? How hold r u Im 48 never had a daughter sadly - 4 grown up boys u? I soooo need to get RL action with a lil daughter. I have not limits re age - u? r u on kik/hangouts?"
5. The AOI sent a reply message:
"ive got my own little princess so im lucky. Nah I don't use any of that, ive got a skype account in another name I use to chat".
6. The Offender sent a message back to CEIU22:
"ofuuccckkk!!! Ur so lucky how old is she? What sur skype? My email which I think is my keype too is mikeynz69@hotmail.com. I'd luv to chat to you about ur sexy lil girl!!!"
7. The AOI provided the Offender with an email address as a contact for the social networking application Skype.
8. On 26 March 2019 the Offender sent two messages to CEIU22 on the website motherless. The messages read:
"hey - Ive added u in skype and sent u a couple of messages. I'm fucking keen to talk u about your sexy lil princess how old is she?"
"great - I have sent u a message there I'm fucking keen to talk to you about ur lil girl!!!"
SKYPE CHATS
9. Between 18 March 2019 and 1 April 2019 the Offender exchanged several messages with the AOI from the email address mikeynz69@hotmail.com.
10. On 1 April 2019 the online identity accepted a friend request from the Offender on the Skype application from the user "mike.zn".
11. On 2 April 2019 the Offender and the AOI engaged in a text conversation via Skype. During the conversation the Offender asked "How old is ur lil girl?" to which the AOI replied "She's 11". The Offender replied "Oh that's very nice age :) Fuck I bet she looks soo sexy! Hope ur looking to have sum play!!. The conversation was then concluded.
12. Later that evening the Offender sent another message "msg me when ur free - Im fucking horny thinking about u and ur sweet lil girl."
13. On 4 April 2019 the Offender engaged in a text conversation with the AOI over Skype. During this conversation the Offender discussed the Offender and the AOI engaging in sexual activity while the daughter is present.
14. During the conversation the Offender asked the AOI:
"would you get wet seeing her playing with my cock?
"would you teach her to suck my cock?"
"id luv to taste her too!!"
"id luv to taste her virgin cunt when u watched!!!"
"ideally my ultimate would be to get my cock into her with u there!!! Hope that's not too far for u!"
15. The Offender told the AOI that he was a Doctor in the field of Skin Cancer, that his real name was Murray and that he was from New Zealand but had lived in Australia for the last 17 years. The Offender stated he travelled for work a lot but resided in Coffs Harbour where he spent about one weekend a month. He provided the online identity with his mobile number [phone number], to contact him and invited the online identity to stay with him in a hotel room at Parramatta on the night of 10 April 2019.
16. The Offender stated that he would be in Parramatta having flown from Melbourne and would be staying at the Park Royal Hotel. He suggested getting room service and for the AOI's child to sleep in the bed with them. The AOI requested that the Offender bring a present for the child to put her at ease. The AOI suggested a "My Little Pony" toy or something sparkly to give her. The Offender stated "I'll buy her whatever increases our chances of playing with her!!! :)".
17. During the conversation the Offender was reminded that the AOI's daughter was 11 years old. The Offender stated that he had a "good collection" of child pornography that he was willing to share with the online identity. During the conversation, the following exchange occurred:
CEIU22: you just have to promise she won't get hurt
mikezn: I absolutely promise. I would never do anything without ur ok
18. On 5 April 2019 the Offender had a phone conversation with the AOI. During this phone call, the Offender confirmed that he was staying at the Park Royal Hotel in Parramatta on the night of 10 April 2019 and that he was looking forward to the AOI and the AOI's child staying the night with him.
19. The Offender suggested that they start by engaging in sexual activity together with the child present and the see how it may progress to an involvement of the child. The Offender expressed his desire to engage in sexual activity with the child, with the AOI watching. He stated that he's like to see the AOI engage in sexual activity with the child while he watched. The Offender stated again that he would sent the AOI some child pornography for her to watch in the presence of the child.
20. During the conversation, the Offender stated that "…I don't have the expectation that I'm gunna get very far with her the first time, you know, like, so I'd love it if I did, but I don't have any expectation like that. I just, you know, I'll take, take your leads."
21. On 9 April 2019, the Offender and the AOI confirmed their arrangements for the meeting. During the communication the Offender again repeated his desire to engage in sexual activity with the child, including while she was asleep.
22. During the conversation, the AOI asked the Offender, "have you ever had the chance to do this before?" The Offender replied, "no. ive wanted to for ages. ur the same?"
23. The Offender sent the AOI 10 videos depicting child sexual abuse through the Skype program. The Offender sent these to give the AOI an indication of what he'd like to do with her child and stated that the 10 videos represented 2% of the child pornography material in his possession.
ARREST
24. At 7.30pm on 10 April 2018 the Offender arrived at the Park Royal Hotel in Parramatta. The Offender checked in to Room 1003 and attended the lobby to meet the AOI and her 11 year old daughter.
25. Officers of the NSW police attended the Park Royal Hotel arrested the Offender in the lobby of the Park Royal Hotel.
26. NSW Police searched the Offender's room and found various data storage devices such as USB sticks, a silver Apple Macbooks, an Apple iPhone and an Apple iPad. Police also found a My Little Pony toy.
27. On 11 April 2019 NSW Police conducted a warrant search of the Offender's address at [address]. NSW Police seized several electronic exhibits for further examination.
28. One of the exhibits seized from the Offender's residence was a Black Seagate Hard Drive. This device 2 Category 1 images and 1 Category 2 image.
29. One of the USB thumb drives seized from Room 1003 of the Park Royal Hotel, a 256GB Corsair Drive, was found to contain in excess of 500 images both of category 1 and 2 child abuse material. The drive also contained 30 videos of both category 1 and 2."
The remarks on sentence of Judge Sweeney of 15 May 2020 are before the Tribunal (Exhibit HCCC 2, tab 11). Although the Tribunal perceives there to be no impediment to the Judge's findings in the criminal proceedings being relied upon in these proceedings, as the Respondent has been unrepresented, and with no disrespect to her Honour, we do not propose, or need to adopt the findings recorded in those remarks. To the extent that "it is entirely plausible that different inferences may be based on common primary facts" by doing so, we do not understand that possibility to create difficulties, as any view formed by the District Court Judge "would be not merely not binding upon the Tribunal, it would be irrelevant to the Tribunal's exercise of its function in assessing the evidence before it" (Alexakis v Health Care Complaints Commission [2021] NSWCA 217 at [15]). The Tribunal will assess the evidence before us, and determine the proceedings by reference to the primary facts as admitted or found, and the legislative provisions which govern the proceedings.
[6]
The evidence which the Respondent relied upon in the District Court
The evidence is contained in exhibit HCCC 2. We have recorded earlier in these reasons why the Tribunal has received the evidence. As the evidence was relied upon in the District Court as "mitigating factors" within s 21A of the Crimes (Sentencing Procedure) Act 1999 (NSW), the Tribunal does not perceive that its receipt into evidence in these proceedings could unfairly prejudice the Respondent.
Dr Henderson, a Consultant and Forensic Psychiatrist, prepared a report dated 13 May 2020, in which, under the heading "Psychiatric Diagnoses" (page 9), Dr Henderson reported the Respondent as suffering:
1. Major Depressive Disorder (DSM 5 - 296.23)
2. Alcohol Use Disorder - in sustained remission - in a controlled environment (DSM 5 - 303.90)
3. Pedophilic Disorder - non-exclusive type, sexually attracted to females (DSM 5 - 302.2).
The basis of each disorder thus diagnosed was set out by Dr Henderson. Most significantly for present purposes, Dr Henderson recorded with respect to the diagnosis of Pedophilic Disorder that it was "made on the basis of the nature of the offending behaviour, which involved the possession of pornographic material of young persons and the attempt to procure sexual activity with a young person. Mr Govan's Pedophilic Disorder is considered non-exclusive as he has engaged in long-term age-appropriate sexual relationships for the majority of his adult life. Mr Govan appears to have experienced an emergence of regressive sexual urges and impulses as a consequence of his untreated major depressive disorder. This is consistent with an absence of past sex offending behaviour, Mr Govan's report that he has not been attracted to young person [sic] and apparent late emergence of this disorder. Mr Govan does not appear to suffer from another paraphilic disorder."
Dr Henderson then addressed "risk assessment" (page 10, paragraph 10.2), and assessed the Respondent's risk of "future sex offending" as "below average risk; higher risk than non-offenders, but lower risk than typical offenders".
Ultimately (page 11, paragraph 10.3), Dr Henderson recorded that "[t]he assessed risk of further sex offending behaviour according to clinical assessment and the utilization of actuarial risk management tools suggest Mr Govan is at a low risk of further offending behaviour".
Dr Henderson stated that "Mr Govan has a diagnosis of major depressive disorder, which is considered a mental illness characterised by a severe disturbance of mood. He also suffers from alcohol use disorder, which is considered to be a mental condition." The reasons for that diagnosis Dr Henderson detailed (page 11, paragraph 11.1), recording that "a latent paedophilic tendency gained conscious expression in the context of his major depressive disorder, alcohol use and overwhelming stress". Dr Henderson further recorded (page 11, paragraph 11.2) that he believed the Respondent's "mental illness and condition represent risk factors in relation to re-offending behaviour, however these risk factors are offset by the numerous protective factors related to his offending behaviour, specifically, his intact personality functioning, absence of past offending behaviour, sexual or otherwise, stable employment and relationship history and preparedness to engage in long-term treatment for his depressive and alcohol use disorder".
Dr Henderson expressed the view (page 12, paragraph 11.2) that "should Mr Govan comply with ongoing treatment of his depressive disorder, alcohol use disorder and sexual deviancy, his risk of further offending behaviour would be very low". Nothing stated by the Respondent before the Tribunal supports a finding that the Respondent is having "ongoing treatment", or reveals any plans or proposals which the Respondent has in that regard, either between now and the time of his release from custody, or after his release from custody and return to New Zealand.
On 14 May 2020 Professor Woods, a Forensic Psychologist, prepared a report dated 14 May 2020. In the course of his report (page 27, paragraph 2.1), Professor Woods referred to an interview on 12 October 2019 with Ms Mathews, who he described as having been in a "marital type relationship" with the Respondent for about 12 months prior to April 2019. In the course of his recording of his interview with Ms Mathews, Professor Woods stated that Ms Mathews was "committed to their relationship" and "intends to join him in New Zealand if he is, as expected, deported after serving a custodial sentence".
Under the heading "Assessment - Mental Status" (exhibit page 32, paragraph 4.1), Professor Woods referred to the Respondent's "Dependent Personality". Under the heading "Personality Inventories" (exhibit page 36, paragraph 4.2) Professor Woods recorded that the Respondent's Million Clinical Multiaxial Inventory - IV (MCMI-IV) was "consistent with the diagnosis of Personality Disorder, but with mixed predominantly obsessive compulsive and dependent features".
Professor Woods further recorded, by reference to the NEO Personality Inventory-3 "very high range T-scores" on five identified "facets of personality" "indicative of a quite severe Personality Disorder" (page 37, paragraph 4.2). Professor Woods assessed the Respondent with respect to "sex offender risk inventories" (page 38, paragraph 4.3) and, by reference to the tests or criteria there identified, concluded and recorded (page 46) that the "Risk Principle" as it applied to the Respondent identified that:
1. other than accessing of child-mother pornography and involvement in related online chats, there is no prior history of offending;
2. the offending behaviour commenced when the Respondent was aged in his late forties and thereafter escalated;
3. individuals who commit the index offence when in the same or older age brackets as the Respondent are less likely to reoffend;
4. notwithstanding, his age related future risk protective factors, an escalation in the nature of sexual offending (as occurred with the Respondent) is recognised as being a high risk factor. Accordingly, his low to moderate rating on Static Inventories must be viewed with an appropriate level of caution;
5. in the Respondent's case, his age at the time of beginning to offend and expected age at the time of release, along with his high level of offence shame and remorse will serve to lower the risk of reoffending while also serving to motivate his continuing commitment to rehabilitation.
Under the heading "Diagnoses" (page 53, paragraph 6.2) Professor Woods recorded that the Respondent suffered from "Major Depressive Disorder", other "specified personality disorder", "Alcohol Use Disorder" ("previously clinically severe and now in remission since being received into a controlled environment") and "Paedophilic Disorder", his opinion being that the Respondent did not satisfy the diagnostic specifier "exclusive type" due to the Respondent's "acknowledged interest in a broad range of pornographic material" and "his reports of not feeling any level of sexual attraction to young persons who he might see in everyday life in the (approximately) twelve (12) month period leading up to and persisting at the time of arrest". Professor Woods noted, however, that the Respondent's "acknowledged growing high-level interest in mother child sexual interaction" was likely to have ultimately met the relevant criteria of "exclusive type" had the Respondent not been arrested in 2019.
In his "Concluding Comments" (page 54, paragraph 7), by reference to page 699 of the DSM-5, Professor Woods noted that "[p]edophilia per se appears to be a lifelong condition. Pedophilic disorder, however, necessarily includes other elements that may change over time with or without treatment; subjective distress (e.g. guilt, shame, sexual frustration, or feelings of isolation) or psychological impairment or the propensity to act out sexually with children". Professor Woods suggested that the relevance of that criteria to the Respondent to be the fact that the Respondent's "paedophilic interest (reportedly) did not develop until aged in his late 40's and only after becoming subject to the loss of his skin cancer clinic and subsequent high demands of his roles as Medical Director, SunDoctors and involvement in the Australasian College of Skin Cancer". Professor Woods recorded that the Respondent had "demonstrated a high level of motivation to address his paedophilic behaviours by way of appropriate treatment". Other than generalised statements by Mr Neil, the Tribunal knows nothing about any of the circumstances to which Professor Woods referred.
Professor Woods further recorded that, as a convicted sex offender, the Respondent would be "subject to strict, close monitoring for a number of years following his release from gaol and will not have the opportunity to access online sites that would allow him to act on his specific paedophilic urges. The lack of opportunity to act on his specific paedophilic urges in addition to treatment will further to lower the risk of reoffending". In the absence of evidence, or submissions in that regard, the Tribunal is unable to consider the extent, if any, to which those matters would be relevant to the exercise of discretion if the power to make protective orders is enlivened.
Professor Woods concluded that the Respondent's "level of offence-related shame, guilt, and remorse is extreme. Relevant research [which had been earlier identified in the report] has consistently documented that offence shame, guilt, and remorse strongly protect against future reoffending".
Without disputing anything recorded in Professor Wood's report, the Respondent said nothing in the proceedings before the Tribunal which enables the Tribunal to form any views with respect to the current level of remorse, shame, or contrition.
On 16 April 2020, Mr Pow, Chaplain, Offender Services and Programs, Corrective Services, NSW Department of Justice, provided a reference for the Respondent based on having "spent some time meeting regularly" with him in the twelve months after the Respondent's arrest and incarceration. Mr Pow recorded that the Respondent had completed a Salvation Army Positive Lifestyle course, which consisted of eight modules to assess self-esteem, anger management, depression and loneliness.
Ms Matthews provided a statement addressed to the "Sentencing Judge", in which she recorded that she and the Respondent had been living together "for about 2.5 years" prior to the Respondent's arrest on 10 April 2019. Ms Matthews expressed her opinion that the Respondent was "a person of good character and that the offences he has been charged with are totally out of the ordinary for him".
In her statement, Ms Matthews recorded that she had remained by the Respondent's side "throughout this whole ordeal and will continue to support him throughout the rest of his journey both in and out of gaol". Ms Matthews did not provide a statement in support of the Respondent in the proceedings before the Tribunal. The Respondent said nothing about her. The Tribunal is unaware what, if any, relationship the Respondent currently has, or will have in the future, with Ms Matthews, either here or in New Zealand.
The father of Ms Matthews provided a statement dated 6 May 2020. Mr Matthews described himself as "retired, having been both a primary and secondary school principal and teacher for over 30 years". Mr Matthews stated that he had known the Respondent for five years. As did Ms Matthews, Mr Matthews referred in general terms to the financial, personal and professional pressure to which the Respondent had been subjected in the period preceding the conduct which gave rise to his incarceration. Mr Matthews stated that he understood that the Respondent "may need continued support following his release from custody" and undertook "to help facilitate ongoing mental and physical support" for the Respondent. As with Ms Matthews, how likely that is is not the subject of any evidence before the Tribunal. It is reasonably apparent from Mr Matthew's statement that he is ordinarily resident in northern New South Wales.
Ms Gowling provided a reference for the Respondent on 10 May 2020. Ms Gowling's reference was provided from an address in New Zealand. Ms Gowling stated that she had known the Respondent for over 20 years, being married to the Respondent's "best friend". As did other lay witnesses, Ms Gowling referred to social, financial and other pressures to which she believed the Respondent was exposed. With respect to Ms Gowling, it is unclear when she last saw the Respondent, or the nature and extent of any contact which she has had with the Respondent since he moved to Australia, or is likely to have in the future.
Ms Clifford, a Registered Nurse, provided a statement on 7 May 2020. In her statement, Ms Clifford referred to having known the Respondent since October 2015, when she commenced working at the Respondent's skin cancer clinic as a Registered Nurse. Ms Clifford referred to the nature and extent of the duties performed by the Respondent. Ms Clifford described the Respondent as "a broken man who needs help and guidance", stating that she, with her husband, would "provide emotional and spiritual support" for the Respondent.
Mr Clifford provided a statement dated 5 May 2020. Mr Clifford is a former South Australian and New South Wales Police Officer, who has known the Respondent since about 2015. Mr Clifford referred to the "benefit" which he believed the Respondent had received from Professor Woods (page 117). Mr Clifford stated that he would "pledge to support" the Respondent "both emotionally and spiritually following his release". As with other lay witnesses who gave evidence on his behalf, Mr Clifford referred to the Respondent's offending conduct as out of character. What, if any, role Ms Clifford or Mr Clifford is likely to have in the Respondent's life after his release from custody is not the subject of any evidence before the Tribunal.
Mr Gowling of New Zealand provided a statement dated 4 May 2020. In that statement Mr Gowling set out his knowledge and experience of the Respondent over a period of approximately twenty years. Mr Gowling said that the Respondent was "a broken man and who knows long it will take him to recover if ever."
The Applicant submitted, (paragraph 33) that the clandestine nature of offences such as those to which the Respondent pleaded guilty mean that opinions about "public conduct carry less weight than they might in other cases" (HCCC v Dr Alex Simring [2010] NSWMT 7 at [105], HCCC v Vincent [2012] NSWNMT 2 at [55]-[56]). We accept that contention, but, as we have earlier noted, none of the persons who supplied "character" statements in the Respondent's sentencing hearing 18 months ago provided a statement in these proceedings. We do not know what, if any, contact or relationship any of those witnesses has or will have with the Respondent upon his release from imprisonment.
The final document in the Respondent's sentence bundle comprised a statement by the Respondent. In that statement, the Respondent expressed his "sincere remorse" for his offences, particularly as they were directed towards "the most vulnerable members of our community and family - the children". The Respondent stated that he could not "express strongly enough how much I regret" his part in the suffering of the children who are victims of sexual abuse, and stated that he would "continue to do everything possible to ensure that my actions are never repeated". What that is intended, or is likely to entail was not revealed to the Tribunal.
The Respondent further stated that, through personal reflection, the programs he participated in whilst on remand and the "treatment from Professor Woods", he realised "how unstable my mental state had become, and how I should have taken the advice of those who loved me and witnessed my decline and sought professional psychological help". The Respondent stated that he had "also learned and gained insight into my sickening behaviour and actions and the consequences these have had on the victims, society and my family and friends".
The Respondent further stated that he accepted and was "fully committed to receive and participate in ongoing treatment, including upon my release, from Prof Woods". Professor Woods, it is clear, practises in the Sydney area. There is no evidence before the Tribunal that Professor Woods practises in New Zealand, or would be able to treat the Respondent if he were, as it is accepted will be the case, deported to New Zealand upon his release from custody in January 2022. The Respondent has not suggested the name of any psychiatrist or psychologist from whom he will seek "ongoing treatment" upon his return to New Zealand.
As noted earlier, neither the Respondent nor Mr Neil gave evidence before the Tribunal. Each was invited to raise such matters with the Tribunal as either thought might assist the Respondent's cause. Other than the evidence referred to above, which does not materially advance the Respondent's case in these proceedings, in reality, the Respondent has raised nothing which militates against making the findings urged on behalf of the Applicant or, if findings in those terms were made, making protective orders in the terms sought by the Applicant.
Mr Neil made submissions in support of his general contention that the Respondent "deserves another chance". As his involvement with the Respondent, and degree of firsthand knowledge of his circumstances was unclear, the factual foundation of Mr Neil's plea is difficult to discern. Mr Neil appears, in ways that were not made clear, to have been primarily involved in the Respondent's life in the last four years in a financial role of an unspecified nature. His loyalty to the Respondent was readily apparent throughout the hearing. Although we do not criticise Mr Neil's loyalty, his understandable lack of objectivity limits the weight which his statements should be afforded.
For reasons which were not suggested, Mr Neil was not a witness for the Respondent in the criminal sentencing proceedings. It is difficult, in the absence of any clear revelation of the extent of the contact between the Respondent and Mr Neil prior to the former's incarceration, to know what weight to give to Mr Neil's statements. It is assumed, but not established, that Mr Neil has been privy to the facts of the Respondent's offending conduct. With respect to Mr Neil, his statements ultimately do not materially assist the Tribunal in determining the protective orders which are appropriate to be made if the power to make such orders is enlivened.
As observed earlier, the Respondent said nothing which gives any objective basis for finding, were he, contrary to his expressed intentions, to seek to resume medical practice, that permitting him to do so would be in the interests of the safety of the community.
The Tribunal has struggled to provide procedural fairness to the Respondent but not transgress, and give him, or be seen to have given, the Respondent legal advice. That is particularly so when probing questioning by the Tribunal may have resulted in responses by the Respondent which were ultimately to his detriment.
[7]
The submissions of the Applicant
The Applicant submitted that the evidence established its claim pursuant to s 144(a) of the National Law. That section relevantly provides:
The following complaints may be made about a registered health practitioner-
(a) Criminal conviction or criminal finding
a complaint the practitioner has, either in this jurisdiction or elsewhere, been convicted of or made the subject of a criminal finding for an offence.
We are comfortably satisfied that the Applicant has made out its case in reliance upon this provision.
The Applicant submitted (paragraph 27) that the circumstances of the Respondent's conduct rendered him unfit to practise, as that term finds expression in s 149C(1)(c) of the National Law, and warrant cancellation of his registration pursuant to that section. Section 149C(1)(c) of the National Law provides that:
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…
The Applicant submitted that the term "public interest" (paragraph 29), though not defined by the National Law, is "a broader concept than the protection of the health or safety of the public and encompasses wider community interests such as the standards to which human conduct is to be held" (Health Care Complaints Commission v Russ [2021] NSWCATOD 5 at [37]).
The Applicant submitted that the "public interest" also encompasses broader principles of "the protection of the public as it relates to the reputation of the profession in the eyes of the public and a recognition of the trust reposed in a practitioner by the public" (Health Care Complaints Commission v Holbrook [2019] NSWCATOD 146 at [67]).
The Applicant submitted that "fitness" within s 149C(1)(c) of the National Law was not subject to the requirement of "probable permanent unfitness" but rather required an assessment of "the practitioner's current fitness to practise", the present issue thus being whether the circumstances surrounding the Respondent's offending currently render the Respondent unfit to practise medicine (Chen v Health Care Complaints Commission (2017) 95 NSWLR 334; [2017] NSWCA 186 at [67]-[71]).
The Applicant emphasised (paragraph 30) that "in the absence of recent evidence and from the Respondent himself, it is difficult to assess his present fitness to practice". Reference to the medical reports tendered at the Respondent's sentencing hearing in the District Court were submitted to indicate that the "mental condition" of the Respondent was "deteriorating at that time". It was thus submitted (paragraph 31) that whilst the Respondent's "curriculum vitae is suggestive of a very competent and skilful practitioner, there is firm evidence from the Respondent's engagement in the index offences that his personal qualities, aside from medical acumen, are not compatible for [sic] those essential to the discharge of his professional responsibilities". No part of the Applicant's case asserts, or is reliant upon any suggested lack of medical skill or competence on the part of the Respondent. The Tribunal's determination of the current proceedings does not involve contrary findings in that regard.
The circumstances of the Respondent's offending were identified, accurately, in support of the foregoing submission. Had it "gone unchecked", the conduct of the Respondent was submitted to have been likely to cause "doleful physical and mental harm to a vulnerable and innocent member of the community". Similar submissions were made in support of the Applicant's contention that the Respondent's "sinister personal attributes" are "the very opposite of the professional responsibility with which he was charged" (paragraph 32).
In reliance upon the matters summarised above, the Applicant submitted that the Respondent's offending conduct was "well within the range of sufficient seriousness" for a finding that he lacks the personal qualities of "probity and scrupulosity" required of a medical practitioner, rendering him "unfit to practise medicine" (paragraph 34). The Applicant particularised aspects of the Respondent's offending conduct by reference to evidence adduced on his behalf at his sentencing hearing in support of its contention (paragraph 35).
The contention of the Applicant (paragraph 36) that "were it not for the actions of police in detecting and disrupting it, the Respondent could potentially, and disturbingly, still be engaged in similar conduct" to that to which he pleaded guilty in the District Court is difficult to dispute. The Respondent has said nothing in these proceedings which militates against acceptance of that contention.
The Applicant reminded the Tribunal that the unsworn statements of contrition and remorse relied upon by the Respondent at his sentencing hearing obliged the District Court Judge sentencing him to treat his statements as of limited weight (R v Qutami [2001] NSWCCA 353 at [58], [79], Alvares v R, Farache v R [2011] NSWCCA 33 at [51]-[58]). We agree with the submission of the Applicant (paragraph 37), that, to the extent that the Respondent expressed any contrition or remorse in these proceedings, we are not in a position to assess the current veracity or genuineness of such expressions, or the level of insight which informs them. Having regard to the protective objects and purposes of the National Law, the absence of material with respect to the Respondent's current insight into his offending conduct, and its impact on the likelihood of its recurrence is more significant than evidence of the Respondent's current feelings of contrition or remorse.
As the unverified statements of the Respondent do not materially assist his case, although permissible, we do not propose to infer that giving evidence on oath or affirmation would not have assisted the Respondent, or to criticise the Respondent for not doing so (Health Care Complaints Commission v Kingston [2018] NSWCATOD 28 at [24]-[28]). The contents of the statements of the Respondent result in there being "many questions left open which only the respondent could answer" (NSW Bar Association v Meakes [2006] NSWCA 340 at [71].
The Applicant submitted (paragraph 39) that the Tribunal's approach to the question of the Respondent reoffending needed to be "guarded", for reasons relating to the evidence before the District Court and the sentencing Judge's remarks on sentence. It was submitted, accurately in our view, that the risk of the Respondent reoffending being "low, or low to moderate", was premised upon the Respondent continuing to obtain appropriate treatment for his conditions, receive supervision, monitoring and support from "significant others", none of which matters is the subject of any evidence in these proceedings.
It was also submitted (paragraph 40), correctly in our view, that the fact that the Respondent had been in custody for over two years, and thereby unable to commit further offences, precluded the passage of time from being a "useful criterion when assessing risk, or, more importantly, considering fitness in this case".
The Applicant also relied significantly upon the expert opinion evidence adduced on his behalf at his sentencing hearing with respect to the likely duration of the Respondent's paedophilic disorder (paragraphs 41 and 42). The Applicant submitted that such condition had "ramifications for both the character and integrity as well as the ability of the practitioner to practice safely" (Health Care Complaints Commission v Geary [2018] NSWCATOD 15 at [114]-[121]).
The Applicant also submitted (paragraph 43) that, in accordance with the Tribunal's "paramount concern for the safety of the community and its need to appropriately denounce the Respondent's conduct and maintain the reputation of the medical profession", the Tribunal would find that the circumstances of the Respondent's conduct render him unfit to practise medicine and that his registration should be cancelled.
It was further submitted by the Applicant (paragraph 44) that the Tribunal could not fail to find that the second complaint was made out, it being clear that, as a matter of record, the Respondent failed, as required, to advise of his charge and conviction and, as is also clear, has not supplied any explanation for such failure. Although in custody from the time of his offending behaviour, the Respondent has not suggested that he was thereby, or otherwise, unable to comply with his obligations.
The Applicant relied upon the decision in Health Care Complaints Commission v Holbrook [2019] NSWCATOD 146 at [31] in which it was said, of s 130 of the National Law, that provisions requiring the notification of certain types of criminal charges to AHPRA were a "significant tool" in the regulatory framework, the failure to comply with which deprived regulatory bodies of the opportunity to "assess risk and take appropriate action to protect the health and safety of the public at the earliest possible stage". It was further noted that the failure to comply enabled a practitioner to continue to hold the benefits of registration and "potentially give themselves the opportunity to continue the same or similar conduct which brought them to the attention of the police and criminal justice system in the first place".
In Holbrook and Health Care Complaints Commission v Amalakumar [2019] NSWCATOD 173, it was accepted that failure to notify in accordance with s 130 of the National Law constituted unsatisfactory professional conduct, in respect of which the Tribunal exercises no discretion. Little more can, or needs to be said about the second complaint. It is undoubtedly made out.
[8]
Consideration of appropriate protective orders
The Applicant sought cancellation of the Respondent's registration with a non-review period of five to seven years pursuant to s 149C(7) of the National Law, and an order prohibiting the Respondent from providing "health services" for a similar period pursuant to s 149C(5) of the National Law. The definition of "health services" in s 5 of the National Law encompasses a number of activities which are directly or indirectly connected with the health of the public. If an order pursuant to s 149C(5) is appropriate, nothing to which the Tribunal has been referred suggests that any health service within s 5 of the National Law should be excluded from its operation.
In support of the relief sought by it, the Applicant relied upon the Judgment of Basten JA in Chen v Health Care Complaints Commission (2017) 95 NSWLR 334; [2017] NSWCA 186, at [21] and [22], in which His Honour described the "fixing of a period within which re-registration may not be sought" as having "a twofold operation". The fixing of such a period "indicates the minimum period within which the Tribunal considers the person should not be able to practise his or her profession" yet "holds open the possibility that an application for re-registration thereafter will at least be considered". His Honour recorded that it was "entirely proper for the Tribunal to consider all aspects of the possible orders available to it in determining what order to make" (paragraph 48).
[9]
Disposition
As observed earlier in these reasons, the Respondent has said little to suggest that he disputes any of the factual matters relied upon by the Applicant with respect to his offending conduct, or the protective orders which it submits should be made. Whilst the Respondent could not successfully dispute any of the matters pertaining to the criminal conduct for which he was imprisoned, and has effectively made no submissions in opposition to anything advanced on behalf of the Applicant, the Applicant bears the onus of establishing the facts upon which it relies in support of the relief sought by it on the balance of probabilities, and by reference to all of the relevant evidence before the Tribunal (Health Care Complaints Commission v Wilcox [2020] NSWCATOD 10 at [52]).
The powers of the Tribunal to make protective orders are found in Part 8, Division 3, Subdivision 6 of the National Law, pursuant to which the Tribunal may, inter alia, cancel registration if it is satisfied of a matter falling within s 149C(1) of the National Law. For the reasons we have earlier recorded, we find that the Applicant has proved its case pursuant to each section.
The power to make the protective orders sought by the Applicant cancelling the Respondent's registration has been enlivened. The issue is thus whether the Respondent's conduct justifies cancellation of his registration as a medical practitioner in order to protect the health and safety of the public (see Health Care Complaints Commission v Karalasingham [2007] NSWCA 267 per Basten JA at [67]) and the making of the additional orders sought by the Applicant.
Section 4 of the National Law requires the Tribunal to exercise its functions having regard to the objectives and guiding principles recorded in s 3 of the National Law. In exercising its powers under the National Law, the Tribunal must regard "the protection of the health and safety of the public" as the "paramount consideration" (National Law, s 3A).
In making protective orders, the task undertaken by the Tribunal has consistently been described as centring "not on punishment as such but on the protection of the public and the maintenance of proper professional standards" (Lee v Health Care Complaints Commission [2012] NSWCA 80 at [21]).
In Director General, Department of Ageing, Disability and Home Care v Lambert (2009) 74 NSWLR 523; [2009] NSWCA 102 at [83] Basten JA said that the specific purpose for which orders are made is "protective in the public interest and is not punitive with respect to the individual" although such orders "may be punitive in effect" and that punitive effect "may be relevant in formulating a protective order". His Honour further observed that the "punitive effects may be directly relevant to the need for protection" so that, "in a particular case, there may be a factual finding that the harrowing experience of disciplinary proceedings, together with the real threat of loss of a livelihood may have opened the eyes of the individual concerned to the seriousness of his or her conduct, so as to diminish significantly the likelihood of its repetition" and to produce "a level of insight into his or her own character or misconduct, which did not previously exist."
The authorities recognise that the Tribunal cannot assume that a medical practitioner has reformed without clear proof, and more than the mere passage of time without misconduct (Lee at [73]). The authorities also suggest that reformation is the exception rather than the norm (Health Care Complaints Commission v Litchfield (1997) 41 NSWLR 630 at 637). The Tribunal must be satisfied that the practitioner has demonstrated "integrity, trustworthiness, high moral and ethical values and a capacity to comply with relevant obligations and codes of practice such that it is appropriate for the practitioner to be held out to the public as a person worthy of their confidence" (Dawson v Law Society of New South Wales [1989] NSWCA 58, Crickitt v Medical Council of NSW (No 2) [2015] NSWCATOD 115).
To what extent, if any, the orders sought by the Applicant in this case will be "punitive" with respect to the Respondent is not clear. Other than in the obvious general sense that the Respondent will be unable to earn income as a medical practitioner for some years, there is no evidence of any financial or non-financial punishment attaching to him as a consequence of orders made by the Tribunal in the terms sought by the Applicant. It is difficult to imagine that making orders in the terms sought by the Applicant would result in any opprobrium attaching to the Respondent which his offending conduct would not already have attracted, or be likely to attract upon his return to the community, wherever that might be.
Similarly, there is no evidence before the Tribunal to establish, to the extent that it may have been "harrowing", that the current proceedings, with or without the real threat of loss of a livelihood, may have "opened the eyes" of the Respondent to the seriousness of his conduct. So far as the likelihood of repetition of that conduct, and level of insight into his or her own character or misconduct which did not previously exist is concerned, the submissions of the Applicant with respect to the caution which the Tribunal should exercise in that regard resonate, particularly as the submissions of the Applicant are based on matters emerging from the psychiatric evidence adduced on behalf of the Respondent at his sentencing hearing.
Protecting the health and safety of the public is not confined to protecting future patients from the risk of harm. The Tribunal may appropriately take into account matters such as the maintenance of standards and the general standing of the medical profession. In Health Care Complaints Commission v Do [2014] NSWCA 307 at [35] the Court of Appeal noted that:
"…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 practice, 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."
In the criminal law, prior good conduct and an otherwise unblemished record of professional service may materially mitigate the severity of the sentence which is imposed for offending conduct. The Tribunal takes those matters into consideration in favour of the Respondent. However, the paramount interest in these proceedings is the health and safety of the public. It is difficult to imagine misconduct which more compellingly calls for orders to protect the health and safety of the public, or "signalling" of the kind described in the authorities, than the offending conduct which the Respondent has admitted.
The community is entitled to feel "safe" when consulting a medical practitioner. We have referred earlier in these reasons to the evidence before the District Court with respect to the risk of the Respondent "re-offending". In our view, any risk of conduct by a medical practitioner of the kind which the Respondent admitted in the criminal proceedings is unacceptable, and incompatible with retention of the rights and privileges of a medical practitioner for so long as that risk exists.
On the evidence before us, it is unthinkable that the Respondent's registration should not be cancelled. Appropriately in our view, the Applicant did not suggest that the Respondent should never have the opportunity to apply for re-registration as a medical practitioner. The question is thus the period during which he should be prevented from applying for such re-registration. During that period, in the circumstances of this matter, an order should be made prohibiting the Respondent from providing health services.
Although the evidence does not suggest that the Respondent would, or may, seek to provide health services within s 5 of the National Law, other than as a medical practitioner, having regard to the nature and gravity of the Respondent's offending conduct, and the matters relied upon by the Applicant which emerge from the medical evidence upon which the Respondent relied in the District Court, failing to make such an order would constitute an unacceptable risk for the health and safety of the public. Put bluntly, the Respondent should not be able to provide health services unless and until he satisfies the appropriate regulatory body that public health and safety would not be at risk if he were permitted to do so.
As the authorities make clear, at the expiration of any period which is imposed, the Respondent has the opportunity to apply for re-registration. On the evidence before us, the Respondent would need to adduce compelling medical and circumstantial evidence establishing that he posed no risk to the public before his re-registration could be seriously considered.
We are mindful that any protective orders which the Tribunal makes should not result in more serious consequences for the Respondent than is reasonably necessary in the execution of the protective purpose of the legislation (NSW Bar Association v Meakes [2006] NSWCA 340 at [113]).
We agree with the submission on behalf of the Applicant that the period of two and a half years during which the Respondent has not reoffended needs to be considered in the light of the fact that he has been unable to reoffend during that period.
During the hearing, the Tribunal asked the Applicant whether there were decisions under the National Law, or its predecessor(s), involving child pornography, or other circumstances similar to those in this case. After the hearing, the Tribunal, the Respondent and Mr Neil were provided with reports of four decisions which were suggested to fall within that description. Given the discretionary nature of our determination of this issue, it is appropriate, and in the interests of justice, that we refer to those decisions.
In HCCC v Dr Alex Simring [2010] NSWMT 7, a case involving a medical practitioner who was convicted of the possession of 30,000 images and hundreds of video files depicting teenage girls in various sexual poses and performing sexual actions with sex toys or with other females or adult men (at [4]), the Tribunal reprimanded the practitioner, and imposed a series of conditions on his ability to practise medicine. The Tribunal's "Discussion" of the appropriate protective orders at [112]-[113] is brief. The practitioner was found, at [107], to have offended "over years" and to have "only ceased" to access child pornography when he was arrested.
In Nursing and Midwifery Board of Australia v Buckley [2010] QCAT 392, a case involving a nurse who was convicted of the possession of 10,000 images of child pornography, including images of sexual penetration of children, the Tribunal ordered that the practitioner not apply for re-registration for a period of two years, and not do so until he had fulfilled a number of conditions.
In Health Care Complaints Commission v Vincent [2012] NSWNMT 2, a case involving a nurse who was convicted of possessing and disseminating child pornography, the Tribunal cancelled the practitioner's registration, and ordered that he not apply for re-registration for a period of two years.
In Health Care Complaints Commission v Dawes [2015] NSWCATOD 8, a case involving a psychologist who was found guilty of grave breaches of professional standards with respect to an adult patient, the Tribunal made protective orders cancelling the practitioner's registration, and preventing him from applying for re-registration, or providing health services for a period of 10 years. The facts of the case differ substantially and importantly from the present case.
In Health Care Complaints Commission v Rouen [2019] NSWCATOD 76, a case involving a psychologist who was convicted of possessing child pornography, the nature of which does not emerge from the Tribunal's reasons, the Tribunal made protective orders cancelling the practitioner's registration, and preventing him from applying for re-registration for a period of three years. The Health Care Complaints Commission did not "actively seek a prohibition order", although such orders were reported, at [83], as having been the subject of "some discussion" in submissions. The Tribunal recorded at [86] that it was not satisfied to the requisite standard that the practitioner presented a substantial risk to the public if he sought to provide a health service.
In exercising our discretion with respect to the appropriate protective orders, we have regard to the decisions recorded above, not in an attempt to achieve something analogous to "parity of sentencing", but to avoid making protective orders which inadequately protect the safety of the public on the one hand, or are more onerous on the Respondent than the safety of the public requires on the other.
Without repeating the matters which were identified and considered earlier in these reasons, the evidence with respect to the circumstances of the Respondent's offending conduct, the mental health issues identified by his own experts in the District Court proceedings, and the numerous and significant matters which the Respondent has "left open" comfortably satisfy us that the circumstances of the Respondent render him unfit in the public interest to practise medicine, and that the protection of the health and safety of the public requires that the Respondent's registration be cancelled pursuant to s 149C(1) of the National Law.
Although minds might reasonably differ, and in reliance upon the matters discussed earlier in these reasons, we are comfortably satisfied that orders pursuant to s 149C(7) and s 149C(5) of the National Law preventing the Respondent from applying for re-registration and prohibiting him from providing health services respectively for a period of five years would be appropriate in all the circumstances. Such period represents, in our view, the period without reoffending, of continuing therapy and rehabilitation which might be likely to be required before the Respondent should have the opportunity to apply for re-registration. The evidence does not suggest that such an order renders nugatory any opportunity for the Respondent to apply for re-registration by reason of age or any other circumstance. To the extent that the exercise of our discretion is less well informed than it might have been, that results from the Respondent's election to "leave open" the matters to which we have earlier identified.
During the course of the hearing, the question of notification of the findings and orders of the Tribunal in these proceedings to the regulatory authorities in New Zealand arose. Although we understand that our findings and orders will be published to the relevant New Zealand authorities, the Applicant is at liberty to formally provide our reasons and orders expeditiously to the relevant New Zealand authorities.
[10]
Costs
The Applicant sought an order for costs. The question of costs was not specifically raised with the Respondent. Although there is a presumption in favour of costs being awarded to the Applicant, we propose to afford the Respondent the opportunity to make written submissions in opposition to such an order.
[11]
Orders
1. That, pursuant to s 149C(1) of the Health Practitioner Regulation National Law (NSW) ("the National Law"), the registration of the Respondent as a medical practitioner is cancelled.
2. That, pursuant to s 149C(5) of the National Law, the Respondent is prohibited from providing health services until the expiration of a period of five years from the date of these orders.
3. That, pursuant to s 149C(7) of the National Law, the Respondent may not make an application for review of order 1 until the expiration of a period of five years from the date of these orders.
4. That costs be reserved.
5. That, within 28 days of the date of these orders, the Respondent file and serve submissions not exceeding 10 pages in length in opposition to the making of an order that the Respondent pay the Applicant's costs of and incidental to these proceedings as agreed or assessed on a party and party basis.
6. That, within 28 days of the receipt of any submissions filed by the Respondent pursuant to order 5, the Applicant file and serve submissions in reply not exceeding 10 pages in length.
[12]
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: 12 January 2022